The Dialectical Behavior Therapy Primer How DBT Can Inform Clinical Practice

Dialectical Behavior Therapy (DBT) has quickly become a treatment of choice for individuals with borderline personality disorder and other complicated psychiatric conditions. Becoming proficient in standard DBT requires intensive training and extensive supervised experience. However, there are many DBT principles and procedures that can be readily adapted for therapists conducting supportive, psychodynamic, and even other forms of cognitive behavioral treatments.Despite this, there is a dearth of easily accessible reading material for the busy clinician or novice.

This new book provides a clinically oriented, user-friendly guide to understanding and utilizing the principles and techniques of DBT for non-DBT-trained mental health practitioners and is an ideal guide to DBT for clinicians at all levels of experience.

Written by internationally recognized experts in suicide, self injury and borderline personality disorder, it features clinical vignettes, following patients through a series of chapters, clearly illustrating both the therapeutic principles and interventions.

Beth S. Brodsky, Ph.D. is Associate Clinical Professor of Medical Psychology in Psychiatry at Columbia University, and a research scientist at the New York State Psychiatric Institute.  Her areas of expertise include  and psychotherapeutic  treatment of self-destructive behavior in borderline   disorder (BPD). She is the Principal Investigator (along with Barbara Stanley)of a NIMH Excellence in Education  to develop and implement a clinical/research curriculum teaching  Dialectical  Therapy  (DBT) in a medical setting. She is the author of many articles and chapters on BPD, DBT, suicide and self-injury and is a frequently invited speaker on BPD, suicidal behavior and DBT.  She is a member of the Virginia Apgar Academy of Medical Educators at Columbia University College of Physicians and Surgeons.

Barbara Stanley, Ph.D. is Professor of Clinical Psychology in the Department of Psychiatry at Columbia University College of Physicians & Surgeons and Research Scientist at New York State Psychiatric Institute. She is a trainer in Dialectical Behavior Therapy for Behavioral Tech, LLC. She has been the principal investigator on NIH-funded grants investigating suicidal behavior, self injury, aggression and borderline personality disorder. She is currently conducting a treatment trial investigating the mechanisms of action of DBT and antidepressants. Along with Dr. Beth Brodsky, she is a principal investigator on an NIMH-funded grant to develop a DBT training curriculum for psychiatrists-in-training.  She has won numerous awards including the American Foundation for Suicide Prevention Research Award and the Suicide Prevention Center of New York Research Award.

About the Authors ix

Foreword xi

Acknowledgments xiii

1 Introduction 3

Part I Theoretical, research, and clinical foundations 13

2 When DBT is indicated: The patients, the clinicians, and the evidence 15

3 BPD: Treatable or untreatable? 27

4 BPD: Diagnosis, stigma, and phenomenology 33

5 Understanding and treating self-harm behaviors in BPD 45

6 The ABC’s of DBT – the theoretical perspective 63

7 The ABC’s of DBT – overview of the treatment 75

Part II Using DBT in clinical practice 83

8 Commitment and goal setting 85

9 The DBT tool kit: The essential DBT strategies and what happens in the individual session 101

10 Skills training: The rationale and structure 125

11 Skills training: The four skill modules 135

12 Between-session contact and observing limits 153

13 Management of suicidal behavior 177

14 The Safety Planning Intervention 185

15 The three C’s of consultation 193

16 DBT case formulation 205

17 Beyond Target 1 – Therapy and “quality of life” interfering behaviors 221

18 The end of treatment 239

Index 245

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