Carolyn McGuffog Ph.D., Ed.D., A.B.S.N.P. Fordham University Therapeutic Techniques Workshop

Carolyn McGuffog, Ph.D., Ed.D., A.B.S.N.P.
Fordham University
Therapeutic Techniques Workshop
April 15, 2010
ƒ also known as insight-oriented therapy
ƒ evolved from Freudian psychoanalysis
ƒ psychodynamic therapists believe that
bringing the unconscious into conscious
awareness promotes insight and
resolves conflict
ƒ Freudian psychology - referred to as the
drive or structural model
ƒ Mental illness is a result of an
unsuccessful progression through the
psychosexual stages of childhood that
results in problems in the balance of your
personality structures (the ego, superego,
and id)
ƒ Sexual and aggressive energies
originating in the id (or unconscious) are
modulated by the ego which moderates
between the id and external reality
ƒ Oral Stage (Birth to 18 months) Focus on oral
pleasures (sucking). Too much or too little
gratification can result in an Oral Fixation or Oral
Personality - preoccupation with oral activities.
May become overly dependent upon others or may
fight these urges and develop pessimism and
aggression toward others.
ƒ Anal Stage (18 months to three years) -focus of
pleasure is on eliminating and retaining feces.
Through societal pressure, the child learns to
control anal stimulation. An anal fixation can result
in an obsession with cleanliness, perfection, and
control (anal retentive) or messiness and
disorganization (anal expulsive).
ƒ Phallic Stage (ages three to six) - pleasure
zone switches to the genitals. A boy develops
unconscious sexual desires for his mother and
becomes rivals with his father. Fear their father
will punish them for these feelings by castrating
them (Oedipus Complex). Out of fear of
castration, boys identify with their fathers. A
fixation at this stage could result in sexual
deviancies and weak or confused sexual
identity.
™Electra Complex - girls go through a similar
situation, developing unconscious sexual
attraction to their father.
ƒ Latency Stage (age six to puberty) sexual urges remain repressed and
children interact and play mostly with
same sex peers.
ƒ Genital Stage (puberty on) - sexual urges
are once again awakened. Adolescents
direct their sexual urges onto opposite sex
peers, genitals are the primary focus of
pleasure.
ƒ Ego Psychology derives from Freudian
psychology.
ƒ Heinz Hartmann
ƒ therapist focuses on enhancing ego
function in accordance with the
demands of reality
ƒ Ego Psychology stresses the
individual’s capacity for defense,
adaptation, and reality testing
ƒ Anna Freud (1966) focused her attention on the ego’s
unconscious, defensive operations
ƒ believes the ego supervises, regulates, and opposes
the id through defenses
ƒ Defense mechanisms are constructions of the ego that
operate to minimize pain and maintain psychic
equilibrium. The superego (conscience) operates to
control id drives through guilt.
ƒ therapist needs to be attuned to the moment-bymoment process of what the patient talks about in
order to identify and interpret defenses.
Reality Testing: The ego’s capacity to distinguish
what is occurring in one’s own mind from what is
occurring in the external world. It is the single most
important ego function because it is necessary for
negotiating with the outside world.
Affect Regulation: The ability to modulate feelings
without being overwhelmed.
Impulse Control: The ability to manage aggressive
and/or libidinal wishes without immediate
discharge through behavior or symptoms.
Judgment: The capacity to act responsibly
through identifying possible courses of
action, anticipating and evaluating likely
consequences, and making appropriate
decisions.
Object Relations: The capacity for mutually
satisfying relationships. The individual can
perceive himself and others as whole
objects.
Thought Processes: The ability to have
logical, coherent, and abstract thoughts. In
stressful situations, thought processes can
become disorganized.
ƒ Synthesis: The synthetic function is the
ego’s capacity to organize and unify other
functions within the personality. It enables
the individual to think, feel, and act in a
coherent manner. It includes the capacity to
integrate potentially contradictory
experiences, ideas, and feelings; for
example, a child loves his or her mother yet
also has angry feelings toward her at times.
The ability to synthesize these feelings is a
pivotal developmental achievement.
ƒ Defensive Functioning: A defense is
an unconscious attempt to protect one
from some powerful identity-threatening
feeling.
ƒ Primitive defenses - develop in infancy
and involve the boundary between the self
and the outer world
ƒ Mature defenses - deal with internal
boundaries such as those between ego
and super ego or the id.
Primitive Defenses
ƒ Denial is the refusal to accept reality and to act as if a
painful event, thought or feeling did not exist. It is
considered one of the most primitive of the defense
mechanisms.
ƒ Projection - attributing your own repressed thoughts
and/or undesired impulses to someone else. A
variation on the theme of Projection is known as
Externalization. In Externalization, you blame others
for your problems rather than owning up to any role
you may play in causing them.
Primitive Defenses
ƒ Splitting - a person can not integrate both
good and bad aspects, so they polarize
their view of a person as "all good" or "all
bad.” Splitting functions by way of
Dissociation, which is the ability to wall off
certain experiences and not think about
them.
ƒ Regression -because of partial fixations
in any of the psychosexual stages of
development, regression can occur
when an individual is faced with high
levels of stress in their life. Regression is
the giving up of mature problem solving
methods in favor of child like approaches
to fixing problems.
ƒ Fantasy; - engaging in daydreams about
how things should be, rather than doing
anything about how things are.
ƒ Acting out - an inability to be thoughtful
about an impulse. The impulse is
expressed directly without any reflection
or consideration as to whether it is a good
idea to do so.
ƒ Passive-aggression - A thought or
feeling is not acceptable enough to a
person to be allowed direct expression so
person behaves in an indirect manner that
expresses the thought or emotion.
ƒ More mature defenses (between ego and
superego)
ƒ Repression is the blocking of unacceptable
impulses from consciousness.
ƒ Reaction Formation is the converting of
wishes or impulses that are perceived to be
dangerous into their opposites. A woman who is
furious at her child and wishes her harm might
become overly concerned and protective of the
child's health.
ƒ Undoing is the attempt to take back
behavior or thoughts that are unacceptable.
An example of undoing would be
excessively praising someone after having
insulted them.
ƒ Rationalization - a post-hoc (after the fact)
defense mechanism - offering logical
reasons for inexcusable actions.
ƒ Displacement is the redirecting of thoughts
feelings and impulses from an object that gives
rise to anxiety to a safer, more acceptable one.
ƒ Intellectualization is the use of a cognitive
approach without the attendant emotions to
suppress and attempt to gain mastery over the
perceived disorderly and potentially overwhelming
impulses. An example might be an individual who
when told they had a life threatening disease
focuses exclusively on the statistical percentages
of recovery and is unable to cope with their fear
and sadness.
ƒ Sublimation is the channeling of unacceptable
impulses into more acceptable outlets.
ƒ first articulated by several British analysts, among
them Melanie Klein, W.R.D. Fairbairn, D.W. Winnicott,
and Harry Guntrip
ƒ human beings are shaped in relation to the significant
others surrounding them
ƒ internal representations of self and others acquired in
childhood are later played out in adult relations
ƒ individuals repeat old object relationships in an effort
to master them and become freed from them.
ƒ Object representation is the mental
representation of a person.
ƒ An external object is an actual
person that has been invested with
emotional energy.
ƒ An internal object is a person’s
representation of another person. It
is a memory, idea or fantasy about
that person.
ƒ Self. Conscious and unconscious
mental representations of oneself.
ƒ Self-representation. A person’s
inner representation of himself or
herself as experienced in relation to
significant others.
ƒ Self-object. A loss of boundaries,
where self and object are blurred and
the distinction between self and
external object is not clear. (This
condition is called “confluence” in
Gestalt Therapy).
ƒ Part Object. This is an object that is
part of a person, such as a hand or
breast. The other is not recognized
as a “whole object”.
ƒ Whole Object. Another person who
is recognized as having rights,
feelings, needs, hopes, strengths,
weaknesses, and insecurities just like
one’s own.
ƒ Object Constancy. Mahler: object
constancy is "the capacity to
recognize and tolerate loving and
hostile feelings toward the same
object; the capacity to keep feelings
centered on a specific object; and the
capacity to value an object for
attributes other than its function of
satisfying needs."
ƒ Stood between classical
psychoanalysis and object relations
theory proper.
ƒ Saw the psychic world of infant and
child as filled with primitive,
murderous and cannibalistic
tendencies.
ƒ Emphasized biological drives and
instincts in the infant. Saw drives as
inherently aimed toward objects.
ƒ Task of therapy: To alleviate the
early anxieties, and modify the
harshness of internalized objects.
ƒ True self - this is the part of the infant
that feels creative, spontaneous, and
real.
ƒ False self - is "built up on the basis of
compliance.“
ƒ With "good enough" care the true
self can emerge, but without it the
false self emerges.
ƒ Holding includes actual physical
holding, and caring for the child over
time. It is psychological as well as
physical.
ƒ Transitional objects are the infant's
first not-me possessions. They are
tangible--can be held onto, grasped,
hugged. They lessen the stress of
separation and soothe the infant.
ƒ Along with Winnicott, places great
emphasis on the importance of holding
a child.
ƒ Psychological holding involves "holding
a space" in which the child can be itself
and feel protected and secure. Be a
container for all that the child brings to
you.
The Separation-Individuation
process has four phases:
1) Hatching. [5 to 9 months]. The
infant becomes aware of the
differentiation between itself and its
mother. It becomes increasingly
aware of and interested in its
surroundings, mother is point of
reference.
2) Practicing. [9 to 16 months]. The
infant can now get about on its own,
first crawling and then walking
freely. The infant begins to explore
actively and becomes more
independent of its mother. The infant
still experiences itself as one with its
mother.
3) Rapprochement. [15 – 24 months]. The
young child once again becomes close to his
mother, but begins to differentiate itself from his
mother. The child realizes that his physical
mobility demonstrates psychic separateness
from his mother. The toddler may become
tentative at this point, wanting his mother to be
in sight so that, through eye contact and action,
he can explore his world.
4) Object Constancy. (Third year and
beyond) Child has an internalized
image of the mother. Can hold the
image of her inside while she's away.
Can use an object like a toy to supply
comfort in her absence.
ƒ The reality principle replaces the pleasure
principle.
ƒ Child is cognitively putting things together,
cause and effect. Remember the past and
think of the future: Mother will return.
ƒ Some children at this stage will actively
seek the father, fear being re-engulfed by
the mother.
ƒ Beginnings of super-ego development.
Learning that there are consequences for
acting in certain ways. Developing a
conscience. "No, I shouldn't do this." If
handled badly by caregivers, this stage
involves the development of pathological
shame and guilt. In adulthood, "I'm not
okay, not good enough, etc."
"Object relations does not take into
account the social system that
creates pathology. It is superficially
an interpersonal approach in the
dyadic relationship between mother
and infant.”
VIDEO
ƒ offshoot of Object Relations Theory
ƒ posits that each individual's self-esteem
and vitality derive from and are maintained
by the empathic responsiveness of others
to his or her needs
ƒ self-psychology therapist emphasize the
role of empathic listening in treating clients
ƒ emphasis on narcissism
Narcisstic pathology is due to the
absence of the parents' empathic
response to the child's needs to be
mirrored ....The parent may be unable
to take pride in the child's
accomplishments and may not fulfill
the child's need for appropriate
admiration.
ƒ The chronic non-responsiveness of the
parent keeps the child from building up the
psychic structures to regulate tension and
tame affects.
ƒ An occasional lapse by the parents is no
big deal.
ƒ Therapy. Emphasizes empathic sensitivity
to the subjective experience of the patient,
especially the patient's experience of the
therapist - transference.
ƒ takes a positive view of human nature and
emphasizes the uniqueness of the
individual
ƒ therapists help clients realize potential
through change and self-directed growth
ƒ Humanistic therapy is also an umbrella
term for Gestalt, Client-Centered, and
Existential therapy.
ƒ Developed by Carl Rogers in the 1940s,
the client-centered method is based on
the empowering idea that the client holds
the answers to her problems--not the
doctor.
ƒ The client-centered therapist's job is to
carefully listen and strive to understand
the client, so that she can tap into her
natural ability to grow and improve.
ƒ Client-centered therapy helps the
client live in the moment and focus on
personality change, rather than on the
origins of her personality structure.
ƒ Rogers believed that the most
important factor in successful therapy
was not the therapist's skill or
training, but rather his or her attitude.
ƒ Three interrelated attitudes on the part of the
therapist are central to the success of personcentered therapy:
ƒ Congruence
ƒ Unconditional positive regard
ƒ Empathy
Congruence refers to the therapist's openness
and genuineness—the willingness to relate to
clients without hiding behind a professional
facade.
Unconditional positive regard means
that the therapist accepts the client
totally for who he or she is without
evaluating or censoring, and without
disapproving of particular feelings,
actions, or characteristics.
Empathy ("accurate empathetic
understanding"). The therapist tries to
appreciate the client's situation from
the client's point of view, showing an
emotional understanding of and
sensitivity to the client's feelings
throughout the therapy session.
ƒ Active Listening - therapist shows
careful and perceptive attention to
what the client is saying.
ƒ Reflection - paraphrasing and/or
summarizing what a client has just
said.
ƒ Self-actualization - personal growth is
facilitated by providing a climate in which
clients can freely engage in focused, indepth self-exploration. It refers to the
tendency of all human beings to move
forward, grow, and reach their fullest
potential.
The concept of self-actualization
focuses on human strengths rather
than human deficiencies.
According to Rogers, self-actualization
can be blocked by an unhealthy selfconcept (negative or unrealistic
attitudes about oneself).
1. The therapist must develop a
warm, friendly relationship with
the child in which good rapport is
established.
2. The therapist accepts the child
exactly as he/she is.
3. The therapist establishes a feeling of
permissiveness in the relationship so that
the child feels free to express his/her
feelings completely.
4. The therapist is alert to recognizing the
feelings the child is expressing and
reflects those feelings back to the child in
such a manner that he/she gains insight
into his/her behavior.
5. The therapist maintains a deep respect
for the child’s ability to solve his own
problems if given the opportunity to do
so. The responsibility to make choices
and to institute change is the child’s.
6. The therapist does not attempt to direct
the child’s actions or conversation in any
manner. The child leads, the therapist
follows.
7. The therapist does not attempt to
hurry the therapy along. It is a gradual
process and is recognized as such by
the therapist.
8. The therapist establishes only those
limitations that are necessary to
anchor the therapy to the world of
reality and to make the child aware of
his responsibility in the relationship.
Several factors may affect the success of
person-centered therapy.
1)If an individual was forced to attend
therapy, that person may not work well
together with the therapist.
2) The skill of the therapist may be another
factor. In general, clients tend to
overlook occasional therapist failures if a
satisfactory relationship has been
established. A therapist who continually
fails to demonstrate unconditional
positive regard, congruence, or empathy
cannot effectively use this type of
therapy.
3) A third factor is the client's comfort level
with nondirective therapy. Some studies
have suggested that certain clients may
get bored, frustrated, or annoyed with a
Rogerian style of therapeutic interaction.
4) does not lend itself to scientific study.
VIDEO
ƒ based on the philosophical belief that
human beings are alone in the world,
and that this aloneness can only be
overcome by creating one's own
meaning, and exercising one's
freedom to choose
ƒ existential therapist encourages
clients to face life's anxieties head on
and to start making his own
decisions.
ƒ therapist will emphasize that along
with having the freedom to carve out
meaning comes the need to take full
responsibility for the consequences of
one's decisions.
ƒ focus on the client's present and
future rather than his past.
ƒ seeks to integrate the client's behaviors,
feelings, and thinking, so that her intentions
and actions may be aligned for optimal mental
health.
ƒ therapist will help the client become more self
aware, live more in the present, and assume
more responsibility for taking care of herself.
ƒ Techniques include confrontation, dream
analysis, and role playing.
ƒ VIDEO
ƒ http://www.youtube.com/watch?v=Okkk1XbF6zE&f
eature=PlayList&p=4B85FA1730242238&playnext_
from=PL&playnext=1&index=48
ƒ founded by Alfred Adler (1870 -1937)
an ex-associate of Freud who
rejected Freud's notion that sex is the
root of all psychological problems.
ƒ takes a positive view of human nature
- we are all goal-oriented creatures
who are striving for social
connectedness, and we are in control
of our destiny.
ƒ believed many personal difficulties stem from
feelings of inferiority - coined the term
"inferiority complex.“
ƒ will use information about a client's family
history, birth order, and behavior patterns to
help the client set new, socially satisfying, and
attainable goals
ƒ VIDEO
ƒ http://www.youtube.com/watch?v=TiFDTS6aF0
ƒ Ego identity is the conscious sense of
self that develops through social
interaction.
ƒ Each stage in Erikson’s theory is
concerned with becoming competent in
an area of life. If the stage is handled
well, the person feels a sense of mastery,
or ego strength. If the stage is managed
poorly, the person will emerge with a
sense of inadequacy.
ƒ Stage 1 - Trust vs. Mistrust (Birth – one year)
Because an infant is utterly dependent, the
development of trust is based on the
dependability and quality of the child’s
caregivers. Caregivers who are inconsistent,
emotionally unavailable, or rejecting contribute
to feelings of mistrust. Failure to develop trust
will result in fear and a belief that the world is
inconsistent and unpredictable.
ƒ Psychosocial Stage 2 - Autonomy vs.
Shame and Doubt (early childhood)
ƒ Focused on children developing a greater
sense of personal control. Erikson believed
that learning to control one’s body functions,
food choice, toy preferences, etc. leads to a
feeling of control and a sense of
independence. Children who successfully
complete this stage feel secure and
confident, while those who do not are left
with a sense of inadequacy and self-doubt.
ƒ Psychosocial Stage 3 - Initiative vs.
Guilt (preschool years)
ƒ Children begin to assert their power and
control over the world through directing
play and social interaction. Children
who are successful feel capable and
able to lead others. Those who fail to
acquire these skills are left with a sense
of guilt, self-doubt and lack of initiative.
ƒ Psychosocial Stage 4 - Industry vs. Inferiority
(5-11)
Through social interactions, children begin to
develop a sense of pride in their accomplishments
and abilities. Children who are encouraged and
commended by parents and teachers develop a
feeling of competence and belief in their skills.
Those who receive little or no encouragement will
doubt their ability to be successful.
ƒ Psychosocial Stage 5 - Identity vs. Confusion
(Adolescence)
ƒ During adolescence, children are exploring their
independence and developing a sense of self.
Those who receive proper encouragement and
reinforcement through personal exploration will
emerge from this stage with a strong sense of
self and a feeling of independence and control.
Those who remain unsure of their beliefs and
desires will feel insecure and confused about
themselves and the future.
ƒ Cognitive therapy focuses primarily
on the thoughts and emotions that
lead to certain behaviors,
while behavioral therapy deals with
changing and eliminating those
unwanted behaviors. Cognitive
Behavioral Therapy focuses on both
thoughts and behavior.
ƒ focuses on changing undesirable
behaviors.
ƒ involves identifying objectionable,
maladaptive behaviors and replacing
them with healthier types of behavior.
ƒ Therapist analyzes the behaviors of
the patient that have a negative
impact on the life of the patient. Once
analysis is complete, the therapist
chooses appropriate treatment
techniques.
ƒ Treatments can include such
techniques as:
Environment Modification
– assess antecedents to the undesirable
behavior and modify those antecedents
– determine what triggers the behavior
– determine what purpose the behavior
serves
– find alternative means of achieving that
goal.
Positive Reinforcement
– specify target behavior, determine a
reinforcer (reward), make the
reinforcement contingent on the
occurrences of the targeted behavior
- social reinforcer – praise
- material reinforcer – stickers.
Modeling (Social Learning)
– demonstrates for the child a more
appropriate response
- can be used to teach skills or to
model coping behavior
- Symbolic modeling – model is in a
story or a puppet
- Participant modeling - models guide
the child.
Shaping
– a way of helping a child get progressively
closer to a targeted goal
– successive approximations – teach skills
gradually towards a desired goal.
- child is given positive reinforcement for
closer and closer approximations to the
desired response.
ƒ Social Skills Training is a form of behavior therapy
that can help people who have difficulties relating to
other people and regulating their behavior. Teach
interpretation of social cues and appropriate
behavioral responses. Role playing.
ƒ Social Stories – teach social skills by providing
detailed information about confusing situations
focusing on: the important social cues, the events and
reactions the individual might expect, the actions and
reactions that might be expected of him, and why. The
goal of the story is to increase the child’s
understanding of and make him more comfortable in
social situations.
Assertiveness Training is a form of
behavior therapy designed to help
people stand up for themselves—to
empower themselves.
- Assertiveness is a response that
seeks to maintain an appropriate
balance between passivity and
aggression.
Self-Control Strategies – teach a child
to use new behaviors and ways of
thinking that enhance the child’s
sense of control. Cognitive selfcontrol programs teach children to
monitor, evaluate and reinforce
themselves for using more adaptive
behaviors and coping skills.
Exposure
– gradual and systematic confrontation
of anxiety provoking stimuli so that
habituation occurs
– anxiety subsides or decreases as a
result of repeated exposure
– in vivo exposure is superior to
imagined exposure, can use both.
Response Prevention
- exposure to a feared stimulus while not
engaging in any safety behaviors.
- subject experiences habituation to the
feared stimulus, while practicing a fearincompatible behavioral response to the
stimulus
- causes some short-term anxiety but
facilitates long-term reduction in
obsessive and compulsive symptoms.
Systematic Desensitization
– process of reducing anxiety or fear by replacing a
maladaptive response with an adaptive one
– accomplished by breaking the association
between a stimulus and the anxiety or fear
response
– prevent the fear response from occurring by
replacing it with an opposing response such as
relaxation and positive self-statements
– imagine a hierarchy of anxiety provoking scenes
in combination with incompatible responses.
ƒ VIDEO OCD
ƒ http://www.youtube.com/watch?v=G5dlLL3FFzg
ƒ Relaxation, Guided Imagery, and Visualization
Techniques
ƒ Deep Breathing - take a breath, hold it and then
release it slowly.
ƒ Progressive muscles relaxation - focus on
different muscles of the body and relax them in a
progressive way.
ƒ Visualization - imagine beautiful, peaceful scenes.
ƒ Tape
Positive Self Statements Affirmations are positive thoughts or
statements about some outcome you
wish to achieve. Affirmations redirect
your values, help formulate goals or
prepare you for challenging
situations.
Bibliotherapy – therapeutic books for
children provide a child model who
copes with a similar situation.
Psychoeducation - providing
accurate information on a topic which
is usually done by teaching children
about the relationship between
events, thoughts, feelings and
behaviors.
ƒ Journal Writing: jot down negative
comments when you think them, write a
general summary of your thoughts at the
end of the day, or just start writing about
your feelings on a certain topic and later
go back to analyze it for content,
journaling can be an effective tool for
examining your inner process.
Replace Negative Statements - Once
you’re aware of your internal dialogue,
here are some ways to change
negative statements:
ƒ Milder Wording: turning more powerful
negative words to more neutral ones
can actually help neutralize your
experience.
ƒ Change Negative to Neutral or
Positive: As you find yourself mentally
complaining about something, rethink
your assumptions. Are you assuming
something is a negative event when it
isn’t, necessarily? [For example, having
your plans cancelled at the last minute
(negative), but what can you do with
your newly-freed schedule (positive)].
ƒ Thought-Stopping: As you notice
yourself saying something negative in
your mind, you can stop your thought
mid-stream my saying to yourself
“Stop”. Saying this aloud will be more
powerful, and having to say it aloud
will make you more aware of how
many times you are stopping negative
thoughts, and where.
ƒ Change Self-Limiting Statements to
Questions: Self-limiting statements like “I
can’t handle this!” or “This is impossible!”
are particularly damaging because they
increase your stress in a given
situation and they stop you from searching
for solutions. Turn it into a question “How can I handle this?” or “How is this
possible?”
ƒ Rubber-Band Snap - walk around
with a rubber band around your wrist;
as you notice negative self-talk, pull
the band away from your skin and let
it snap back. It’ll serve as a slightly
negative consequence that will make
you more aware of your thoughts and
help to stop them.
ƒ therapist will then encourage her to
change her actions to align with her
new, rational beliefs to relieve her
emotional problems
ƒ active approach often includes
homework assignments
ƒ developed by Albert Ellis and was one of
the first cognitive-behavioral therapy
approaches.
ƒ posits that our emotions result from our
beliefs, many of which are irrational, and
thus cause us to suffer unnecessarily.
ƒ therapist will question the client's beliefs to
help use her natural ability to think clearly
ƒ EMDR is an information processing therapy that
helps clients cope with trauma, addictions, and
phobias.
ƒ patient focuses on a specific thought, image,
emotion, or sensation while simultaneously
watching the therapist's finger or baton move in
front of his or her eyes. Then the client is asked
to think of new thoughts, while again
simultaneously focusing on the external
stimulus.
ƒ believe that the treatment loosens one's
traumatic memories and allows them to be
reprocessed with positive ones
ƒ a therapeutic methodology developed
by Marsha M. Linehan to treat persons
with borderline personality disorder (BPD).
ƒ Individuals with BPD react abnormally to
emotional stimulation due to invalidating
environments during upbringing and
biological factors as yet unknown.
ƒ their level of arousal goes up much more
quickly, peaks at a higher level, and takes
more time to return to baseline.
Borderlines have ineffective methods for
coping with these sudden, intense surges
of emotion. Hence, emotional lability and
crises (drama) prevail in their lives.
DBT teaches patients skills to manage
emotional trauma rather than focusing on
the crises.
ƒ DBT combines standard cognitivebehavioral techniques for emotion
regulation and reality-testing with
concepts of mindful awareness,
distress tolerance, and acceptance
largely derived from Buddhist
meditative practice.
Individual Component
The therapist and patient therapist and patient work
towards improving skill use and discuss issues that
come up during the week, recorded on diary cards.
Follow a treatment target hierarchy. Selfinjurious and suicidal behaviors take first priority,
followed by therapy interfering behaviors.
Group Component
ƒ ordinarily meets once weekly for two to
two-and-a-half hours,
ƒ clients learn to use specific skills that are
broken down into four modules:
™core mindfulness skills
™interpersonal effectiveness skills
™emotion regulation skills
™distress tolerance skills
ƒ views problems within the family as
the result not of particular members'
behaviors, but of the family's group
dynamic.
ƒ family is seen as a complex system
having its own language, roles, rules,
beliefs, needs and patterns.
ƒ therapist helps each individual
member understand how her
childhood family operated, her role in
that system, and how that experience
has shaped her role in her current
family.
ƒ therapists with the MFT credential are
usually trained in Family Systems
therapy.