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Dialectical Behavior Therapy in Clinical Practice: Applications Across Disorders and Settings

Shannon, Kelly E. LCSW-C

The Journal of Nervous and Mental Disease: April 2010 - Volume 198 - Issue 4 - p 313
doi: 10.1097/NMD.0b013e3181d60584
Book Reviews

Coordinator, DBT Programs; The Retreat at Sheppard Pratt; Towson, MD

Dimeff, Linda A, Koerner, Kelly (Eds) (2007) New York: Guilford Press. ISBN 1-57230-974-1. xviii + 363 pp.

Dialectical Behavior Therapy in Clinical Practice is a collection of chapters composed by many of the leading practitioners of dialectal behavior therapy (DBT). Their goal in writing this book was to aid frontline clinicians with a working knowledge of DBT to most effectively use DBT within their program structures and target populations.

One of the long-standing difficulties in using DBT is that in its original and comprehensive format, it was structured to be a year long, intensive, outpatient treatment for borderline personality disorder. Unfortunately, the majority of clinicians working with high-risk self-harming patients are often working within shorter term residential treatment or crisis inpatient settings. Compounding challenges include working with a variety of patients or a patient population with different characteristics and perceived needs, working with managed care companies, and working under administrations that have other (at times conflicting) agendas. These realities make it impossible to adhere to the comprehensive DBT format and require significant modifications.

It is clear that with these challenges, clinicians must think outside the box. In doing this, one must adhere to the initial 5 functions of comprehensive DBT, initially developed by Marsha Linehan (enhancing client capabilities, improving motivation, ensuring generalization, enhancing therapist skill and motivation, and structuring the environment through contingency) to maintain the efficacy of treatment. As long as these 5 functions are maintained, the integrity of providing empirically based DBT is present.

This is the underlying message evident within each individual adaptation described beautifully throughout the book. Clear examples are provided of how DBT has been used effectively in inpatient, residential, and outpatient settings, and with adolescent, dually diagnosed, eating-disordered, and geriatric patient groups. Individual chapters are devoted to the various complications and headaches (and how they were reduced) for each of these settings and with each of these patient populations. The authors are quite practical and often include adapted diary cards, commitment strategies, chain analyses, and skills worksheets aimed at getting the clinician on the right path.

In addition, included are several tips on how to overcome financial challenges and staff burnout. There is dedication to training alternate frontline staff, collecting data to support the efficacy of DBT treatment, and clients involved with several different centers or modalities.

This collection will prove invaluable to clinicians interested in adding DBT to a current treatment program or developing a DBT clinic. Rather than reinvent the wheel, it promotes creative critical thinking when making decisions about which modes one might use from comprehensive DBT and which modes one might adapt to best fit a given treatment setting and patient population.

It should be cautioned that this approach is meant to be used only by clinicians intensively trained in comprehensive DBT. One must have a clear understanding of the initial comprehensive model to ethically adapt DBT to another treatment setting. The text makes a reference to the impending need for certification of a program to legitimately claim it is providing DBT. This further emphasizes the need to put the time and effort into adapting DBT to an existing program. This volume demonstrates how such efforts can pay dividends.

Kelly E. Shannon, LCSW-C

Coordinator, DBT Programs

The Retreat at Sheppard Pratt

Towson, MD

© 2010 Lippincott Williams & Wilkins, Inc.