Teach 1 summary of course
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Transcript of Teach 1 summary of course
DBT Training 2014Part 1
Fiona Kennedy for
Skills Development Service
Aims of the week
To enable participants to begin practising DBT with supervision as soon as they get home!
To give enough information to allow practitioners to be effective
To develop enough skills to allow practitioners to be effective
To provide sufficient support after the week to allow further learning and safe practice
How we plan to do this
Using the Kolb/Lewin model of adult learning
act
review
reflect
plan
What is DBT?
A mix of behaviour therapyvalidation andZen practicein context of dialectical thinking about change
How Dialectics views the world
Reality is interrelated and whole (don’t just look at parts look at whole)
Reality isn’t static but made up of internal opposing forces
THESIS ANTITHESIS
SYNTHESIS
Dialectical view of thinking
Both-and NOT either-orBlack and white and extreme thinking = not dialectical
Individual is unable to move to synthesis
Can be translated as ‘value opposites and find the middle way’
Emotional dysregulation
Low threshold
High intensity
Long recovery
BIOAspects affecting
development loosely categorised as
biological: e.g.genetics, epigenetics,
neural structures,hormonal influences,
nutrition
SOCIALAspects affecting
development loosely categorised as social environment: parenting, stimulation, friendships, traumatic events, abuse, neglect
theory
Biology (‘bio’)
Limbic system reactivity?Attentional control?Genetic links?Environment in the womb?Trauma modifying neurology?epigenetics
Social: Invalidating environments
Communication of private experiences is met by erratic, inappropriate and extreme responses
Expression of private emotion is punished/trivialised - Invalidated
Intolerant of expressed emotion ‘Perfect environments/perfect child’ Be happy,
never give in, there’s nothing you can’t do’ Behaviours attributed to manipulation/not
trying/hostility
Biosocial Theory
Component Parts of DBT
Skills Training GroupIndividual TherapySupport for generalisation of skills – telephone coaching
Consultation Meeting
Orienting client to treatment Building
commitment(strategies)
Testing motivation and ability
Individual therapySession agendaBehaviours to reduceCollaborative behavioural analysisAcceptanceChange
Skills groupLearn new skillsBehaviours to increaseMindfulnessInterpersonalEmotion regulationDistress tolerance
CoachingGive input at time neededClose to target behaviourUse relationshipContact also possible to repair relationship
Consult groupSupport and supervision for therapistsTherapist assumptionsRecursive values and techniquesRole play
ReviewTarget behavioursSkills acquiredClients perception
DischargePlanned endingRelapse planGoodbye letter?
Post dischargeStage 2 needed?If relapse?Gap between therapies?
DBT in a nutshell
Orienting client to treatment
Building commitment(strategies)
Testing motivation and ability
Commitment (pre-therapy) stage
Individual therapySession agendaBehaviours to reduceCollaborative behavioural analysisAcceptanceChange
Skills groupLearn new skillsBehaviours to increaseMindfulnessInterpersonalEmotion regulationDistress tolerance
CoachingGive input at time neededClose to target behaviourUse relationshipContact also possible to repair relationship
Consult groupSupport and supervision for therapistsTherapist assumptionsRecursive values and techniquesRole play
Therapy Stage: 4 aspects
Review
Target behavioursSkills acquiredClients perception
Discharge
Planned endingRelapse planGoodbye letter?
Post dischargeStage 2 needed?If relapse?Gap between therapies?
Ending DBT therapy
Twin Tasks of DBT
INCREASE skills
DECREASE problematic &
unskilful behaviour
Individual therapy
◦ Target behaviours list◦ Create a context of validation rather
than blaming◦ Block or extinguish maladaptive
behaviours◦ Drag out effective behaviours◦ Make the effective behaviours so
reinforcing that the client stops using the maladaptive ones!
Further work
(Linehan)Stage 2: PTSDStage 3: achieve self-validation and self-respect
problem-solving
validation
client therapist
Validation (acceptance)
1. Find the nugget of wisdom somewhere in what the client says/does!
2. Observe and believe in client’s ability to get out of the misery that is her life and build a life worth living
Play to client’s strengths, not her fragility
Problem solving (change)
Analyse target behaviours (chain analysis)Solution analysesOrient client to solutionGet commitment to engageDo it!
irreverent reciprocal
Interpersonal styles
Consultation to the client
Strong bias towards client being her own case manager
Therapist coaches client how to solve problems herself
Inappropriate behaviour of professionals regarded as learning opportunity
Consultation to the environment
Interventions by DBT therapists to change the environment, solve problems, co-ordinate professional treatment are used when
1. It is important2. Client clearly is not capable of producing
the outcome
Treating the therapist
SupervisionCase consultationConsult groupStay in DBT frameTreatment of the therapist is integral to
the therapy
Telephone consultation
Inhibition of asking for helpAsking for help abusively, demandinglyPhone provides practice in changing these
patternsGeneralisation of skillsRepair of relationship
DBT assumptions
Clients are doing the best they can
Clients want to improve
Clients need to do better, try harder
Clients may not have caused all their problems but have to solve them anyway
DBT assumptions
Suicidal clients’ lives are unbearable as currently lived
Clients must learn new behaviours in all relevant contexts
Clients cannot fail in therapy
DBT therapist assumptions
Therapists treating clients with BPD need support
Therapists should show:
Warm empathyPersistent focusEndless hopeDialectical viewNon-judgmental stance
Practice DBT on themselves and each other
Skills Training in DBT
To learn and refine skills in changing behavioural, emotional and thinking patterns associated with problems in
living that are causing misery and distress.
Core Mindfulness
WHATObserveDescribeParticipate
HOWNon-judgmental
stanceFocus on one
thing in-the-moment
Being effective: do what works
DISTRESS TOLERANCE
DistractingSelf-soothingImproving the momentRadical acceptance (turning the mind, willingness)
EMOTION REGULATION
Identify and label affectObstacles to changeReducing vulnerability to emotional mind
Mindfulness to emotionOpposite action
INTERPERSONAL EFFECTIVENESS
Asking and saying noCoping with conflictObtaining desired changes while keeping the relationship and one’s own self-respect
Increasing behavioural skills-SELF-MANAGEMENT
NOT A MODULEKnowing principles of behaviour changeRealistic goal-settingBehavioural analysis skillsContingency management skillsEnvironmental controlRelapse preventionTolerating limited progress
Consult Groups
Read and sign therapist consultation agreements
Set any other rules you feel necessary for working as a team
Discuss how you will manage lateness/non-attendance
Read and discuss case study-how would you usually approach this case?