Dialectical Behavior Therapy: Part II. Clinical Application of DBT for Patients with Multiple Problems

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In Part I, of this two part article (January 1998), the authors described the theoretical principles that underlie the use of Dialectical Behavior Therapy (DBT) in the treatment of patients with borderline personality disorder (BPD). In Part II, they present the clinical application of DBT to help clinicians understand how DBT techniques are used in working with this multi-problem population. The authors first review the eight basic assumptions about DBT and the treatment of patients with BPD. Strategies that set the stage for treatment, including contracting and commitment, are reviewed. The authors then describe how to use the four basic treatment strategies of DBT: 1) the core strategies of problem-solving (change) and validation (acceptance); 2) dialectical strategies that facilitate a shift from extreme patterns of “either/or” thinking, emotions, and behaviors to more balanced responses; 3) stylistic strategies for achieving interpersonal and communication styles compatible with DBT; and 4) case management strategies. The application of these strategies is illustrated using excerpts from therapy sessions.

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