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The Dialectical Behavior Therapy Primer - How Dbt Can Inform Clinical Practice


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Table of Contents

About the Authors ix Foreword xi Acknowledgments xiii 1 Introduction 3 Part I Theoretical, research, and clinical foundations 13 2 When DBT is indicated: The patients, the clinicians, and the evidence 15 3 BPD: Treatable or untreatable? 27 4 BPD: Diagnosis, stigma, and phenomenology 33 5 Understanding and treating self-harm behaviors in BPD 45 6 The ABC?s of DBT ? the theoretical perspective 63 7 The ABC?s of DBT ? overview of the treatment 75 Part II Using DBT in clinical practice 83 8 Commitment and goal setting 85 9 The DBT tool kit: The essential DBT strategies and what happens in the individual session 101 10 Skills training: The rationale and structure 125 11 Skills training: The four skill modules 135 12 Between-session contact and observing limits 153 13 Management of suicidal behavior 177 14 The Safety Planning Intervention 185 15 The three C?s of consultation 193 16 DBT case formulation 205 17 Beyond Target 1 ? Therapy and ?quality of life? interfering behaviors 221 18 The end of treatment 239 Index 245

About the Author

Beth S. Brodsky, Ph.D. is Associate Clinical Professor ofMedical Psychology in Psychiatry at Columbia University, and aresearch scientist at the New York State PsychiatricInstitute. Her areas of expertise include andpsychotherapeutic treatment of self-destructive behaviorin borderline disorder (BPD). She is the PrincipalInvestigator (along with Barbara Stanley)of a NIMH Excellence inEducation to develop and implement a clinical/researchcurriculum teaching Dialectical Therapy (DBT) ina medical setting. She is the author of many articles andchapters on BPD, DBT, suicide and self-injury and is a frequentlyinvited speaker on BPD, suicidal behavior and DBT. She is amember of the Virginia Apgar Academy of Medical Educators atColumbia University College of Physicians and Surgeons. Barbara Stanley, Ph.D. is Professor of Clinical Psychologyin the Department of Psychiatry at Columbia University College ofPhysicians & Surgeons and Research Scientist at New York StatePsychiatric Institute. She is a trainer in Dialectical BehaviorTherapy for Behavioral Tech, LLC. She has been the principalinvestigator on NIH-funded grants investigating suicidal behavior,self injury, aggression and borderline personality disorder. She iscurrently conducting a treatment trial investigating the mechanismsof action of DBT and antidepressants. Along with Dr. Beth Brodsky,she is a principal investigator on an NIMH-funded grant to developa DBT training curriculum for psychiatrists-in-training. Shehas won numerous awards including the American Foundation forSuicide Prevention Research Award and the Suicide Prevention Centerof New York Research Award.


As the authors state at the outset, it is likely mostuseful for clinicians wondering what DBT is and what it includes,as well as for non-clinicians wondering what DBT is about. Some ofthe concepts are good therapy (e.g., the emphasis on validation),whereas some are unique to DBT (e.g., the consult team). Becausesome of the elements of DBT are good practice and can beincorporated into other treatment modalities, the authors succeedin finding a middle path between ignorance of DBT and trainedpractice of allelements. (British Journal ofPsychology, 6 January 2014)

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