Dialectical Behavioral Therapy

IntroductionDialectical Behavioral Therapy is a cognitive behavioral model of psychotherapy designd primarily to treat individuals diagnosed with borderline reputation Disorder (BPD). The interference was manualized in 1993 (Linehan, 1993a Linehan, 1993b) and met criteria as an empirically validated, come up-established sermon for BPD in 2001 (Koons et al, 2001). DBT has also been found to be powerful in a range of interference effecttings with a variety of populations.The empirically based handling of DBT is a series of cognitive behavioral strategies that be applied to BPD populations. The get along provides psycho-social skills training to encourage development of good cognitive, emotional, and behavioral skills. Learning DBT skills increases a lymph glands ability to achieve positive outcomes by systematically developing effective coping mechanisms, and facilitating the decrease of maladaptive behaviors (Linehan, 1993a Linehan, 1993b).The characteristics that disting uish DBT atomic number 18 (1) the immediate heighten on acceptance and administration (2) the violence on treating behavior that interferes with therapy (3) the focus on the therapeutic comparisonship (4) the focus on dialectics, syndissertation, and wreak (Linehan, 1993a).DBT theory-based Frame practiceDBT is based upon a dialectal view of human behavior consisting of deuce-ace primary principles. The first principle is one of interrelatedness and wholeness a system must be analyzed as a totality, as the parts are temporary and only exist in relation to the whole. The second principle is polarity macrocosm is not static notwithstanding is made up of opposing forces, that when integrated, create a new set of opposing forces.The third principle is continuous change the tension between oppositional yet connected parts produces a process of change, rather than a structure, which is an underlying condition of human nature (Linehan, 1993a).In the DBT process, change occurs in the center of dialectical tension. This tension is a process created by the clients attempt to say homeostasis, while the therapist uses persuasion techniques to support the clients process of self-transformation. The therapist overcomes the clients unsusceptibility by on-going dialogue with the client that is some(prenominal) encouraging and directive (Linehan, 1993a).One of the nerve centre components of DBT is increasing the capacity to regulate emotions (Linehan, 1993a). Among persons suffering from Borderline Personality Disorder, the unfitness to regulate emotions results in emotional exposure and maladaptive strategies for coping. Emotional vulnerability is defined by (1) high sensitivity to emotional stimuli, (2) intense resolution to emotional sensitivity, and (3) difficulty reducing the sensitivity and returning to a popular emotional baseline.Similar to Cognitive Behavior Therapy (CBT), DBT also includes ongoing self-monitoring of behaviors, realistic manipulat ion goals, a strong therapeutic alliance, and treatment compliance. Client agreement in the manualized treatment includes, but is not limited to the following (1) A consignment to a one year, renewable agreement, (2) Compliance to the weekly meetings and attendance, (3) Notification to the therapist in advance if they are unable to attend scheduled therapy sessions, (4) Confidentiality in stem settings, (5) Willingness to work on any and all riddles that interfere with therapy, (6) transcription in group treatment settings to not form personal or sexual affinitys with other group members, (8) Commitment to not come to therapy under the influence of drugs or alcohol, and (9) Willingness to participate in both individual and group treatment if appropriate (Linehan, 1993a Linehan, 1993b).Therapist agreements in the manualized treatment include but are not limited to (1) Professional and reasonable effort to conduct therapy with client, (2) union to ethical guidelines, (3) Attenda nce at all scheduled sessions, and if unable, agreement to schedule with advance notice, (4) Agreement to respect the autonomy and integrity of the client, and (5) Confidentiality within the marches of the law (Linehan, 1993a).DBT PhilosophyIn order to truly essay DBT, it is first important to examine how Marsha Linehan designed DBT to treat BPD. In her book Cognitive-Behavioral Treatment of Borderline Personality Disorder, Linehan (1993 a) depict DBT as the application of cognitive and behavioral therapy strategies to help work through problems.DBT is based on a dialectical philosophy that emphasizes reality as an interrelated system composed of opposing forces that are endlessly changing. At the core of this philosophy is accepting the client as they are while assisting to promote healthy change. Linehan (1993a) further described DBT asThe emphasis on assessment data collection on current behaviors fine operational definition of treatment targets a collaborative on the job( p) relationship between therapist and patient, including attention to orienting the patient to the therapy program and unwashed commitment to treatment goals application of standardized cognitive and behavior therapy techniques, (p. 19)DBT therapists use treatment procedures such as problem solving, exposure techniques, skill training, hazard management, and cognitive modification to help clients find new ways of working through the problems that brought them into therapy. DBT requires that the therapist balance change and acceptance in for each one interaction with the patient (Linehan, 1993a, p. 19).This treatment philosophy along with the application of problem-solving and validation strategies becomes the DBT process (Linehan, 1993a). DBT blends a matter of fact, somewhat irreverent, and at times dreadful attitude about current and previous parasuicidal and other dysfunctional behaviors with therapist warmth, flexibility, responsiveness to the client, and strategic self-dis closure (Linehan, 1993a, p. 19).DBT works to reframe suicidal and other dysfunctional behaviors that had antecedently been part of the clients learned problem solving patterns. Therapy focuses on active problem solving and is balanced with a corresponding emphasis on confirmative the clients current emotional, cognitive, and behavioral responses as they are in that moment. Focus on dialectics and the balance of acceptance and change are crucial elements of the DBT process (Linehan, 1993b).DialecticsAlthough DBT has similarities to standard cognitive and behavioral techniques, it also has many defining characteristics that make it a unique treatment. It is important to review the key elements of DBT in order to bid its application to a population such as BPD. For example, DBT emphasizes dialectics. Dialectics keep be described as the reconciliation of opposites in a continual process of synthesis (Linehan, 1993a, p. 19). It stresses interrelatedness and wholeness, parts of a syste m is of limited hold dear unless the analysis clearly relates the part to the whole (Linehan, 1993a, p. 19).DBT therapists work with clients to examine a more global meaning to what had previously been polarized as extreme ideas or thoughts. Linehan stated that the most fundamental dialectic is the necessity of accepting patients as they are within a context of trying to teach them to change. Linehan go along by stating that reality is not static, but is comprised of internal opposing forces, thesis and antithesis, out of whose integration (synthesis) evolves a new set of opposing forces (Linehan, 1993a, p. 19).Linehan described how although dialectics focus on the whole, they also emphasize how complex the whole can be, including the oppositions they contain. With this notion in mind, DBT places an emphasis on acceptance as a balance to change (Linehan, 1993a). DBT therefore focuses on accepting the client for who he or she is in the moment, while also working toward more effecti ve behaviors and ways of interacting with ones present experience and the surroundings.In addition, DBT emphasizes the necessity of teaching clients to accept themselves and their knowledge base as they are in the moment. Linehan discussed how this unique strategy works well with BPD because it provides the validating environment so crucial to those with injured self-esteems. She also discussed the splendor of providing a structured setting to learn and practice new skills.DBT includes both acceptance of the patients experiences including validation of their emotional pain and suffering, and offering new psychological coping strategies that include a refocus on meaning and cognitive content in their life, exposure to previously intolerated emotions, prevention of emotional escape, and introduction of a behavior focus. (Marra, 2005, p. 7) This behavior focus includes goal orientation and new solution-based strategies to replace maladaptive coping skills (Marra, 2005, p. 7).An im portant caveat to remember as treatment progresses is that there is a natural process of change that occurs as treatment progresses. Linehan discussed how DBT assumes that reality is a process full of apparent movement and change. Therefore, immediate client stability and consistency are not a focus. Conversely, acceptance and movement with change are key elements of this process. The therapist and client work together in a changing relationship and a changing environment (Linehan, 1993 a).In her work with individuals who struggled with self-injurious and suicidality, Linehan utilized dialectics and the philosophy of balancing acceptance with change to provoke treatment effectiveness. She also observed that most of her clients presented with BPD characteristics. As such, she incorporated dialectical philosophy as the bedrock of her treatment when designing DBT for individuals with BPD characteristics.