DialecticalBehaviourTherapy辩证行为疗法.ppt

DialecticalBehaviourTherapyinPerthNorthMetroArea MargaretCole11thJuly2006 GoalToBuildALifeWorthLiving Steps1 ClearStructure2 DoBehaviourTherapy3 AddValidation4 AddDialectics5 AddMindfulness 1 ClearStructure AssumptionsAboutClients Therapy 1 Clientsaredoingthebesttheycan2 Clientswanttoimprove3 Clientsneedtodobetter tryharderandbemoremotivatedtochange4 Clientsmaynothavecausedalloftheirownproblemsbuttheyhavetosolvethemanyway5 Thelivesofsuicidalborderlineindividualsareunbearableastheyarecurrentlybeinglived6 Clientsmustlearnnewbehavioursinallrelevantcontexts7 Clientscannotfailintherapy8 Therapiststreatingborderlineclientsneedsupport AssumptionsaboutTherapy Therapists 1 Themostcaringthingatherapistcandoishelpclientschangeinwaysthatbringthemclosertotheirultimategoals unwaveringcentredness 2 Clarity precisionandcompassionareoftheutmostimportanceintheconductofDBT3 Thetherapeuticrelationshipisarealrelationshipbetweenequals therearedifferencesinexpertisebutnoarbitrarypowerdifferential 4 Principlesofbehaviourareuniversal affectingtherapistsnolessthanclients5 DBTtherapistscanfail6 DBTtherapycanfailevenwhentherapistsdonot7 Therapiststreatingborderlineclientsneedsupport AgreementsTherapistAgreements EVERYREASONABLEEFFORTAGREEMENTETHICSAGREEMENTPERSONALCONTACTAGREEMENTCONSULTATIONAGREEMENT TherapistConsultationAgreements DIALECTICALAGREEMENTCONSULTATIONTOTHECLIENTAGREEMENTCONSISTENCYAGREEMENTOBSERVINGLIMITSPHENOMENOLOGICALEMPATHYAGREEMENTFALLIBILITYAGREEMENT ClientAgreements ONEYEARTHERAPYAGREEMENTATTENDANCEAGREEMENTSUICIDALBEHAVIOURSAGREEMENTTHERAPY INTERFERINGBEHAVIOURSAGREEMENTSKILLSTRAININGAGREEMENTRESEARCHANDPAYMENTAGREEMENT 2 DoBehaviourTherapy Theconsequencesofabehaviouraffecttheprobabilityofthebehaviour soccurringagain Everytherapistresponseexperiencedbytheclientcanbeneutral punishingorreinforcing thuseverycontingentresponseisaninformalcontingencyprocedure BehaviouralAssessment ThereisnosubstituteforgoodbehaviouralanalysistodeterminewhatispromptingandmaintainingmaladaptivebehaviourChainAnalysis AssessNecessaryIntervention 1 Arethebehavioursinthepersonsbehaviouralrepertoire No BehaviouralSkillsTraining2 Areineffectivebehavioursbeingreinforced Yes ContingencyManagement3 Areeffectivebehavioursinhibitedbyunwarrantedfearsorguilt Isthepersonemotionphobic Yes Exposure4 Areeffectivebehavioursinhibitedbyfaultybeliefsandassumptions Yes CognitiveModification 3 AddValidation LevelsofValidation 1 Stayingawake unbiasedlisteningandobserving2 Accuratereflection summarising3 Articulatetheunverbalisedemotions thoughtsorbehaviourpatterns takeaslightleapandreadbeyondwhatthey vesaid maybesafertousea multiple choiceapproach 4 Validationintermsofpastlearningorbiologicaldysfunction5 Validationintermsofpresentcontextornormativefunctioning6 Radicalgenuineness beingyourselfwiththeclientasyouarewithothers sametoneofvoice samelanguage notsteppingintoarole 4 AddDialectics Dialectics1 AWorldView 1 ThePrincipleofInterrelatednessandWholenessSystemsperspectiveonreality identityisrelational 2 ThePrincipleofPolarityRealityisnotstaticbutiscomprisedoninternalopposingforcesoutofwhichsynthesisisachieved Contradictorytruthsdonotnecessarilycanceleachotheroutordominateeachother butstandsidebyside invitingparticipationandexperimentation Goldberg 1980 3 ThePrincipleofContinuousChangeChange orprocess ratherthanstructureorcontent istheessentialnatureoflife Roleofconflictandoppositioninthechangeprocess Dialectics2Dialogue Relationship Aboutbalancingwiththeclient see sawexampleChangebypersuasionPersonalaccountofevents exposingcontradictorypositionsThespiritofadialecticalpointofviewisnevertoacceptafinaltruthorindisputablefact Thinking whatisbeingleftoutofourunderstanding Toavoidsplitting whichalmostalwaysresultsfromaclinicianassumingthatthey andsometimestheyalone have thetruth aboutaclientorclinicalproblem ActivePassivityVSApparentCompetence Passive helplessproblemsolvingTriestogetotherstohelpEmotionfocusedcoping SometimesappearcompetentAbletocopeinsomesituationsCopingfollowedbycrisisDifficultygeneralising Dilemma NeedshelpbutfeelsshameforaskingIsitlackofmotivationorlackofskills Therapisttoodemandingvstoorescuing DialecticalDilemma sPosedbyBorderlineClients DialecticalTherapistCharacteristics FindingabalancebetweenapparentlyopposingstancesOrientedtoChangeVSOrientedtoAcceptance NecessityofchangeClientswishtochangePrinciplesofBehaviourChange AcceptanceexactlyinthismomentAsthingsarerightnowInherentwisdomand goodness ofcurrentmoment Mistakesareinevitable whatthetherapistdoesafterwardsisabetterindexofgoodtherapy Linehan DialecticalTherapistTechniques FindingabalancebetweenapparentlyopposingstancesValidationVSProblemSolving ActiveobservingReflectionSearchforvalidity ActiveapproachBehaviouralfocus DialecticalBehaviourPatterns BalancedLifestyle WalkingthemiddlepaththroughthefollowingareasSkillenhancementVSSelf acceptanceProblemsolvingVSProblemacceptanceAffectregulationVSAffecttoleranceSelf efficacyVSHelpseekingIndependenceVSDependenceTransparencyVSPrivacy 5 AddMindfulness GeneralGoalofSkillsTraining Tolearnandrefineskillsinchangingbehavioural emotionalandthinkingpatternsassociatedwithproblemsinliving thatis thosecausingmiseryanddistress GeneralPoints Shotgunapproach someoftheskillswillworkforsomeofthepeoplesomeofthetimeThepartsoftheskillsarerarelynew butthecombinationoftenisClientsneedtobeconvincedthatwhatthey relearningisgoingtobeuseful relevanttothem marketing theskills Clientswilloftenhaveattendedothergroups needtodiscusshowthismightbedifferent e g notprocessoriented Emphasizegoaloflong termreliefvs immediatereliefEmphasizeneedforpractice practice practice TheSkills CoremindfulnessInterpersonaleffectivenessEmotionregulationDistresstolerance Mindfulness bringinganunshakeablefriendlinessanddeepdegreeofcuriosityandinteresttowhatishappeninginandaroundyou anddoingthisagainandagainandacclimatisingtothiswayofbeing TarchinHearn Mindfulnessintotalityhastodowiththequalityofawarenessthatape