Understanding DBT Therapy- Overview and Case Formulation for Counseling CEUs for LPC and LMHC

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• published: 07 Nov 2013
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Introduction to the basic concepts of Dialectical Behavior Therapy. (DBT) View the New Harbinger Catalog and get your 25% discount on their products by entering coupon code: 1168SNIPES when you check out. Great selection of easy to understand and use DBT books Fundamentals Assumptions about clients Doing the best they can with the tools they have at any given time Want to improve Cannot fail in DBT Experience life as unbearable as it is currently being lived Must learn new behaviors in all relevant contexts May not have caused all of their problems, but have to resolve them Clients need to increase their motivation for change Assumptions about therapists The most caring thing is to help a client change Clarity, compassion and precision are of the utmost importance The relationship between client and therapist is one between equals Therapists can fail to apply DBT effectively, and DBT can fail to achieve the desired outcome Therapists who treat patients with pervasive emotional dysregulation need support Concepts of DBT Dialectics---The possibility that two opposing viewpoints can co-occur and be equally valid I want to live/I want to die I want to be clean/I want to use I love you/I hate you I love my family/I wish everybody would leave me alone Polarization is expected and the valid points of both poles must be considered. Emotional Dysregulation DBT is most appropriate for people who struggle with pervasive emotional dysregulation Emotional dysregulation arises from the interplay of biological vulnerabilities and invalidating social environments Linehan proposed three characteristics that may contribute to vulnerabilities High Sensitivity/Low Threshold High Reactivity/Intense Reactions Long-Lasting Arousal/Slow Return to Baseline Additional factors impacting vulnerabilities Neurochemicals Sleep Sickness Blood sugar Pain Prior trauma leading to hypervigilence (increased sensitivity) Secondary Behavioral Patterns Develop as a result of constant overregulating and underregulating emotional experiences. 3 primary patterns Emotional Vulnerability and Self Invalidation Highly sensitive followed by telling self that she should not feel that way. Active Passivity and Apparent Competence Responding to problems passively in the face of insufficient help while communicating in ways that will activate others Due to emotions controlling behaviors, people may appear competent and capable at times and not at others. Unrelenting Crises and Inhibited Grieving---Person creates and is controlled by incessant aversive events (Address a crisis with a dysfunctional behavior that leads to another crisis.) Often patient's have multiple inter-related problems and working on one may destabilize the rest. Structure Assess and prioritize problems based on patient safety. Behavioral Regulation Emotional Experiencing Enhancing capabilities through skills training/psychoeducation, pharmacotherapy Mindfulness (Reasonable, emotional, wise (HHG)) Distress Tolerance (Distract, self-soothe, radical acceptance) Interpersonal effectiveness (Communication, interpretation) Emotional Regulation (CBT, reduce vulnerability) Improving self awareness through daily diary cards Improving motivation by increasing awareness of connections between tasks and client goals Reducing factors that inhibit progress and drawing connections between current behaviors and distress Assisting the client in generalizing new skills to the natural environment Role playing Group process Phone coaching Enhancing therapist capabilities, insight and motivation through consultation and support Structuring the environment to support client and therapist Boundary and limit setting Contingency management Program development. Problematic behavior may be a consequence of emotional dysregulation Invalidation plays a role in maintenance of current difficulties Common patterns develop as a person struggles to regulate emotion and deal with invalidation People with emotional dysregulation often have multiple, interconnected "wicked problems" Treatment begins with adding structure to the chaos and prioritizing based on the patient's degree of dysfuction.