Lane D. Pederson

Dialectical Behavior Therapy: A Contemporary Guide for Practitioners Lane D. Pederson

Marc Notes: Includes bibliographical references and index. Table of Contents: Acknowledgments ix To the Reader xi Definitions xiii 1 Why Learn DBT? 1 2 Introduction to DBT: Brief Background and Current Controversies 4 3 The Contextual Model and DBT 9 Comparisons of DBT with Other Therapies 10 Therapeutic Factors that Most Affect Outcomes 13 Adopting versus Adapting Standard DBT: The Question of Treatment Fidelity 15 The Answer to Fidelity: EBP 21 4 DBT: An Eclectic yet Distinctive Approach 23 5 Is It DBT? A Guide for DBT-Identified Therapists and Programs 27 6 Dialectical Philosophy 31 Dialectics in Practice 32 Validation versus Change 32 Acceptance of Experience versus Distraction from or Changing Experience 33 Doing One's Best versus Needing to Do Better 34 Noting the Adaptive in What Seems Maladaptive 34 Nurturance versus Accountability 35 Freedom versus Structure 36 Active Client versus Active Therapist 37 Consultation to the Client versus Doing for the Client 37 Dialectics and Evidence-Based Practice 38 When Not to Be Dialectic: Dialectical Abstinence 38 Dialectics with Clients 39 7 The Biosocial Theory: Emotional Vulnerability, Invalidating Environments, and Skills Deficits 41 The Role of Invalidation 44 How the Biosocial Theory Guides Practice 45 Being Flexible to the Client's Theory of Change 47 8 Client, Therapist, and Treatment Assumptions 49 Client Assumptions 49 Therapist Assumptions 51 Treatment Assumptions 53 9 The Five Functions of Comprehensive DBT 55 Motivate Clients 55 Teach Skills 56 Generalize the Skills with Specificity 56 Motivate Therapists and Maximize Effective Therapist Responses 57 Structure the Environment 57 10 Treatment Structure 58 How Much Structure? Level-of-Care Considerations 59 Program Treatment Models 61 Individual Therapy Treatment Structure 70 Group Skills-Training Session Structure 72 Additional Treatments and Services 73 Expectations, Rules, and Agreements 73 11 DBT Treatment Stages and Hierarchies 79 Pretreatment Preparation 80 Pretreatment and the "Butterfly" Client 81 Stage One: Stability and Behavioral Control 82 Stage Two: Treating PTSD, Significant Stress Reactions, and Experiencing Emotions More Fully 85 Stage Three: Solving Routine Problems of Living 85 Stage Four: Finding Freedom, Joy, and Spirituality 85 12 The DBT Therapeutic Factors Hierarchy 87 1. Develop and Maintain the Therapy Alliance 87 2. Develop Mutual Goals and Collaboration on Methods 88 3. Identify and Engage Client Strengths and Resources to Maximize Helpful Extratherapeutic Factors 89 4. Establish and Maintain the Treatment Structure 89 13 Self-Monitoring with the Diary Card 90 14 Validation: The Cornerstone of the Alliance 96 Levels of Validation 97 Validation versus Normalization 99 15 Commitment Strategies 101 16 Educating, Socializing, and Orienting 107 17 Communication Styles 110 Reciprocal Communication 110 Irreverent Communication 114 18 Mindfulness 118 19 Skills Training 125 20 Changing Behaviors 133 Behavioral Contingencies 139 Behaviorism and the Therapist 142 The Most Effective Methods of Changing Behaviors 143 21 Behavioral Analysis 150 Behavioral Analysis Example 152 22 Dialectical Strategies 160 23 Cognitive Interventions 168 24 Telephone Coaching 177 25 Dealing with Safety Issues 180 Essential Practices 180 Suicide Risk Factors 183 Protective Factors 183 Suicide Assessment 184 Self-Injury Assessment 187 Creating the Safety Plan 190 Safety or No-Harm Contracts 193 From a Safety Plan to a Safety Commitment 194 26 Use of the Hospital 197 27 Consultation 200 28 Evaluation of Clinical Outcomes 209 Appendix A Mindfulness Exercises 216 Appendix B Plans for Safety and Skills Implementation 218 Appendix C Professional Growth in DBT 227 References 229 Index 241Biographical Note: Lane Pederson is the owner of Mental Health Systems (MHS), one of the largest DBT-specialized practices in the USA, and is the founder of the Dialectical Behavior Therapy National Certification and Accreditation Association (DBTNCAA). As a DBT speaker, Dr. Pederson has trained over 7,000 therapists across the US, Canada, and Australia. An outspoken advocate of flexible and evidence-based applications of DBT, his books include "The Expanded Dialectical Behavior Therapy Skills Training Manual" and "Dialectical Behavior Therapy in Integrated Dual Disorder Treatment Settings."Jacket Description/Back: "Dr. Pederson's clinical expertise shines as he takes DBT out of the hands of researchers and translates it into a practical, flexible, and powerful approach to human problems. This is your all-in-one source for understanding and practicing DBT and, beyond that, for doing good clinical work in tough client situations."Barry L. Duncan, Psy. D., author of "On Becoming a Better Therapist: Evidence-Based Practice One Client at a Time""Bridging research and practice, with this straightforward, accessible guide, Pederson delivers on his promise to place DBT philosophies and techniques all-squarely into the hands of real-world clinicians working with real-world clients who so desperately need it!"Linda Curran, clinician, trainer, and author of "Trauma Competency: A Clinician's Guide and 101 Trauma-Informed Interventions""New to DBT? Been using it for a while? Either way, this text will deepen your knowledge and strengthen your clinical skills. Dr. Pederson is an expert DBT clinician and trainer. He has created a comprehensive overview of DBT that has sufficient breadth and depth to empower readers to begin using DBT or improve their current practice. This text will be your go-to resource for all things DBT."Cathy Moonshine, author of "Acquiring Competency and Achieving Proficiency with Dialectical Behavior Therapy, Volumes I and II""This book promises to be the most influential DBT publication to date, not only in its superb description of the approach but also in the way it builds a bridge between research and practice with a focus on what is most effective for clients. The future of our field rests on outcome-based modifications and customizations to evidence-based treatments, and Dr. Pederson provides an in-depth analysis of research that empowers DBT therapists to embrace the future now. This is a must read for all DBT therapists."Dr. Mark Carlson, DBT trainer for PESI Healthcare and author of "CBT for Chronic Pain and Psychological Well-Being""This is a clear, succinct, and readable guide for those who want to understand DBT. Dr. Pederson describes the components and techniques necessary to deliver the comprehensive treatment as well as some intriguing adaptations to standard DBT. Readers will find practical information that allows them to provide effective, evidence-based treatment with a sharp focus on the therapeutic relationship and, ultimately, outcomes. Anyone looking to improve his or her clinical skill and be a more effective clinician will find this book to be a useful resource."Britt H. Rathbone, co-author of "Dialectical Behavior Therapy for At-Risk Adolescents"This is the first book to show in detail how dialectical behavior therapy skills and approaches can beadapted and integrated into the broader evidence-based practice of psychotherapy. DBT was first developed in the late 1980s by Marsha Linehan as a response to the failure of standard cognitive and behavioral models to effectively treat chronically suicidal clients, and was built on a "dialectical" balance of acceptance and change. The "standard" form of DBT remains highly structured, as was appropriate to its original treatment group. However, today's therapists are increasingly encouraged to combine and integrate empirically supported treatments in a broader form of evidence-based practice that recognizes the importance of therapist expertise and judgment balanced with client needs and preferences. In short, most therapists want to incorporate DBT into their skills portfolio rather than become a specialist. This groundbreaking book makes a compelling case that today's best research evidence supports the adaptation of DBT, and presents the approach as a robust theoretical orientation that can be applied to a wide range of clinical presentations. Commendation Quotes: Dr. Pederson's clinical expertise shines as he takes DBT out of the hands of researchers and translates it into a practical, flexible, and powerful approach to human problems. This is your all in one source for understanding and practicing DBT, and beyond that, for doing good clinical work with tough client situations.--Barry Duncan, Psy. D., author of "On Becoming a Better Therapist: Evidence Based Practice One Client at a Time" Bridging research and practice, with this straightforward, accessible guide, Pederson delivers on his promise to place DBT philosophies and techniques all-squarely into the hands of us "real-world clinicians" working with our "real-world clients" who so desperately need it!--Linda Curran, clinician, trainer and author of "Trauma Competency: A Clinician's Guide & 101 Trauma-Informed Interventions" "Dialectical Behavior Therapy: A Contemporary Guide for Practitioners" is a valuable resource for all levels of clinicians. There are several highlighted evidence-based interventions throughout the chapters that are well crystallized and easy to apply, which Dr. Pederson supports with a wealth of research and relevant background information. New and experienced practitioners who include DBT interventions in their practice will find a treasure chest of skills and ideas. The vast array of psychoeducational strategies offers a great "go to" resource and will quickly become a clinician's best friend!--Judith Belmont, MS, Author of the "Tips and Tools For the Therapeutic Toolbox" series Dr. Pederson's book is so timely. I am ever so grateful for a book that is practical in its tone and still grounded in the DBT worldview. It is so important to present DBT to our clients in a way that they can internalize and generalize the skills and techniques. This book is honest in its appraisal and tone of how to adapt the DBT principles in the "real world" with real clients. It gives a practitioner the confidence to teach and dialogue about dialectical dilemmas and the concepts of DBT that have previously felt vague while simultaneously pedantic in tone. Having implemented many of Dr. Pederson's approaches, I can verify that these techniques work to bring clients to a comprehensive understanding of how to live fully in a world that has judged them to be "untreatable" and "lost causes." I recommend this book to any practitioner, be it student or an extensively trained therapist, tasked with working with individuals that suffer with a pervasive dysregulation of their emotions.--Eboni Webb, PsyD, HSP, Owner, Kairos Mental Health Cooperative, LLC and DBT Trainer, PESI Mental Health In "Dialectical Behavior Therapy, A Contemporary Guide for Practitioners," Lane Pederson has written a very comprehensive, readable guide to Dialectical Behavior Therapy in which he is able to bring clarity and understanding to complex concepts. Following a cogent discussion about the dialectics inherent in the ongoing controversy of adherence to DBT vs. adapting DBT, Dr. Pederson develops a synthesis by focusing on helping practitioners to provide DBT in a way that will be most effective for their clients. He clearly and succinctly presents very thorough practical guidance about providing DBT, with relevant and helpful examples of skills, treatment, client behaviors and dialogue with clients, while always focusing on the importance of the therapeutic relationship. For practitioners who have been using DBT in our practice of many years, this book provides new insights and ideas that will increase effectiveness. For new practitioners who want to understand more about how to use DBT with their clients, this book is a must read. For any practitioner, this is an incredibly useful book about a very effective form of treatment.--Pat Harvey, LCSW-C, DBT Coach, Trainer and Consultant, Co-Author of "Parenting a Child Who Has Intense Emotions" and "DBT for AT-Risk Adolescents." This book promises to be the most influential DBT publication to date, not only in its superb description of the approach, but in the way it builds a bridge between research and practice with a focus on what is most effective for clients. The future of our field rests on outcome-based modifications and customizations to evidence-based treatments, and Dr. Pederson provides an in-depth analysis of research that empowers DBT therapists to embrace the future now. This is a must read for all DBT therapists.--Dr. Mark Carlson, DBT trainer for PESI Healthcare and author of "CBT for Chronic Pain and Psychological Well-Being" In reading "Dialectical Behavior Therapy," I am reminded of the story of Siddhartha Gatauma, a dutiful student of the contemporary spiritual masters, who searched for The Way, but ultimately rejected the dogmatic teachings of his time and attained Enlightenment by questioning "truth" while sitting under a Bodhi tree. Dr. Marsha Linehan brought this same spirit of "doing what works" to the field of psychotherapy with suicidal clients over 30 years ago. Like her, Dr. Pederson challenges the status quo, asks for us to look again at the evidence, and reminds us to make sure we are asking the right questions.--Dr. Stephanie Vaughn, National DBT Consultant and Trainer, and founder of Vanderbilt University's DBT Peer Consultation Team "Dialectical Behavior Therapy, A Contemporary Guide" is a clear, succinct and readable guide for those who want to understand DBT. Pederson describes the components and techniques necessary to deliver the comprehensive treatment as well as some intriguing adaptations to standard DBT. Readers will find practical information that allows them to provide effective, evidence-based treatment, with a sharp focus on the therapeutic relationship and ultimately, outcomes. Anyone looking to improve his or her clinical skill and be a more effective clinician will find this book to be a useful resource.--Britt H. Rathbone, author of "DBT for At-Risk Adolescents" New to DBT? Been using if for a while? Either way, this text will deepen your knowledge and strengthen your clinical skills. Dr. Pederson is an expert DBT clinician and trainer. He has created a comprehensive overview of DBT that has sufficient breadth and depth that will empower readers to begin using DBT or improve their current practice. This text will be your go to resource for all things DBT.--Cathy Moonshine, author of "Acquiring Competency and Achieving Proficiency with Dialectical Behavior Therapy, Volumes I and II" In "Dialectical Behavior Therapy: A Contemporary Guide for Practitioners," Lane Pederson is taking Dialectical Behavior Therapy (DBT) to the next level by demonstrating its efficacy with psychiatric illnesses other than borderline personality disorder (BPD), as well as the efficacy of adapted models versus the original model. In this book, Pederson helps clinicians learn how to provide the traditional DBT model for BPD as it was originally designed, while also encouraging us to take a more dialectical approach than has traditionally been taken with DBT: while it is innovative, it is also a therapy that derives many of its techniques from other tried and true therapies. In this respect, Pederson is helping us continue to move in the direction of making DBT more accessible to therapists, and therefore also to individuals in need of a client-centred, nonjudgmental, skills-based model. This is a wonderful, thorough book that is a great introduction to DBT for newcomers, or that will help seasoned therapists develop a more thorough understanding of the model and how to make it best suit their practice and, more importantly, their clients' needs!--Sheri Van Dijk, MSW, RSW, psychotherapist, international speaker and author of "The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder," "Calming the Emotional Storm," and "DBT Made Simple"