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Saturday, December 10, 2011

Dialectical Behavior Therapy

Herrick Hospital psychiatry grand rounds, November 14, 2011,  DBT:  An Overview.  Mardell Gavriel, Psychologist, Psy.D. 

A theory of therapy, an offshoot of Cognitive Behavioral Therapy, which has gained some recent renown, was discussed by Dr. Gavriel who uses this method at the mental health services division of the Haight Ashbury Clinic. 
An underlying principle is that if you change one part of the triad---thinking-feeling-behavior, all will change.  This harkens back to family systems therapy theory wherein it was postulated that if one part of the system changed, all parts would have to shift.  It is like a suspended mobile:  If you touch one part, the entire mobile moves (John Bradshaw).
Any kind of emotional dysregulation  can be addressed by this type of therapy.
Goals are:  To do dialectical thinking
.                  To be a flexible problem solver.
                   To find truth in more than one position.
                   To be able to synthesize apparent contradictions.
                   To learn to seek the middle path.
                   To not get caught up in black and white thinking.
                   To learn that ambivalence is possible.
                   One person can have more than one truth.
The DBT therapist uses techniques such as Diary Cards, Homework and Skills Training.
Usually DBT can only be fully utilized in a clinic setting as it requires team strategies (the team is made up of a group of health care providers) who will consult about the patient.  However, individual practitioners can still benefit from some of the ideas and apply them in their practice.

In DBT the therapist and patient work based on a hierarchy of targets, resolving first what DBT considers to be the most serious.  These must be dealt with before moving on to the next target.  The first to be addressed is if there are any dangers-to-self behaviors, on the part of the patient.  The next is therapy interfering behaviors.  Next to be addressed is anything that lowers the quality of the therapy.  And, finally, what DBT calls life interfering behaviors-usually the problems which people come into therapy to work on.
The hoped for outcome for the patient of DBT is:
  • Enhanced capabilities
  • A more efficient life
  • Improved motivational factors
  • Ability to transfer a learned skill from one situation to another
  • Structure the environment to live more effectively
  • Eliminate self-harm behaviors
  • Increase distress tolerance
  • Emotional self regulation
  • Better interpersonal effectiveness
If you, the reader, have ever been able to partake of the therapy process, you will recognize some of the ideas outlined by Dr. Gavriel.   It isn't all new but it is newly organized.
This is not a comprehensive description of this type of therapy; it is a brief rendition of some parts of it.  For more info, see,
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