Doing Dialectical Behavior Therapy: A Practical Guide

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Overview

 

Dialectical behavior therapy (DBT) is expressly designed for - and shown to be effective with - clients with serious, multiple problems. Filled with vivid clinical illustrations, this volume provides an accessible introduction to DBT and demonstrates the nuts and bolts of implementation. Kelly Koerner is an experienced DBT clinician and trainer and longtime collaborator of the therapy's originator, Marsha M. Linehan. In straight-talking language, Koerner shows therapists of any orientation how to integrate the concepts and techniques of DBT into their work with emotionally dysregulated clients.

 

 

The book presents a roadmap for understanding and treating self-destructive behavior, including suicidality, and helping clients develop the crucial capacity to regulate their emotions. Koerner explains the DBT approach to case formulation, offering guidance for prioritizing therapeutic goals and creating an individualized treatment plan. Extensive sample dialogues reveal what the core strategies of DBT -- behavior change, validation, and dialectical strategies -- look like in action. Concrete suggestions are provided for dealing with common challenges, such as how to offer validation and acceptance in the midst of emotional dysregulation. Focusing on the moment-to-moment process of therapy, Koerner identifies specific things the therapist can say and do to keep the relationship strong while moving urgently for change. The book also discusses the critical importance of DBT peer consultation teams for therapists doing this demanding work.

 

 

Clear and practical, this is an essential guide for clinical psychologists, social workers, counselors, and psychiatrists, both experienced DBT therapists and those seeking new ideas for addressing tough-to-treat problems.

 

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Editorial Reviews

Doody's Review Service
Reviewer: Gary B Kaniuk, Psy.D.(Cermak Health Services)
Description: Part of the Guides to Individualized Evidence-Based Treatment series, this book focuses on applying dialectical behavior therapy (DBT) concepts to patients with multiple serious problems, such as those with self-destructive behaviors and personality disorders and also may be impacted by homelessness, poverty, or unemployment.
Purpose: According to the preface, "this book shows why, when, and how to use the principles and strategies of dialectical behavior therapy (DBT) in individual psychotherapy." It is designed as a user's guide, with clinical vignettes and step-by-step descriptions.
Audience: It is intended for clinical psychologists, social workers, counselors, and psychiatrists, "both experienced DBT therapists and those seeking new ideas for addressing tough-to-treat problems." The author is the founder and creative director of the Evidence-Based Practice Institute and is an expert clinician in DBT, as well as a trainer and supervisor. She also has worked closely with Marsha Linehan, the developer of DBT.
Features: An introduction to DBT begins the book, which posits that serious psychological problems develop due to pervasive emotion dysregulation. Next, it shows how to translate symptoms into treatment plans, along with understanding the dynamics of the case. Most of the book is spent discussing specific treatment strategies, including change strategies (e.g. orienting, didactic, skills training, contingency management), validation strategies (e.g., when, how, what to validate), and dialectical strategies. Chapter six, "Assess, Motivate, and Move" brings it all together and shows how the treatment strategies can be integrated to address the presenting problems. The book ends with a discussion of the importance of consultation teams to improve the delivery of services to clients. Numerous figures and tables help to clarify the text and the case examples show how DBT theory is applied in a practical way.
Assessment: This practical book teaches how to apply DBT theory to clinical problems, providing concrete ideas regarding the therapeutic process. The numerous case vignettes are excellent and create the effect of having a mentor telling you how to proceed. If you want to learn more about DBT, this is the book to have. When Marsha Linehan writes the foreword to a book on DBT, you know that it is a work that stays true to DBT theory and practice.
From the Publisher
"This superb book finds the true dialectic between sophisticated writing and a 'how-to' approach. It is a 'must' for the shelves of every DBT therapist and those interested in the approach. Koerner is to be commended for this major contribution to the field."—Perry D. Hoffman, PhD, President, National Education Alliance for Borderline Personality Disorder

"An incredibly useful book showing you how to work with difficult-to-treat clients. The presentation of DBT is crystal clear and highly practical, including systematic guidelines and concrete examples of actual interactions. I recommend this book to students and to new and advanced mental health practitioners, who will all encounter emotionally dysregulated clients."—Leslie S. Greenberg, PhD, Distinguished Research Professor, Department of Psychology, York University, Canada

"A beautifully written, engaging description of emotional dysregulation and its treatment through DBT. The book is richly illustrated with case material and extensive client-therapist dialogues that truly demonstrate DBT in action."—Andrew Christensen, PhD, Department of Psychology, University of California, Los Angeles

"Koerner, an expert DBT therapist, has written a hands-on, clinically rich work that provides guidelines for when and how to apply DBT strategies for complex cases. The material is accessible to both experienced clinicians and therapists in training. This book is an invaluable guide and a handy tool kit for working with patients with pervasive emotion dysregulation."—Stefan G. Hofmann, PhD, Department of Psychology, Boston University

PsycCRITIQUES
"A must read for anyone wanting to master the techniques of individual therapy in dialectical behavior therapy (DBT). It is recommended for graduate classes in DBT, beginning and experienced therapists with or without prior knowledge of DBT, and those interested in clinical applications of emotions research....More than fulfills Kelly Koerner's promise in the preface of providing a user-friendly guide to conducting nuanced, competent individual therapy, using the theory and techniques of DBT. It is full of clear, straightforward information about how to initiate DBT, motivate clients, and use effective strategies to help emotionally and behaviorally dysregulated clients reduce their vulnerability and gain mastery in their lives. This book is equally strong in providing an overview of DBT and in explaining in detail the nitty-gritty steps of executing the treatment as it unfolds moment to moment. That Koerner is a DBT master therapist is evident throughout. Graduate students in the helping professions and beginning therapists will learn much about conducting DBT and how to move seamlessly from theory to execution. Experienced practitioners, both DBT therapists and those new to DBT, will benefit from the comprehensive overview, case formulations, and applications demonstrated in clinical vignettes. Clinicians from other theoretical orientations may find value in the discussions of boundaries, use of confrontation, and working with the therapeutic alliance. Therapists who are aware of only DBT skills training may be surprised at the expertise required to execute the individual therapy of DBT. The book is part of the well-respected Guides to Individualized Evidence-Based Treatment series, edited by Jacqueline Persons....Koerner does a truly impressive job...of presenting how the theory and spirit of DBT play out in practice. In eminently readable prose, she presents the nuts and bolts of therapeutic techniques clearly and succinctly. The book packs a tidal wave of information into a relatively brief volume....A major contribution to the 'how-to' therapy literature."—PsycCRITIQUES
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Product Details

Meet the Author

Kelly Koerner, PhD, is Founder and Creative Director of the Evidence-Based Practice Institute, where she explores how technology can be used for learning and collaboration to help practitioners get better clinical outcomes. She is an expert clinician, clinical supervisor, and trainer in DBT, with specialized training in many other evidence-based treatments. She has served as Director of Training for Marsha M. Linehan’s research investigating the efficacy of DBT for suicidal and drug-abusing individuals with borderline personality disorder; Creative Director at Behavioral Tech Research, where she developed e-learning and other technology-based methods to disseminate evidence-based practices; and Co-Founder and first CEO of Behavioral Tech, a company that provides training in DBT. Dr. Koerner is a Clinical Faculty member at the University of Washington and maintains a small clinical consulting practice in Seattle.

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Table of Contents

Foreword, Marsha M. Linehan
1. Tools for Tough Circumstances
2. Navigating to a Case Formulation and Treatment Plan
3. Change Strategies
4. Validation Principles and Strategies
5. Dialectical Stance and Strategies: Balancing Acceptance and Change
6. Assess, Motivate, and Move: Getting the Most from Each Interaction
7. The Individual Therapist and the Consultation Team

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