2022年医学专题—DialecticalBehaviourTherapy：辩证行为疗法(1).ppt

Dialectical Behaviour Therapyin Perth North Metro Area,Margaret Cole11th July 2006,第一页，共三十三页。,GoalTo Build A Life Worth Living,第二页，共三十三页。,Steps1.Clear Structure2.Do Behaviour Therapy3.Add Validation4.Add Dialectics5.Add Mindfulness,第三页，共三十三页。,1.Clear Structure,第四页，共三十三页。,Assumptions About Clients&Therapy,1.Clients are doing the best they can2.Clients want to improve3.Clients need to do better,try harder and be more motivated to change4.Clients may not have caused all of their own problems but they have to solve them anyway5.The lives of suicidal borderline individuals are unbearable as they are currently being lived6.Clients must learn new behaviours in all relevant contexts7.Clients cannot fail in therapy8.Therapists treating borderline clients need support,第五页，共三十三页。,Assumptions about Therapy&Therapists,1.The most caring thing a therapist can do is help clients change in ways that bring them closer to their ultimate goals(unwavering centredness)2.Clarity,precision and compassion are of the utmost importance in the conduct of DBT3.The therapeutic relationship is a real relationship between equals(there are differences in expertise but no arbitrary power differential)4.Principles of behaviour are universal,affecting therapists no less than clients5.DBT therapists can fail6.DBT therapy can fail even when therapists do not7.Therapists treating borderline clients need support,第六页，共三十三页。,AgreementsTherapist Agreements,EVERY REASONABLE EFFORT AGREEMENTETHICS AGREEMENTPERSONAL CONTACT AGREEMENTCONSULTATION AGREEMENT,第七页，共三十三页。,Therapist Consultation Agreements,DIALECTICAL AGREEMENTCONSULTATION TO THE CLIENT AGREEMENTCONSISTENCY AGREEMENTOBSERVING LIMITSPHENOMENOLOGICAL EMPATHY AGREEMENTFALLIBILITY AGREEMENT,第八页，共三十三页。,Client Agreements,ONE YEAR THERAPY AGREEMENTATTENDANCE AGREEMENTSUICIDAL BEHAVIOURS AGREEMENTTHERAPY-INTERFERING BEHAVIOURS AGREEMENTSKILLS TRAINING AGREEMENTRESEARCH AND PAYMENT AGREEMENT,第九页，共三十三页。,2.Do Behaviour Therapy,第十页，共三十三页。,The consequences of a behaviour affect the probability of the behaviours occurring again.Every therapist response experienced by the client can be neutral,punishing or reinforcing,thus every contingent response is an informal contingency procedure.,第十一页，共三十三页。,Behavioural Assessment,There is no substitute for good behavioural analysis to determine what is prompting and maintaining maladaptive behaviour Chain Analysis,第十二页，共三十三页。,Assess Necessary Intervention,1.Are the behaviours in the persons behavioural repertoire?No Behavioural Skills Training2.Are ineffective behaviours being reinforced?Yes Contingency Management3.Are effective behaviours inhibited by unwarranted fears or guilt?Is the person emotion phobic?Yes Exposure4.Are effective behaviours inhibited by faulty beliefs and assumptions?Yes Cognitive Modification,第十三页，共三十三页。,3.Add Validation,第十四页，共三十三页。,Levels of Validation,1.Staying awake unbiased listening and observing2.Accurate reflection summarising3.Articulate the unverbalised emotions,thoughts or behaviour patterns take a slight leap and read beyond what theyve said,may be safer to use a“multiple-choice approach”4.Validation in terms of past learning or biological dysfunction5.Validation in terms of present context or normative functioning6.Radical genuineness being yourself with the client as you are with others,same tone of voice,same language,not stepping into a role,第十五页，共三十三页。,4.Add Dialectics,第十六页，共三十三页。,Dialectics 1-A World View,1.The Principle of Interrelatedness and WholenessSystems perspective on reality(identity is relational)2.The Principle of PolarityReality is not static but is comprised on internal opposing forces out of which synthesis is achieved.“Contradictory truths do not necessarily cancel each other out or dominate each other,but stand side by side,inviting participation and experimentation”Goldberg(1980)3.The Principle of Continuous ChangeChange,or process,rather than structure or content,is the essential nature of life.Role of conflict and opposition in the change process.,第十七页，共三十三页。,Dialectics 2Dialogue&Relationship,About balancing with the client see-saw exampleChange by persuasionPersonal account of events,exposing contradictory positionsThe spirit of a dialectical point of view is never to accept a final truth or indisputable fact.Thinking“what is being left out of our understanding?”(To avoid splitting,which almost always results from a clinician assuming that they,and sometimes they alone,have“the truth”about a client or clinical problem),第十八页，共三十三页。,Active PassivityVSApparent Competence,Passive,helpless problem solvingTries to get others to helpEmotion focused coping,Some times appear competentAble to cope in some situationsCoping followed by crisisDifficulty generalising,Dilemma:Needs help but feels shame for askingIs it lack of motivation or lack of skills?Therapist too demanding vs too rescuing,Dialectical Dilemmas Posed by Borderline Clients,第十九页，共三十三页。,Dialectical Therapist Characteristics,Finding a balance between appare