Sunday, November 04, 2007

Call for Response and the Restorative Approach™ and DBT

First, I would like any one who is reading this to read the previous guest post from Devereaux and respond to the thought-provoking questions they pose through clicking on the "comment" button below.

Last week I attended the first week of intensive training in Dialectical Behavior Therapy (DBT). The State of Connecticut Department of Children and Families is providing this training for 18 agencies chosen through an RFP process. The trainers are from Behavioral Tech, the official training group of Marcia Linehan, who authored DBT. (

Several people asked the trainers how DBT fits with a relational model. The trainers stated, and I completely agree, that DBT is a relational model, and pays a lot of attention to the quality of the relationship between the treater and the client. DBT states that the relationship is our main source of power and reward, and our main vehicle for changing behavior.

Many aspects of DBT promote a relationship approach. First of all, the DBT assumption that the client is doing the best they can, and that we must adopt a stance of radical empathy and search for a non-prejorative, phenomenological empathetic interpretation of the clients makes a relationship possible. We are more able to form a relationship with the client if we are not blaming him for his behavior. Secondly, DBT promotes radical genuineness on the part of the therapist. It is okay (inevitable in fact) for the therapist to have personal limits, to be affected by the clients' behavior and to have reactions. These can be shared with the client in a real way. The emphasis on transparency, on teaching the client everything you are doing, on respect for the client's ability to learn and understand, also promotes a strong relationship. The therapists’ ability to respect her own limits decreases her becoming angry with the client.

A critical component of DBT is the consultation team, which supports the treater. The Consultation Team assumptions of fallibility and non-defensiveness, as well as the dialectical method of problem solving, create a strong and healthy team. Therefore, relationships with other providers enable the treater to have strong relationships with the client.

DBT pays very close and careful attention to what the treater does within the relationship. DBT speaks about positive and negative consequences for behavior, and emphasizes contingency management. But most often they are not referring g to 10 minutes more Nintendo time. They are asking us to closely notice what we do within the relationship. When do we spend time with the child? When do we smile, talk in a warm voice, pull back, frown, be closer, be more distant? All of these can reward or punish behaviors. And we need to use these contingencies carefully and planfuly, lest we inadvertently reinforce the very behaviors we are trying to change.

DBT even has a concept of restoring relationships after there has been a problem, and of over correction- doing more than you strictly need to to make sure the breach is healed.

Although there were some parts of the training I need to think more about to integrate with our current approach, over all I think that DBT and the Restorative Approach™ compliment each other.

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