DialecticalBehaviourTherapyinPerthNorthMetroAreaMargaretCole11thJuly2006GoalToBuildALifeWorthLivingSteps1.ClearStructure2.DoBehaviourTherapy3.AddValidation4.AddDialectics5.AddMindfulness1.ClearStructureAssumptionsAboutClients&Therapy1.Clientsaredoingthebesttheycan2.Clientswanttoimprove3.Clientsneedtodobetter,tryharderandbemoremotivatedtochange4.Clientsmaynothavecausedalloftheirownproblemsbuttheyhavetosolvethemanyway5.Thelivesofsuicidalborderlineindividualsareunbearableastheyarecurrentlybeinglived6.Clientsmustlearnnewbehavioursinallrelevantcontexts7.Clientscannotfailintherapy8.TherapiststreatingborderlineclientsneedsupportAssumptionsaboutTherapy&Therapists1.Themostcaringthingatherapistcandoishelpclientschangeinwaysthatbringthemclosertotheirultimategoals(unwaveringcentredness)2.Clarity,precisionandcompassionareoftheutmostimportanceintheconductofDBT3.Thetherapeuticrelationshipisarealrelationshipbetweenequals(therearedifferencesinexpertisebutnoarbitrarypowerdifferential)4.Principlesofbehaviourareuniversal,affectingtherapistsnolessthanclients5.DBTtherapistscanfail6.DBTtherapycanfailevenwhentherapistsdonot7.TherapiststreatingborderlineclientsneedsupportAgreementsTherapistAgreementsEVERYREASONABLEEFFORTAGREEMENTETHICSAGREEMENTPERSONALCONTACTAGREEMENTCONSULTATIONAGREEMENTTherapistConsultationAgreementsDIALECTICALAGREEMENTCONSULTATIONTOTHECLIENTAGREEMENTCONSISTENCYAGREEMENTOBSERVINGLIMITSPHENOMENOLOGICALEMPATHYAGREEMENTFALLIBILITYAGREEMENTClientAgreementsONEYEARTHERAPYAGREEMENTATTENDANCEAGREEMENTSUICIDALBEHAVIOURSAGREEMENTTHERAPY-INTERFERINGBEHAVIOURSAGREEMENTSKILLSTRAININGAGREEMENTRESEARCHANDPAYMENTAGREEMENT2.DoBehaviourTherapyTheconsequencesofabehaviouraffecttheprobabilityofthebehaviour’soccurringagain.Everytherapistresponseexperiencedbytheclientcanbeneutral,punishingorreinforcing,thuseverycontingentresponseisaninformalcontingencyprocedure.BehaviouralAssessmentThereisnosubstituteforgoodbehaviouralanalysistodeterminewhatispromptingandmaintainingmaladaptivebehaviourChainAnalysisAssessNecessaryIntervention1.Arethebehavioursinthepersonsbehaviouralrepertoire?No–BehaviouralSkillsTraining2.Areineffectivebehavioursbeingreinforced?Yes–ContingencyManagement3.Areeffectivebehavioursinhibitedbyunwarrantedfearsorguilt?Isthepersonemotionphobic?Yes–Exposure4.Areeffectivebehavioursinhibitedbyfaultybeliefsandassumptions?Yes–CognitiveModification3.AddValidationLevelsofValidation1.Stayingawake–unbiasedlisteningandobserving2.Accuratereflection–summarising3.Articulatetheunverbalisedemotions,thoughtsorbehaviourpatterns–takeaslightleapandreadbeyondwhatthey’vesaid,maybesafertousea“multiple-choiceapproach”4.Validationintermsofpastlearningorbiologicaldysfunction5.Validationintermsofpresentcontextornormativefunctioning6.Radicalgenuineness–beingyourselfwiththeclientasyouarewithothers,sametoneofvoice,samelanguage,notsteppingintoarole4.AddDialecticsDialectics1-AWorldView1.ThePrincipleofInterrelatednessandWholenessSystemsperspectiveonreality(identityisrelational)2.ThePrincipleofPolarityRealityisnotstaticbutiscomprisedoninternalopposingforcesoutofwhichsynthesisisachieved.“Contradictorytruthsdonotnecessarilycanceleachotheroutordominateeachother,butstandsidebyside,invitingparticipationandexperimentation”Goldberg(1980)3.ThePrincipleofContinuousChangeChange,orprocess,ratherthanstructureorcontent,ist...
