Sunday, April 01, 2012

Doing Dialectical Behavior Therapy

As I have mentioned, we use Dialectical Behavioral Therapy in several of our programs. I have attended an intensive training, read Marcia Linehan’s books, and attended many other trainings. I highly recommend th new book by Kelly Koerner, Doing Dialectical Behavior Therapy.  (Doing Dialectical Behavior Therapy: A Practical Guide (Guides to Individualized Evidence-Based Treatment)  Kelly Koerner PhD Guilford Press; 1 edition, December 2, 2011). Dr. Koerner uses many case examples to describe what  the therapist actually does in this complex therapy. In true dialectical spirit, Dr. Koerner demonstrates both the complexity and difficulty of the therapy and the use of the theory and structure to provide guidance in what to do. Dr. Koerner starts with an overview of the bio-social origins of Borderline Personality disorder. She identifies the core problem, emotional dysregulation. She then describes the key DBT strategies.
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.

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