DialecticalBehaviourTherapy辯證行為療法

會計(jì)學(xué)1DialecticalBehaviourTherapy辯證行為療法

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

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

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

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

ChainAnalysis

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

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

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

Systemsperspectiveonreality(identityisrelational)2.ThePrincipleofPolarity

Realityisnotstaticbutiscomprisedoninternalopposingforcesoutofwhichsynthesisisachieved.

“Contradictorytruthsdonotnecessarilycanceleachotheroutordominateeachother,butstandsidebyside,invitingparticipationandexperimentation”Goldberg(1980)

3.ThePrincipleofContinuousChange

Change,orprocess,ratherthanstructureorcontent,istheessentialnatureoflife.

Roleofconflictandoppositioninthechangeprocess.

第16頁/共32頁Dialectics2

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

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

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