On June 24, Dr. Alec Miller led a NJ-ACT workshop on Dialectical Behavior Therapy (DBT). Dr. Miller described DBT as a compassionate, flexible, patient-driven (not manual-driven) treatment. Since DBT was developed for impulsive and over-emotional patients, obtaining patient commitment is of paramount importance. Miller outlined various strategies including: 1) asking patients to commit to a large number of sessions, then settling for fewer; 2) frequently reminding patients of their commitment to attend a specific number of sessions; and 3) playing devil’s advocate -- asking patients why they want to go through this difficult treatment.
The therapist begins each DBT session by discussing self-destructive behaviors such as suicide attempts, parasuicide, and drug abuse. The therapist then moves on to behaviors that interfere with therapy, such as missing sessions and arriving late. Finally, the therapist discusses those issues the patient wants to talk about.
Miller emphasized that therapists should assess the intent of every self-destructive behavior. Taking three aspirins might be a suicide attempt, while taking 60 might be an attempt to fall asleep.
DBT advocates frequent telephone contact with patients. Marsha Linehan, who developed DBT, found that encouraging patients to call actually reduces the number of calls. However, therapists must limit the length of calls to fifteen minutes at most.
Detailed functional analysis, called “chain analysis,” is an important part of DBT: 1) Identify the proximate stimulus that evoked the impulsive or overemotional response; 2) Identify more distal stimuli, such as lack of sleep or food; 3) Identify reinforcers such as getting attention for self-destructive behavior; and 4) Ask the patient to ask friends and relatives to provide reinforcement for healthy behavior.
Additional information about DBT can be found at the following website: http://www.BehavioralTech.com
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