Dialectical

Behavioral
Therapy
 COUNSELING CASE:
 A college student from USLT, she was raped by her step
father and her mother wont believed her accusation to her
father.
 She was referred to DSWD for interventions.
 Her father was sentenced to the court.
 She worked out her relationship with her mother.
 She finished her college degree and was able to cope with
his struggles.
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 THE CLIENTS
EMOTIONAL VULNERABILITY INABILITY TO REGULATE EMOTION

React to things others wouldn’t Difficulty identifying/labeling

react to emotions
Reaction is more intense than Difficulty understanding why
others they feel that way
Recovery time is longer than for Difficulty expressing the
others emotion in an effective way

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DIALECTICAL
THEORY
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1.
Everything is
interconnected
(Action/reaction)
Examine examples of action/reaction

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 Addiction

 Anger

 Depression

 Social
Interactions

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2.
Reality is in a
constant process
of change Reality is
in a constant
process of change
 How you perceive something now
may be different than how you
perceive it in an hour?
 What changes perceptions?
 What does the emotional mind
say? The reasonable mind? The
wise mind?
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3.
The truth (always evolving) can
be found by integrating multiple
perspectives, and tolerating that
two opposite things may co-
exist.
SIMULTANEOUS
(understanding things differently by taking
multiple people’s perspectives of the same event)
Example: Crime scene
Example: Interpersonal disagreement

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 LONGITUDINAL
(understanding things differently as knowledge is gained)
Example: Mommy had no use for us and that is why she
left.
Example: Mommy loves me, but she beats me, so I must be
bad.

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Skills Training
Groups

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Core Mindfulness

 Increase self-awareness of thoughts, feelings

and urges
 Develop an understanding of emotions as
things that do not have to be acted upon

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 Interpersonal
Effectiveness
 Develop assertiveness skills
 Identify the goals of relationships and
skills/activities needed to achieve those goals

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Emotion
Regulation Skills
 Label and effectively communicate feeling states
 Understand the function of emotions and why we
don’t want to eliminate them
 Learn the connection between thoughts, feelings
and behaviors and how to break the chain

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 Distress Tolerance
Skills
 Survival skills/alternatives to self-harm

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DBT Assumptions
  They want to get better
 They need to work harder/smarter
Clients and be more motivated
 Even if clients didn’t create their
are doing problems, they have to fix them
their best  Clients need to learn to act
skillfully in EVERY area of their lives
 Clients cannot fail in therapy
TREATMENT PRIORITIES IN DBT
Suicidal or self-harming behaviors
Behaviors that interfere with therapy (including clinician)
Suicidal or self-harm ideation and misery
Maintaining treatment gains
Other goals identified by the client

Mindfulness
Emotion Regulation
Interpersonal Effectiveness
Distress Tolerance
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Stages of Treatment

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  Identify behaviors that pose a direct
threat to the clients (or other’s)
safety
 Monitor the frequency, intensity of
Stage 1: behaviors using a Behavior Tracking
Attaining Form
Basic  Address
Capacities Suicidal/self-harming behaviors
Behaviors that interfere with therapy
Suicidal ideation and “misery”
Maintaining treatment gains
Client initiated goals
 SUBGOALS
Stage 2  Negative relationships
Reducing experiences related to
emotional dysregulation
Traumatic  Lack of interpersonal
Stress skills

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 Stage 3: Increasing
Self-Respect and
Achieving Individual
Goals

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The “B” in DBT
Benefits--Positive and Punishment – Consequences - Negative,
Negative Positive and Negative Positive and Neutral
Reinforcement

Intermittent reinforcement Modeling

(variable interval or ratio)

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- Reinforcers: Increase the likelihood of a behavior
- Punishments: Reduce the likelihood of a behavior
- Vulnerabilities: Increase the likelihood of fight or flight
responding
- Backward Chaining
- Outburst --- Co-Worker said something insensitive ---
Felt drained upon awakening --- Had to put cat down the
day before
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 TRIGGERS (+/-)
Cause a reaction
Remind the person of a prior situation in
which a behavior was:
- Rewarded—Lashing out makes gave client
control
- Punished– Lashing out did no good increasing
client’s sense of helplessness
Communicate to the person there is a threat
Prompt feelings of wellbeing

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 Shaping
Rewarding/reinforcing “successive
approximations”
Example: Anger
Level 1: Not throwing things or being
physically aggressive
Level 2: Disengaging until the urge to
be verbally or physically aggressive
was gone
Level 3: Being able to calmly discuss
issues/problems
 Shaping
Example: Addiction or other self-
harm
Level 1: Engaging in secondary coping
behavior (smoking, walking, eating,
listening to music, drawing)
Level 2: Taking a mindfulness minute
to evaluate the situation, then
choosing a behavior consistent with
goals
MINDFULNESS
-Developing an in-the-moment awareness of how you are:
Emotionally
Mentally
Physically
-Exploring the interconnection of thoughts, feelings and physical
sensations
-Distress in one leads to distress in others
-Becoming aware of the emotional wave
REDUCING EMOTIONAL REACTIVITY
-Reduce Vulnerability: (Please)
P & L Treat Physical Illness
Eating
Altering Drugs
Sleep
Exercise
-Build Positive experiences
-Be mindful of current emotion
DISTRESS TOLERANCE
Activities: Do hobbies, watch a video, go for a walk
Contribute. Do volunteer work
Compare yourself to people coping the same as or less well than
you
Emotions. Distract with opposite (i.e. Comedy)
Push away a distressing situation by leaving it mentally for
awhile.
Thoughts. Think about something else (Puzzles, book)
Sensations. Distract with intense sensations
WHAT CLIENTS NEED TO KNOW ABOUT EMOTIONS
1. Increasing the Positive
2. Decreasing the Negative
Interpersonal Effectiveness
 Assertiveness
 Distress tolerance
 Emotion identification and communication
 Understanding
-Your needs
-The needs of others
 Exploring situations using dialectical theory
 Interpersonal Effectiveness
 DEARMAN - Getting what we want/need:
 Describe our situation.
 Express why this is an issue or need and how we feel about
it.
 Assert: Sharing clearly what we feel and asking directly for
what we want/need.
 Reinforce our position by offering a positive outcome
(win/win)
 Mindful focusing on what we are requesting Appear
Confident
 Summary
 DBT is a great tool to help clients
 Become more aware of emotions
 Identify the thoughts, feelings and urges associated with
emotions
 Develop a greater sense of self-awareness regarding
 The whys of emotions
 Vulnerabilities which make them more likely to be emotionally
reactive or sensitive
 Provide a framework for teaching skills groups that benefit an
array of clients who have difficulty with emotionality.