DialecticalBehaviourTherapy辯證行為療法

會(huì)計(jì)學(xué)1DialecticalBehaviourTherapy辯證行為療法

GoalToBuildALifeWorthLiving第1頁(yè)/共32頁(yè)Steps1.ClearStructure2.DoBehaviourTherapy3.AddValidation4.AddDialectics5.AddMindfulness第2頁(yè)/共32頁(yè)1.ClearStructure第3頁(yè)/共32頁(yè)AssumptionsAboutClients&Therapy1.Clientsaredoingthebesttheycan2.Clientswanttoimprove3.Clientsneedtodobetter,tryharderandbemoremotivatedtochange4.Clientsmaynothavecausedalloftheirownproblemsbuttheyhavetosolvethemanyway5.Thelivesofsuicidalborderlineindividualsareunbearableastheyarecurrentlybeinglived6.Clientsmustlearnnewbehavioursinallrelevantcontexts7.Clientscannotfailintherapy8.Therapiststreatingborderlineclientsneedsupport

第4頁(yè)/共32頁(yè)AssumptionsaboutTherapy&Therapists1.Themostcaringthingatherapistcandoishelpclientschangeinwaysthatbringthemclosertotheirultimategoals(unwaveringcentredness)2.Clarity,precisionandcompassionareoftheutmostimportanceintheconductofDBT3.Thetherapeuticrelationshipisarealrelationshipbetweenequals(therearedifferencesinexpertisebutnoarbitrarypowerdifferential)4.Principlesofbehaviourareuniversal,affectingtherapistsnolessthanclients5.DBTtherapistscanfail6.DBTtherapycanfailevenwhentherapistsdonot7.Therapiststreatingborderlineclientsneedsupport第5頁(yè)/共32頁(yè)Agreements

TherapistAgreementsEVERYREASONABLEEFFORTAGREEMENTETHICSAGREEMENTPERSONALCONTACTAGREEMENTCONSULTATIONAGREEMENT第6頁(yè)/共32頁(yè)TherapistConsultationAgreementsDIALECTICALAGREEMENTCONSULTATIONTOTHECLIENTAGREEMENTCONSISTENCYAGREEMENTOBSERVINGLIMITSPHENOMENOLOGICALEMPATHYAGREEMENTFALLIBILITYAGREEMENT第7頁(yè)/共32頁(yè)ClientAgreementsONEYEARTHERAPYAGREEMENTATTENDANCEAGREEMENTSUICIDALBEHAVIOURSAGREEMENTTHERAPY-INTERFERINGBEHAVIOURSAGREEMENTSKILLSTRAININGAGREEMENTRESEARCHANDPAYMENTAGREEMENT

第8頁(yè)/共32頁(yè)2.DoBehaviourTherapy第9頁(yè)/共32頁(yè)Theconsequencesofabehaviouraffecttheprobabilityofthebehaviour’soccurringagain.Everytherapistresponseexperiencedbytheclientcanbeneutral,punishingorreinforcing,thuseverycontingentresponseisaninformalcontingencyprocedure.第10頁(yè)/共32頁(yè)BehaviouralAssessmentThereisnosubstituteforgoodbehaviouralanalysistodeterminewhatispromptingandmaintainingmaladaptivebehaviour

ChainAnalysis

第11頁(yè)/共32頁(yè)AssessNecessaryIntervention1.Arethebehavioursinthepersonsbehaviouralrepertoire? No–BehaviouralSkillsTraining2.Areineffectivebehavioursbeingreinforced? Yes–ContingencyManagement

3.Areeffectivebehavioursinhibitedbyunwarrantedfearsorguilt?Isthepersonemotionphobic? Yes–Exposure4.Areeffectivebehavioursinhibitedbyfaultybeliefsandassumptions? Yes–CognitiveModification第12頁(yè)/共32頁(yè)3.AddValidation

第13頁(yè)/共32頁(yè)LevelsofValidation1.Stayingawake–unbiasedlisteningandobserving2.Accuratereflection–summarising3.Articulatetheunverbalisedemotions,thoughtsorbehaviourpatterns–takeaslightleapandreadbeyondwhatthey’vesaid,maybesafertousea“multiple-choiceapproach”4.Validationintermsofpastlearningorbiologicaldysfunction5.Validationintermsofpresentcontextornormativefunctioning6.Radicalgenuineness–beingyourselfwiththeclientasyouarewithothers,sametoneofvoice,samelanguage,notsteppingintoarole第14頁(yè)/共32頁(yè)4.AddDialectics第15頁(yè)/共32頁(yè)Dialectics1-AWorldView1.ThePrincipleofInterrelatednessandWholeness

Systemsperspectiveonreality(identityisrelational)2.ThePrincipleofPolarity

Realityisnotstaticbutiscomprisedoninternalopposingforcesoutofwhichsynthesisisachieved.

“Contradictorytruthsdonotnecessarilycanceleachotheroutordominateeachother,butstandsidebyside,invitingparticipationandexperimentation”Goldberg(1980)

3.ThePrincipleofContinuousChange

Change,orprocess,ratherthanstructureorcontent,istheessentialnatureoflife.

Roleofconflictandoppositioninthechangeprocess.

第16頁(yè)/共32頁(yè)Dialectics2

Dialogue&RelationshipAboutbalancingwiththeclient–see-sawexampleChangebypersuasionPersonalaccountofevents,exposingcontradictorypositionsThespiritofadialecticalpointofviewisnevertoacceptafinaltruthorindisputablefact.Thinking“whatisbeingleftoutofourunderstanding?”(Toavoidsplitting,whichalmostalwaysresultsfromaclinicianassumingthatthey,andsometimestheyalone,have“thetruth”aboutaclientorclinicalproblem)第17頁(yè)/共32頁(yè)ActivePassivity VS ApparentCompetencePassive,helplessproblemsolvingTriestogetotherstohelpEmotionfocusedcopingSometimesappearcompetentAbletocopeinsomesituationsCopingfollowedbycrisisDifficultygeneralisingDilemma:NeedshelpbutfeelsshameforaskingIsitlackofmotivationorlackofskills?TherapisttoodemandingvstoorescuingDialecticalDilemma’sPosedbyBorderlineClients第18頁(yè)/共32頁(yè)DialecticalTherapistCharacteristicsFindingabalancebetweenapparentlyopposingstancesOrientedtoChange VS OrientedtoAcceptanceNecessityofchangeClientswishtochangePrinciplesofBehaviourChangeAcceptanceexactlyinthismomentAsthingsarerightnowInherentwisdomand“goodness”ofcurrentmoment第19頁(yè)/共32頁(yè)“Mistakesareinevitable;whatthetherapistdoesafterwardsisabetterindexofgoodtherapy”

Linehan第20頁(yè)/共32頁(yè)DialecticalTherapistTechniquesFindingabalancebetweenapparentlyopposingstancesValidation VS ProblemSolvingActiveobservingReflectionSearchforvalidityActiveapproachBehaviouralfocus第21頁(yè)/共32頁(yè)DialecticalBehaviourPatterns:

BalancedLifestyleWalkingthemiddlepaththroughthefollowingareasSkillenhancement VS Self-acceptanceProblemsolving VS ProblemacceptanceAffectregulation VS AffecttoleranceSelf-efficacy VS HelpseekingIndependence VS DependenceTransparency VS Privacy第22頁(yè)/共32頁(yè)5.AddMindfulness第23頁(yè)/共32頁(yè)GeneralGoalofSkillsTrainingTolearnandrefineskillsinchangingbehavioural,emotionalandthinkingpatternsassociatedwithproblemsinliving,thatis,thosecausingmiseryanddistress.第24頁(yè)/共32頁(yè)GeneralPointsShotgunapproach–someoftheskillswillworkforsomeofthepeoplesomeofthetimeThepartsoftheskillsarerarelynew,butthecombinationoftenisClientsneedtobeconvincedthatwhatthey’relearningisgoingtobeuseful,relevanttothem(‘marketing’theskills)Clientswilloftenhaveattendedothergroups,needtodiscusshowthismightbedifferent(e.g.notprocessoriented)Emphasizegoaloflong-termreliefvs.immediatereliefEmphasizeneedforpractice,practice,practice第25頁(yè)/共32頁(yè)TheSkillsCoremindfulnessInterpersonaleffectivenessEmotionregulationDistresstolerance第26頁(yè)/共32頁(yè)Mindfulness“bringinganunshakeablefriendlinessanddeepdegreeofcuriosityandinteresttowhatishappeninginandaroundyou…anddoingthisagainandagainandacclimatisingtothiswayofbeing”TarchinHearn“Mindfulnessintotalityhastodowiththequalityofawarenessthatapersonbringst