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Knowledge of the structure and key assumptions of DBT. An ability to draw on knowledge that DBT interventions address behaviours in the following. order of priority, decreasing any behaviours that are life threatening specifically suicidal. parasuicidal homicidal and imminently life threatening. decreasing any behaviours that will interfere with therapy. decreasing those behaviours as defined by DBT that will impact negatively on the. client s quality of life, increasing the client s skilful behaviour as it relates to their capacity. to be mindful,to regulate their emotion,to tolerate distress. to be interpersonally effective, An ability to draw on knowledge that DBT makes eight key assumptions about Individuals. clients are doing the best they can,clients want to improve. clients need to do better try harder and be more motivated to change. clients may not have caused all of their own problems but they have to solve them. the lives of suicidal borderline clients are unbearable as they are currently being lived. clients must learn new behaviours in all relevant contexts. clients cannot fail in therapy whatever the circumstances the reasons for a lack of. therapeutic success are never attributed to the client. therapists treating individuals with BPD need support. Knowledge of the use of agreements in DBT, An ability to draw on knowledge that DBT employs explicit agreements between therapist. and client about the content of therapy, An ability to draw on knowledge of the principles underpinning the content and application of. agreements e g, a commitment by the client to the structure of the intervention e g attending. regularly working on reducing suicidal behaviours attending skills training in addition. to individual therapy, a commitment by therapists to maintain professional and clinical standards. An ability to draw on knowledge that DBT therapists work within the context of a set of. principles or explicit consultation agreements, highlighting dialectical tensions and seeking the nugget of truth in both poles. dialectical agreement, helping the client to deal with the world instead of changing the world to fit the needs. of the client consultation to the patient agreement. helping the client to accept that different individuals and therapists will have different. ways of behaving and expectations consistency agreement. acknowledging that different therapists have different limits at different times. observing limits agreement, adopting a non pejorative and empathic stance towards the client s behaviour under. all circumstances phenomenological empathy agreement. acknowledging that all therapists are fallible, Knowledge of the principles underpinning the structure of DBT interventions. An ability to draw on knowledge that there are five functions in a DBT program provided. through five modalities and that the clinical effectiveness of DBT is assumed to rest on the. coherent delivery of all these elements as a package of interventions. An ability to draw on knowledge of the five functions of a DBT programme. enhancing the client s skills,improving the client s motivation. assuring generalisation to the natural environment. improving therapist s motivation and adherence to the model. structuring the environment to reinforce more adaptive skilful behaviour. An ability to draw on knowledge that the five functions of a DBT programme are commonly. delivered through five therapeutic modalities for clients and for therapists. weekly individual therapy,skills training groups, out of hours contact e g access to out of hours telephone consultation. weekly team consultation for staff, adjunctive groups therapy or training that is compatible with DBT e g family groups. couples therapy training for non DBT staff members in behavioural principles. An ability to draw on knowledge that each client will have one primary therapist who. oversees all components modes of treatment, Knowledge of target hierarchies within each modality of DBT. An ability to draw on knowledge that each modality has its own set of hierarchies the order. of priority in which behaviours are addressed, An ability to draw on knowledge that in individual therapy the target hierarchy is to. address the risk of life threatening behaviours in relation to the self or others. decrease suicidal and parasuicdal imminently life threatening and homicidal. behaviours,decrease therapy interfering behaviours. decrease quality of life interfering behaviours as defined by DBT. increase behavioural skills, An ability to draw on knowledge that in skills training the target hierarchy is to. stop behaviours likely to destroy therapy, increase skills acquisition strengthening and generalisation. decreasing therapy interfering behaviours, An ability to draw on knowledge that during telephone calls to the primary therapist the target. hierarchy is to,decrease suicidal crisis behaviours. increase generalisation of behavioural skills, decrease the sense of conflict alienation and distance from the therapist. An ability to draw on knowledge that in relation to telephone calls to the skills trainer or other. therapists the target hierarchy is to decrease behaviours likely to destroy therapy. Knowledge of the stages of treatment in DBT, An ability to draw on knowledge of the stages of DBT and how and where these stages are. commonly delivered, Pre treatment first four sessions which focuses on orientating the client to the. treatment gaining their commitment creating a hierarchy of behaviours to be worked on. in therapy and identifying what the client considers is a life worth living. Stage 1 which focuses on, helping clients gain control over suicidal parasuicidal homicidal or imminently life. threatening behaviours, reducing behaviours of client or therapist that interfere with the client receiving. reducing destabilising behaviours e g severe interpersonal dysfunction high risk. sexual behaviours or criminal behaviours that may lead to loss of liberty or. destabilising factors e g other mental health disorders homelessness long term. unemployment that adversely impact on the client s quality of life. Stage 2 helping the client to move from a position of quiet desperation where. behaviours are controlled but there is still a lot of emotional pain to a position of non. anguished emotional experiencing reduced alienation from others and also focusing on. any residual axis I disorders, Stage 3 helping clients increase their self respect and attain a sense of mastery over. everyday problems so that they experience ordinary happiness and unhappiness. Stage 4 focusing on reducing the sense of incompleteness so that clients achieve a. sense of freedom spiritual fulfilment and expanded awareness. An ability to draw on knowledge that the focus of most publically funded DBT programmes. will be restricted to stages 1 and 2,Knowledge of the goals of skills training in DBT. An ability to draw on knowledge that DBT includes skills training modules that can be. delivered individually or in a group, An ability to draw on knowledge that skills training aims to help clients develop skills to. decrease interpersonal dysfunction and increase their interpersonal effectiveness. decrease emotion dysregulation and increase their ability to up regulate or down. regulate their emotion, reduce their behavioural and cognitive dysregulation and increase their ability to. tolerate distress, decrease their disrupted sense of self and increase their core mindfulness skills. An ability to draw on knowledge that each area of skill is identified and named so that once. learned the therapist can orient the client to the skill that might be required in a given. circumstance e g,core mindfulness skills,distress tolerance skills. emotion regulation skills,interpersonal effectiveness skills. Ability to convey didactic information about the DBT approach. An ability to communicate effectively to the client carers and or staff the DBT model of. emotional dysregulation and problem behaviours, An ability to discuss the relationship between dysfunctional behaviours and a deficit in. problem solving skills, An ability to teach effectively and keep the attention of clients who are emotionally. dysregulated, Ability to develop and maintain a DBT congruent relationship with the client. An ability to draw on knowledge that in DBT the therapist aims to ensure that the client feels. connected to them and to others in their social world using the relationship to help keep. the client alive at moments of crisis, An ability for the therapist to accept the relationship as it is in the present accepting and. validating the client as they are currently, An ability to work with the assumption that disruptions in the relationship will occur. An ability to work on repairing the relationship and to convey to the client that this. represents an opportunity for them to learn the skills for making an effective repair. An ability to help the client to generalise behaviours learned in the therapy relationship to. other relationships outside of therapy,Establishing a target hierarchy. An ability to construct a DBT target hierarchy and use this to identify specific behavioural. targets for the session, An ability to track target behaviours by asking the client to complete a diary card before each. session and to use this to review progress, An ability if the client does not bring the diary card to the session to consider reasons for. this and to problem solve, An ability to maintain a focus on targets relevant to the current stage of therapy but also to. revisit earlier stages if problems relevant to these stages recur. An ability to monitor the client s progress in other modes of therapy. Ability to maintain a dialectical focus, An ability to conduct a dialectical assessment by taking into account both individual and. contextual factors taking a holistic position and including all available information. An ability to model a dialectical stance throughout the intervention to help the client. synthesize based on available information, An ability to use a range of strategies to help the client adopt a dialectical perspective and. develop the skills to synthesise the dialectic e g. identifying when a metaphor would be helpful constructing a relevant metaphor and. helping the client consider how the metaphor applies. identifying and or adopting a paradoxical position in order to highlight or increase. dialectical tensions, extending the client s position in order to increase dialectical tension or introduce a. dialectical position,taking the devil s advocate position. An ability to maintain a dialectical balance between treatment strategies e g between. acceptance and change stability and flexibility, An ability to model that taking a dialectical approach is characterised by being able to go to. either end of a dilemma and still be open to the truth in the opposing side rather than taking. up a middle position, An ability to facilitate change by keeping the client slightly off balance by adapting and. changing the approach in accordance with the principles of the treatment. An ability to model dialectical thinking and behaviours by looking for the both and position. rather than the either or, An ability to help the client to find wise mind by consulting both logic and emotion mind. An ability to work with the client to make lemonade out of lemons identifying the adjustment. that can be made to render an unpleasant situation more palatable or to gain some benefit. from it by looking the situation in different way or taking a different action. An ability to allow change where it occurs naturally in therapy. Ability to validate the client s experience, An ability to weave an appropriate level of validation into the session in order to help the. client s motivation and to facilitate change, An ability to employ a range of strategies to validate the client s experience and behaviour. verbalising the client s unspoken emotions e g mind reading what the client might. be feeling but is finding hard to express, validating the client s behaviour in the context of their past learning or their biological. antecedents e g their history of depression, validating in terms of a normative response in the current context. An ability to provide functional validation e g responding by immediately moving towards. finding a solution and hence by implication directly validating the client s perspective on a. distressing event, An ability to respond in a radically genuine way to a client s communication without editing. responses according to a professional role, an ability to ensure that unedited responses are employed in a strategic manner. An ability to use a range of strategies to validate the client s emotional expression. behaviours and cognitions,An ability to validate emotional expression e g. by empathising with emotional expression, by helping the client observe and label the component parts of an emotional response. by conveying that all emotions a response to something and do not occur randomly. by linking the client s emotional responses to their learned experiences e g of. previous relationships,An ability to validate the client s behaviour e g. by helping the client observe and describe their own behaviour both overt as well as.