This week I attended a workshop on how to use Dialectical Behaviour Therapy (DBT) with difficult clients. I thought it might be valuable to share some of the strategies presented. Most people in the mental health field know DBT as a therapy for individuals with Borderline Personality Disorder. Although DBT was originally created to work with Borderline Personality Disorder, and has undergone 11 empirical studies with clients who have the disorder, the therapy has also been empirically validated for populations including eating disorders, suicidal teens, and depression in the elderly. However, based on the information in the workshop it was clear that the skills taught in DBT are transferable to multiple client issues.
DBT evolved out of traditional cognitive therapy and incorporates cognitive techniques with mindfulness and acceptance strategies and Zen practices. The therapy focuses not only on changing maladaptive behaviours, but balancing change with acceptance of things that cannot be changed. In order to achieve acceptance of things that are not under the client’s control, DBT teaches a number of skills. These skills include distress tolerance skills, mindfulness skills and emotional regulation skills. The therapist’s role is not only to teach, process, and model the skills with the client, but to thoroughly understand, validate and accept that the behaviours being exhibited by the client have served a function in the client’s life despite producing maladaptive consequences. The goal is to balance the position of the therapist (the thesis) with the position of the client (the antithesis) and to find a middle ground.
One of the strategies presented in the workshop was the Chain Analysis. Marsha Linehan (1993), the creator of DBT, stated that “the purpose of the behavioral analysis is to figure out what the problem is, what is causing it, what interferes with the resolution of the problem, and what aides are available to help solve the problem.” To do this the therapist, in collaboration with the client, chooses the problem behaviour and then works backwards from the behaviour obtaining a detailed description of all the events, behaviours, feelings, and thoughts that led up to the problem behaviour. It is also important to gather information about the consequences of the behaviour in order to understand what reinforcing factors are occurring after the behaviour has taken place. The main suggestion for conducting a chain analysis is to conduct this investigation in excruciating detail and to not make assumptions and to question everything. The analysis stops when the function of the behaviour has been determined and enough information has been gathered to solve the problem.
For more information about DBT contact the Vancouver DBT Centre: www.dbtvancouver.com
*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA