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“In her elegantly delivered treatise, Rizvi unpacks the central structural element of DBT individual therapy. With concise, engaging writing, Rizvi highlights the behavior therapy core of DBT and the foundational nature of good assessment. With clarity and precision, she discusses essentials of targeting, illustrates how to examine the function of problem behaviors, and details solution analysis using the various DBT change strategies. She addresses such subtleties as differences between first and repeated chaining of a behavior; chaining urges or the absence of effective behaviors; and differences between micro and macro chains. Through frequent disclosure of her own case experiences and highly instructive client dialogues, and through modeling expert therapist assessment and interventions, Rizvi’s indispensable volume positions the clinician for success.”

—Jill H. Rathus, PhD, Department of Psychology, Long Island University Post; Cognitive Behavioral Associates, Great Neck, New York


“Rizvi's cogent clinical examples not only vividly teach DBT's key assessment concepts, but also, importantly, model the clinical decision making essential to helping clients with complex problems. This book facilitates the kind of learning that is typically available only through expert supervision. A 'must have' for training clinics.”

—Kelly Koerner, PhD, Evidence-Based Practice Institute, Seattle, Washington


“Rizvi discusses an often overlooked but crucial ingredient of any effective intervention—assessment. This is not categorical diagnosis in the DSM tradition, but a thoroughgoing functional analysis of the controlling variables of the patient's problems. Rizvi’s substantial clinical and research experience and her compelling, personal writing style make this book an essential source for graduate students, academics, clinical supervisors, and practitioners. The kind of functional analysis intrinsic to DBT is relevant to any cognitive-behavioral intervention.”

—Gerald C. Davison, PhD, Department of Psychology, University of Southern California


“Chain analysis is the cornerstone of DBT, as successful treatment depends on accurate assessment of the problem. Through extensive clinical examples, this book richly illustrates the importance of chains as well as strategies for making them effective and engaging. For clients with PTSD, chain analysis will help to identify the factors that are maintaining PTSD as well as the potential role of PTSD as a controlling variable for other problem behaviors. Rizvi’s expert tips will be invaluable to both new and seasoned DBT clinicians seeking to master this crucial DBT strategy.”

—Melanie Harned, PhD, ABPP, VA Puget Sound Health Care System and Department of Psychiatry and Behavioral Sciences, University of Washington


“This masterful book tells us why and how to use chain analysis in optimal and suboptimal clinical conditions. Rizvi's incisive instructions are beautifully illustrated with vivid, realistic dialogues from therapy sessions. While chains are typically used to assess overt dysfunctional behaviors, Rizvi makes it perfectly clear how to apply them to covert behaviors such as problematic thoughts and action urges. The book offers a sophisticated explanation of how to pivot back and forth between chain analysis and other DBT strategies. Simply put, this book provides the most comprehensive and practical handling of chain analysis available, and should be standard reading for DBT therapists.”

—Charles R. Swenson, MD, Department of Psychiatry, University of Massachusetts Medical School

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Table of Contents

1. The Basics of the Chain Analysis

2. Guidelines for Client Orientation and Collaboration for Chain Analyses

3. Getting to Know the Target Behavior: Assessing a Problem the First Time

4. Keeping the Client Engaged (and You Too!)

5. Incorporating Solutions into Chains

6. When a Behavior Isn’t Changing

7. Chains on Thoughts, Urges, and Missing Behaviors

8. Chain Analyses in Consultation Teams, Skills Training, and Phone Coaching

References

Index

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About the Author

Shireen L. Rizvi, PhD, ABPP, is Associate Professor of Clinical Psychology in the Graduate School of Applied and Professional Psychology at Rutgers, The State University of New Jersey. At Rutgers, she holds affiliate appointments in the Department of Psychology, School of Arts and Sciences, and the Department of Psychiatry, Robert Wood Johnson Medical School. Her research interests include improving outcomes, training, and dissemination of dialectical behavior therapy (DBT) for the treatment of complex and severe problems. Dr. Rizvi is board certified in Behavioral and Cognitive Psychology and in Dialectical Behavior Therapy. She is past president of the International Society for the Improvement and Teaching of DBT and was the Society's Conference Program Chair for 2 years. She has trained hundreds of practitioners from around the world in DBT. Dr. Rizvi is a recipient of the Spotlight on a Mentor Award from the Association of Behavioral and Cognitive Therapies and the Presidential Fellowship for Teaching Excellence from Rutgers.

• All titles by Shireen L. Rizvi

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Audience

Clinical psychologists, psychiatrists, clinical social workers, mental health counselors, and psychiatric nurses.

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Course Use

May serve as a supplemental text in graduate-level courses.