Week 8- Personality Disorders Flashcards
What are characteristics of clients with chronic difficulties?
- RIGIDITY OF INGRAINED WAYS OF BEING
• AVOIDANCE of thoughts, feelings and experiences
• INTERPERSONAL DIFFICULTIES
• EMOTION DYSREGULATION, including emotional vulnerability and emotional regulation difficulties
• SELF-CONCEPT UNDERDEVELOPED, problematic
What is DBT?
- broad-based CBT (combines CBT with mindfulness)
- developed specifically for individuals struggling with suicidal behaviours, namely BPD
- can be used for other problems where emotion dysregulation is a major feature
- highly structured and focused on therapeutic rs
- targets four areas of instability: emotional, behavioural, interpersonal and self- dysregulation
How is DBT multi-modal?
- Outpatient individual psychotherapy
- Outpatient group skills training
- Telephone consultation
- Therapists consultation meeting
What are the functions of DBT?
- enhances client capabilities
- improves client motivation to change
- ensures new skills generalise to natural environment
- structures environment to support client and therapist capabilities
- enhances therapist capabilities and motivation to treat client’s effectively
What are DBT treatment targets?
- decreasing life threatening behaviours and suicidal behaviours including self harming behaviours
- decreasing behaviours that interfere treatment particularly non-compliance
- decreasing behaviours that have a severe effect on quality of life
- increasing behavioural skills
- resolving post traumatic stress responses
- enhancing self-respect
- resolving problems in living
- enhancing the capacity for joy
What are some examples of therapy interfering behaviours?
• Non collaborative behaviours (e.g. crying non stop)
• Non compliance (e.g. not doing diary card, not following treatment
recommendations)
• Non attendance (e.g. not showing for apts)
• Behaviours that interfere with other clients
• Behaviours that burn out the therapist
• Behaviours that push therapists’ limits
• Behaviours reducing therapists motivation to treat
What is the overarching goal of DBT?
- a life worth living
What is the meaning of dialectics?
- finding the middle path
- don’t compromise
- getting your behaviour to change whilst accepting who you are
What is the dialectical focus of the therapist?
- acceptance with change
- flexibility with stability
- nurturing with challenging
- focus on capabilities with a focus on limitations and deficits
What is Linehan’s (1993) model?
- CHILDHOOD: emotion regulation dysfunction, invalidating environment
- CORE PROCESS: Emotional vulnerability (affective instability)
leads to… - BORDERLINE PATTERNS: behavioural instability, interpersonal instability, self instability, cognitive instability
What are the DBT assumptions about therapy?
- most caring thing a therapist can do is help client change in a way that brings them closer to their own ultimate goals
- clarity, precision and compassion are utmost importance in conduct of DBT
- principles of behaviour are universal
- DBT therapists can fail
- DBT can fail even when therapists do not
- therapists treating BPD clients need support
Why do we validate in DBT?
- needed to balance change strategies
- to teach the client to validate themselves (i.e. to help them trust themselves)
- validation can be used to calm a client who is too emotionally aroused to talk about anything else
- validation can be used to repair therapeutic errors
- validation can be a strategy to learn about the client’s current experiences
What is the purpose of mindfulness and give an example
- to learn to be in control of your mind instead of letting your mind control you
(OBSERVE; DESCRIBE, PARTICIPATE; NON - JUDGMENTAL STANCE - DON’T JUDGE IT AS GOOD OR BAD; ONE MINDFULLY)
E.G. balance between reasonable mind, emotion mind to make WISE MIND
What is the purpose of distress tolerance in DBT and give an example?
- crisis survival skills which are used to learn to tolerate painful emotional events that cannot be changed or made better right away
eg. distract wise mind ACCEPTS: Activities, Contribution, Comparison, Emotions, Thoughts, Sensations; Self-Soothe with 5 senses; Pros and cons - next part is radical acceptance –> observe the breath, half smile and radical acceptance
What is the purpose of emotion regulation skills in DBT and give an example?
- skills for understand emotions, reducing emotional vulnerability and decreasing emotional suffering
- include lots of
e. g. PLEASE Master –> Physical illness, eating, avoid alcohol, get enough sleep, balanced exercise, BUILD Mastery
