Dialectical Behavior Therapy for Wellness and Recovery E-Book

Andrew Bein

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 325

Veröffentlichungsjahr: 2013

Beschreibung

This hands-on guide addresses the present day realities of applying dialectical behavior therapy in a mental health and substance abuse recovery context. The book presents the DBT concept, Wise Mind, as adapted by author Andrew Bein, as central to a simple, powerful, empirically supported framework that respectfully engages clients in their own efforts to enhance personal well-being. The book includes empirically supported exercises with an emphasis on collaboration and client empowerment using a recovery oriented model for client treatment and improved outcomes.

Leseprobe

Contents

Foreword

Preface

Chapter One: Applying Dialectical Behavior Therapy: Toward Access for Diverse Client Needs

Gifts of Dialectical Behavior Therapy

Chapter Two: Emotion Regulation and Resilience: Developing Wise Mind

Emotion Regulation Strategies and Helping Framework

The Skillfulness of Intention: Am I in Wise Mind?

The Intention of Self-Compassion

Mindfulness of the Moment

Responding to Emotions in the Moment

Expanding the Moment: Resilience Building and the Bigger Picture

Validation and Acceptance to Support Client Change

Chapter Three: Applying DBT to Mental Health and Substance Abuse Recovery

Overview of Issues

Practicing Mental Health Recovery in DBT-WR

Motivational Interviewing

Substance Abuse Recovery

Chapter Four: Accounting for Trauma

Overview

Trauma to Normalize Emotion Regulation Challenges

Neuroscience Engenders Hope and Interest

Acknowledgment of Trauma and Extreme Stress Validates Clients

Being Mindful of Trauma in the Here-and-Now

Resilient Zone

Chapter Five: Clinician’s Use-of-Self: Foundation for Effective Practice

Strong Back, Soft Front

Use-of-Self Interface with Radical Acceptance

Intention and Mindfulness Fueling Effective Practice

Use-of-Self with Challenging Clients and Circumstances

Responding to Diversity as Opportunity, Not as Nuisance

Practitioner Nondefensiveness

Language of Invitation

Use-of-Self Summary

Chapter Six: Lessons and Activities: Dialectical Behavior Therapy for Wellness and Recovery

Principles for Using Lessons

Improve the Moment: Language and Meaning

Session Structure and Flow

Homework

Approaching the Lessons With a Light-Hearted Spirit

Lesson 1: Mindfulness and the Brain

Lesson 2: Facing Emotions and Thoughts and Improving the Moment

Lesson 3: Dealing With Judgments

Lesson 4: Expanding the Moment

Lesson 5: Dealing With Difficult Times

Lesson 6: Opposite Action

Lesson 7: Not Getting Stuck Doing the Usual

Exercise 8: Friend to Self: Willing Participation and Mindful Walking

Lesson 9: Primary and Secondary Emotions

Lesson 10: Friend to Self: Doing What Is Needed and Self-Care

Lesson 11: Getting Grounded: Finding Wellness Amidst Distress, Anxiety, and Worry

Lesson 12: Finding the Zone: Moving From Suffering to Balance

Lesson 13: Self-Nurturance and Joy

Lesson 14: Effective Speech and Telling the Truth

Lesson 15: Inspiring the World With Our Courage and Path

References

Appendix

Acknowledgments

About the Author

Author Index

Subject Index

Praise forDialectical Behavior Therapy for Wellness and Recovery: Interventions and Activities for Diverse Client Needs

“It is exciting when a book comes along in the mental health field that both changes the way we think about our work and can be immediately applied to our work in a practical way, and Andrew Bein’s book does just that! As a mindfulness-oriented therapist in a busy university counseling center, I am excited to start using this book in my work with clients, and I know it will be a resource I will turn to again and again.”

Ronni Arensberg, PsyD, LP, North Dakota State University Counseling Center

“Andrew Bein’s latest book brilliantly captures the essence of DBT and integrates self-regulatory concepts that are key to healing trauma. The practical exercises and monitoring tools are excellently designed and will be helpful tools that will enhance recovery. This book will not only be useful for clinicians but clients as well.”

Elaine Miller-Karas, LCSW; Executive Director of the Trauma Resource Institute

“This is a thoughtful book that dares to venture into the uncharted territory of rethinking treatment for persons diagnosed with personality disorders based on the recovery paradigm. While DBT has always been a respectful, and empowering, approach, Bein courageously challenges some of the core assumptions upon which traditional psychotherapeutic practice has been based in order to engage clients in a more collaborative relationship that enables them to assume an active, and central, role in their own recovery.”

Larry Davidson, PhD, Professor of Psychiatry, Yale University School of Medicine

“Like water on rock, Dr. Bein reshapes Dialectical Behavior Therapy with a deepened appreciation for emotion regulation through mindfulness practice. This practical and clearly presented model offers a much needed treatment model for use in diverse settings. It is filled with simple, well-constructed exercises and tools that make basic DBT principles more accessible than ever before. Dialectical Behavior Therapy for Wellness and Recovery is an invaluable contribution not only for therapy, but for quality everyday living.”

Satsuki Ina, PhD, MFT; Director, Family Study Center; Producer and Director, Children of the Camps

“Dr. Bein skillfully brings DBT, essential mindfulness practices, and skills-building to the everyday world of therapists and clients. Andy presents a cohesive and comprehensive model of integrative therapy that benefits those willing to take on practices promoting growth and development from the ground up.”

Edward Brown, Zen priest; Author; Tassajara Bread Book

“Dr. Bein’s thoughtful exploration of recovery reminds us that our clients bring extraordinary strengths and life experience to the healing process. The book’s concepts are presented in ways that are refreshing and new, giving the clinician immediate clarity and sense of how to teach the material. I plan to use DBT-WR for my next therapy group.”

Nancy White, LCSW, Private Practice; Former DBT Group Leader, Kaiser Permanente

“Bein writes with authenticity and empathy, and, in his strong and soft voice, concepts such as intention, self-compassion, mindfulness, and radical acceptance become not only of therapeutic value but a template for all of us to live with presence and integrity.”

Shauna L. Smith, MSW, LMFT; Author, Making Peace With Your Adult Children: A Guide to Family Healing; Co-Founder, Therapists for Social Responsibility

Cover Image: ©iStockphoto.com/antishock

Cover design: Andrew Liefer

Copyright © 2014 by John Wiley & Sons, Inc. All rights reserved

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Published simultaneously in Canada

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Library of Congress Cataloging-in-Publication Data

Bein, Andrew M.

Dialectical behavior therapy for wellness and recovery : interventions and activities for diverse client needs / Andrew Bein.

1 online resource.

Includes bibliographical references and index.

Description based on print version record and CIP data provided by publisher; resource not viewed.

ISBN 978-1-118-65333-3 (pbk) — ISBN 978-1-118-69061-1 (ebk) — ISBN 978-1-118-75997-4 (ebk)

1. Dialectical behavior therapy. 2. Mental health. 3. Clinical health psychology. I. Title.

RC489.B4

616.89'142—dc23

2013021305

Foreword

Dialectical Behavior Therapy (DBT) was originated and developed by Dr. Marsha Linehan in the 1980s as a psychological intervention for persons with a history of multiple suicide attempts who were very sensitive to criticism and emotionally dysregulated. DBT combined principles and practices of behavior therapy with philosophies and therapeutic strategies designed to balance both acceptance of the client and efforts toward change in therapy simultaneously. The core elements of DBT, as described by Linehan and colleagues, include:

(1) a biosocial theory of disorder that emphasizes transactions between biological disposition and learning; (2) a developmental framework of stages of treatment; (3) a hierarchical prioritizing of treatment targets within each stage; (4) delineation of the functions that treatment must serve, and treatment modes to fulfill those functions; and (5) sets of acceptance strategies, change strategies, and dialectical strategies. (Robins, Schmidt, & Linehan, 2004, pp. 31–32)

Dr. Andrew Bein, in this pioneering new book, has taken DBT to another level of innovation, in what he terms dialectical behavior therapy for wellness and recovery (DBT-WR). Dr. Bein’s innovation, in this richly detailed and highly practical volume, is to develop a DBT-informed approach that draws from his extensive clinical practice experience, rigorous DBT training, and his own extensive training and practice in mindfulness meditation. DBT-WR, as so clearly described in this volume, has been developed so as to be appropriate for application in community mental health, private practice, residential day treatment, and high school settings, and particularly for persons having substance abuse histories and dual diagnoses.

Dr. Bein’s approach in DBT-WR reflects not only his deep appreciation of relevant clinical science and his clinical practice experience, but also draws extensively from his own long-term meditation practice and review of recent neuroscientific studies of meditation, particularly mindfulness meditation.

Meditation has been attracting an increasing number of persons in recent years, witnessed by the number of books, magazines, and websites concerned with meditation. Various clinical interventions involving meditation practices have been taught within such contexts as hospitals, clinics, and schools. Over the past few decades, there has been a dramatically increasing number of published cognitive, affective, and neuroscientific studies of meditation practice and meditation-derived clinical interventions, and in the funding of such studies by governmental and private sources. Research within this growing domain, now being referred to as “contemplative science,” has frequently focused on attention, memory, emotion response, and emotion regulation, in both long-term and short-term practitioners of meditation such as Buddhist and other spiritual traditions, as well as in those provided brief training in the modern secular form referred to as mindfulness meditation. The results of this body of research, as pointed out by Dr. Bein in this volume, have particular relevance for how he has conceptualized and applied DBT-WR in his clinical practice and training of students.

In light of these societal, scientific, and clinical/educational developments, Dr. Bein’s new book seems particularly timely, filling a need for specific guidance being sought by clinicians who wish to bring the benefits of DBT- and mindfulness-informed therapies to a wide range of persons within mental health, substance abuse treatment, and educational settings. The clarity of Dr. Bein’s writing further enhances both the practical value and pure pleasure of reading this important contribution. It is my hope that it will be widely read, positively influencing both present and future generations of practitioners.

Alfred W. Kaszniak, PhD

Professor of Psychology, Neurology, and Psychiatry

University of Arizona

Preface

Nearly 25 years ago, Dr. Marsha Linehan forged a different way of working with clients combining traditions of Western psychology and Eastern thought. Her depth of wisdom and clarity of vision were compelling, as she fashioned the dialectical behavior therapy (DBT) approach. DBT addressed the change-acceptance paradox present in therapeutic endeavors and brilliantly integrated pragmatic and self-empowering skill-building for clients who were considered among some of the hardest to reach, those diagnosed with borderline personality disorder. The perfect storm of Dr. Linehan’s emergent interest in and practice of mindfulness; her depth of understanding the clientele and ways the clientele could work effectively within the therapeutic process; her commitment to empirical research; her unconventional style; and her deep, heartfelt connection to those who were suffering contributed to what DBT is today. In recent years, Dr. Linehan has revealed her own emotional struggles, and we wonder to what degree her past challenges contributed to her profound wisdom and passion as well as DBT’s evolution.

This book brings DBT to the different corners of the psychotherapy and counseling world—from the crisis residential program that usually works with clients from 1 to 3 months to the private practice office, where emotion regulation skills are on the plate along with other issues. It deals with the reality that, in many settings, people are either passing through quickly or experience barriers for traditional DBT engagement. Dr. Linehan developed her workbook based on clients who stayed in 2- to 3-hour DBT groups over the course of at least 1 year and had supplemental skills coaches (1993); present-day resources and support for therapy make these conditions rare.

Applying Dialectical Behavior Therapy

The approaches here are unique, pragmatic, and designed for the present-day realities of many mental health practitioners and their diverse clients. The model and activities capture the major principles of DBT; however, it is reconfigured enough to be a DBT-informed practice. The model and activities reflect my DBT training, mindfulness training, and direct practice and evaluation in the following settings: community mental health, substance abuse with women, dual diagnosis, private practice, high school mental health, and residential day treatment. The Chapter 6 lessons and activities have been used with groups and individuals, and the treatment approach integrates a wellness and recovery orientation, thus the treatment is referred to as dialectical behavior therapy for wellness and recovery (DBT-WR).

Competence With the Realities of Practice

The book’s discussion of interventions, guiding framework, and its precise client activities respond to practice environment and practitioner realities and offer the following elements.

Access to DBT for Diverse Clientele

Transdiagnostic clients benefit from DBT-WR. They do not need to receive the whole, traditional DBT package in order to reduce their emotional reactivity, enhance the skillfulness of their responses, and learn how to live more effectively and joyfully in the here and now. Use of this book will help clients gain access to DBT interventions in a manner similar to the way clients, across populations and settings, benefit from cognitive behavior therapy interventions.

Practice Model That Facilitates Client Integration of DBT

A simplified model is more memorable for clients—especially shorter term ones. This model starts with the client intention to practice Wise Mind and then focuses on acceptance and improving the moment as core strategies in order to deal with difficulty. Client self-compassion supports the entire endeavor. The complete model is pictorially represented (see Chapter 6), which is helpful for more visual learners. (The practitioner version of the model is found in Chapter 2.) Easily comprehended neuroscience explanations are offered that motivate and interest clients. One finding discussed in the book was how much providing neuroscience information helped clients feel like they were being respected for their intelligence.

Clear Activities Designed for Client Engagement

Fifteen practice lessons are clearly laid out in Chapter 6. Each lesson has a theme and activities reengage concepts from prior lessons because (a) it is important for clients to see and experience interconnections, for example, how mindfulness and acceptance helps someone come to terms with arising judgments; and (b) people may join open groups and interjection of earlier presented concepts helps them get “up to speed.” Suggestions are provided at the beginning of Chapter 6 on ways to implement the 15 lessons and permission is granted to practitioners to reproduce these materials for their clients or consumers.

Comprehensible, Applicable Tools for Clinicians

Practitioners, regardless of prior experience or training, understand the DBT-WR principles as presented. Relevant dialectical relationships (or paradoxes) are depicted and explained throughout. Although the book is describing theory and practices that are profound, meaningful, and effective, the language is direct and presumes no particular practitioner background with DBT or mindfulness. The mindfulness tools presented in the book yielded client benefit as per Kentucky Inventory of Mindfulness Scale scores (Richards & Sehr, 2011).

Respects Client Diversity, Aspirations, and Meaning Systems

DBT-WR grapples with the increasing expectation that mental health practitioners are accountable to mental health recovery principles. The book deals with the dilemma of how to flatten the practitioner–client hierarchy and not have DBT-WR work embody top-down, expert–nonexpert dynamics or reinforce stigma. Exploring the recovery paradigm, accounting for client ethnic/racial and cultural diversity, determining the relevance and use of motivational interviewing to spur engagement, and examining DBT-WR through a mental health recovery lens are unique and vital contributions.

Incorporates Substance Abuse and Dual Diagnosis Issues

The interface of clients struggling with emotion regulation challenges and substance abuse is addressed. The DBT tradition has language that is parallel to 12-step programs and clinicians can make useful connections and distinctions. The degree to which our clients have a dual diagnosis needs to be considered in DBT-WR and data is provided. This book helps clinicians understand similarities and differences regarding mental health and substance abuse recovery as well as their respective treatment implications.

Accounts for Trauma and Engages in Neuroscience Discussions With Clients

The implications of trauma for those receiving DBT-WR treatment is discussed. Many clients considered to have emotion regulation challenges have a history of trauma. This book accounts for issues such as validating people’s experiences without, necessarily, deeply processing them; attuning to and effectively addressing people’s activation or understimulation levels within sessions; engaging in related practices to help people learn to become grounded (e.g., cognitive-behavioral therapy and Trauma Resilience Model); and incorporating hopeful neuroscience discussions regarding neuroplasticity as well as fight–freeze–flight terminology for people struggling with posttraumatic stress disorder or other trauma-related effects.

Inclusive Spiritual Approaches

The DBT-WR model integrates bigger picture or spiritual practices that assist people’s emotion regulation and overall sense of wellness. The charge is that it is irresponsible to not account for and address this main source of hope, meaning, comfort, and well-being (see Hodge, 2005, for overview). DBT-WR directly opens possibilities for people to seek support from their higher power for emotion regulation, or to explore ways in which moving beyond their “small self” may be liberating. For people who are disabled, unemployed, or underemployed, reframing their “job”—in such terms as how they inspire the world through their courage and personal healing—can be powerful and comforting in times of despair, uncertainty, or boredom. Bigger picture strategies are inclusive of people on the spirituality spectrum from formally religious to nonreligious, humanist. The interface with 12-step spirituality is consistently examined.

Practitioner Use-of-Self

Finally, the practitioner’s use-of-self is investigated in Chapter 5. Some clinicians who had taken prior DBT workshops claimed that they never quite understood DBT until they were exposed to the use-of-self material in this book. This information is in service of clients who deserve to have practitioners who meaningfully integrate DBT-WR rather than approach it as a set of techniques. The material in this chapter is also in service of DBT-WR practitioners who find that embodiment and integration of mindfulness and radical acceptance, as well as their capacity to manifest a strong back and soft front (Bein, 2008) in the middle of uncertainty bring immeasurable reward, growth, and competence.

May this book be of benefit to you and your clients!

Chapter One

Applying Dialectical Behavior Therapy: Toward Access for Diverse Client Needs

Gifts of Dialectical Behavior Therapy

The tools and lessons of dialectical behavior therapy (DBT) may be seen as gifts for taking care of the self. Instead of suffering with a mind hijacked (Goleman, 1995) by emotional reactivity, pervasive and troublesome thoughts, and mood states, DBT clients learn to effectively deal with, cope with, and embrace life and arising moment-to-moment experience. There are two elements of DBT—a dialectic orientation and mindfulness—that are revolutionary in terms of a therapeutic method. We will briefly address these elements here but will explore them in more detail later.