Dr. Koerner uses straightforward language, humor and case examples to create a road map to follow in difficult, complex cases through a formulation and a treatment plan. She shows how to use the specific DBT hierarchies to plan the case interventions. She demonstrates the use of the chain analysis to provide direction for the therapist and client. At all times Dr. Koerner respects the difficulty of the change process for both the client and the therapist. She demonstrates deep respect for the client and operates from the assumption that the client is doing the best she can and still must do better. In the lengthy transcriptions of sessions, she demonstrates how the therapist avoids being distracted from the change task while respecting the client’s pain and lack of skills.
One interesting section is the one in which Ms. Koerner examines the use of relationship contingencies in shaping behavior. This is an area that we do not use deliberately enough. Another refreshing aspect is that Dr. Koerner is always aware that it may be the therapist, not the client, who is creating the problem.
Validation strategies are the key to successful therapy. The client cannot respond to change strategies without extensive validation. And Dr. Koerner states and demonstrates how accurate, precise validation is the most powerful, and describes what, when and how to validate.
Dr. Koerner teaches us how to hold a dialectical stance toward the therapy itself, and use dialectics to help us decide what to do next. She ends with a description of the role of the Consultation Team in supporting the therapist.
I think that anyone who is doing DBT will be greatly enriched by reading this book.