By Charles R. Swenson MD, Marsha M. Linehan PhD ABPP
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Additional resources for DBT® Principles in Action: Acceptance, Change, and Dialectics
In DBT that is a dialectical strategy. To review: I had begun the session within the acceptance paradigm, had shifted to the change paradigm by pressing her about the diary card, had come back to acceptance as I listened to her angry response, was feeling stuck, and had shifted into a dialectical paradigm with a lemonade-out-of-lemons strategy, highlighting our opposition and looking for synthesis. This shift broke the 28 DBT PRINCIPLES IN ACTION logjam. ” and wondered how I could be a good therapist if I interrupted people.
Moving through the steps of pretreatment was a slow, halting, and torturous process. The pervasive invalidation she experienced from her environment had transformed into self-loathing. In Getting Started in Therapy 17 moments of uncertainty or ambiguity, in the relationship with the therapist and others, she anticipated the imminent recurrence of environmental invalidation. I oriented her to the problem from a skills deficit perspective. I explained that I could only assume that in the course of her life she had not been taught or encouraged to have a dream, to share that dream, and to set some goals in a relationship context like this current one.
If entering DBT were entering a swimming pool, there is no shallow end. Finally, the life-worth-living conversation is the best illustration to the patient that DBT is not primarily a “suicide-prevention” treatment, it is a treatment focused on building a life worth living. It is so much more motivating to strive toward something that results in a better life, than to aim only to reduce a variety of dysfunctional behaviors. If the patient succeeds in improving the quality of her life, the plan, the urge, and the idea to commit suicide becomes naturally less compelling and less necessary.