Chapter 11.Treatment Techniques in Dialectical Behavior Therapy

This chapter begins with a focus on problem-solving techniques of dialectical behavior therapy (DBT), which is based on cognitive-behavioral therapy (CBT). Next, I discuss acceptance-oriented strategies, including validation, and then, finally, dialectical strategies. Although the main focus is on the use of DBT techniques in the context of individual therapy, it is important to recognize that the same repertoire of strategies is used in all DBT treatment modes, such as group skills training sessions; telephone calls to the therapist for skills coaching; and among therapists in the DBT consultation team. For instance, group skills training classes begin with a review of patients’ homework practice from the prior week. The skills group leader uses validation strategies in the service of strengthening the connection between therapist and patient, then uses a range of change-oriented techniques to improve the patient's skillful capacities. The skills training group leader, for instance, briefly uses behavioral chain analysis to assess problems in homework compliance or ineffective skills use, then intervenes with brief, targeted problem-solving practices to strengthen compliance, effective use of skills, and generalization of the learning to the natural environment. Later in the same group meeting, while teaching the new skill of the week, the leader draws from the whole package of problem-solving, validation, and dialectical strategies to heighten skills acquisition and strengthening. The chapter concludes with brief comments on how to bring the three paradigms and the multitude of strategies together in therapy sessions.