DialecticalBehaviourTherapyinPerthNorthMetroAreaMargaretCole11thJuly2006第一页，共三十三页。GoalToBuildALifeWorthLiving第二页，共三十三页。Steps1.ClearStructure2.DoBehaviourTherapy3.AddValidation4.AddDialectics5.AddMindfulness第三页，共三十三页。1.ClearStructure第四页，共三十三页。AssumptionsAboutClients&Therapy1.Clientsaredoingthebesttheycan2.Clientswanttoimprove3.Clientsneedtodobetter,tryharderandbemoremotivatedtochange4.Clientsmaynothavecausedalloftheirownproblemsbuttheyhavetosolvethemanyway5.Thelivesofsuicidalborderlineindividualsareunbearableastheyarecurrentlybeinglived6.Clientsmustlearnnewbehavioursinallrelevantcontexts7.Clientscannotfailintherapy8.Therapiststreatingborderlineclientsneedsupport第五页，共三十三页。AssumptionsaboutTherapy&Therapists1.Themostcaringthingatherapistcandoishelpclientschangeinwaysthatbringthemclosertotheirultimategoals(unwaveringcentredness)2.Clarity,precisionandcompassionareoftheutmostimportanceintheconductofDBT3.Thetherapeuticrelationshipisarealrelationshipbetweenequals(therearedifferencesinexpertisebutnoarbitrarypowerdifferential)4.Principlesofbehaviourareuniversal,affectingtherapistsnolessthanclients5.DBTtherapistscanfail6.DBTtherapycanfailevenwhentherapistsdonot7.Therapiststreatingborderlineclientsneedsupport第六页，共三十三页。AgreementsTherapistAgreementsEVERYREASONABLEEFFORTAGREEMENTETHICSAGREEMENTPERSONALCONTACTAGREEMENTCONSULTATIONAGREEMENT第七页，共三十三页。TherapistConsultationAgreementsDIALECTICALAGREEMENTCONSULTATIONTOTHECLIENTAGREEMENTCONSISTENCYAGREEMENTOBSERVINGLIMITSPHENOMENOLOGICALEMPATHYAGREEMENTFALLIBILITYAGREEMENT第八页，共三十三页。ClientAgreementsONEYEARTHERAPYAGREEMENTATTENDANCEAGREEMENTSUICIDALBEHAVIOURSAGREEMENTTHERAPY-INTERFERINGBEHAVIOURSAGREEMENTSKILLSTRAININGAGREEMENTRESEARCHANDPAYMENTAGREEMENT第九页，共三十三页。2.DoBehaviourTherapy第十页，共三十三页。Theconsequencesofabehaviouraffecttheprobabilityofthebehaviour’soccurringagain.Everytherapistresponseexperiencedbytheclientcanbeneutral,punishingorreinforcing,thuseverycontingentresponseisaninformalcontingencyprocedure.第十一页，共三十三页。BehaviouralAssessmentThereisnosubstituteforgoodbehaviouralanalysistodeterminewhatispromptingandmaintainingmaladaptivebehaviourChainAnalysis第十二页，共三十三页。AssessNecessaryIntervention1.Arethebehavioursinthepersonsbehaviouralrepertoire?No–BehaviouralSkillsTraining2.Areineffectivebehavioursbeingreinforced?Yes–ContingencyManagement3.Areeffectivebehavioursinhibitedbyunwarrantedfearsorguilt?Isthepersonemotionphobic?Yes–Exposure4.Areeffectivebehavioursinhibitedbyfaultybeliefsandassumptions?Yes–CognitiveModification第十三页，共三十三页。3.AddValidation第十四页，共三十三页。LevelsofValidation1.Stayingawake–unbiasedlisteningandobserving2.Accuratereflection–summarising3.Articulatetheunverbalisedemotions,thoughtsorbehaviourpatterns–takeaslightleapandreadbeyondwhatthey’vesaid,maybesafertousea“multiple-choiceapproach〞4.Validationintermsofpastlearningorbiologicaldysfunction5.Validationintermsofpresentcontextornormativefunctioning6.Radicalgenuineness–beingyourselfwiththeclientasyouarewithothers,sametoneofvoice,samelanguage,notsteppingintoarole第十五页，共三十三页。4.AddDialectics第十六页，共三十三页。Dialectics1-AWorldView1.ThePrincipleofInterrelatednessandWholenessSystemsperspectiveonreality(identityisrelational)2.ThePri...
