Dialectical Behavior Therapy in Clinical Practice

Applications across Disorders and Settings

Edited by Linda A. Dimeff and Kelly Koerner
Foreword by Marsha M. Linehan

Hardcovere-bookprint + e-book
August 14, 2007
ISBN 9781572309746
Price: $56.00 $47.60
363 Pages
Size: 7" x 10"
March 1, 2011
ePub ?
Price: $56.00 $47.60
363 Pages
print + e-book
Hardcover + e-Book (ePub) ?
Price: $112.00 $61.60
363 Pages

First developed to treat suicidal individuals with borderline personality disorder, dialectical behavior therapy (DBT) has since been adapted to a range of settings and populations. This practical book—edited by close collaborators of DBT originator Marsha M. Linehan—presents applications for depression, substance dependence, eating disorders, psychosis, suicidal and assaultive behaviors, and other complex problems. Leading contributors, including Linehan herself, describe how to implement this evidence-based treatment with adults, adolescents, couples and families, and forensic clients. Issues in establishing and maintaining an effective DBT program are also addressed. Over a dozen reproducible worksheets and forms can be downloaded and printed in a convenient 8½" x 11" size.

See also Doing Dialectical Behavior Therapy: A Practical Guide, by Kelly Koerner, which demonstrates DBT techniques in detail.

“Each chapter is written by individuals who have extensive firsthand experience implementing and operating DBT successfully in the setting about which they are writing—and the experience shows.”

Psychiatric Services

“I like this book. It meets its stated design and purpose....Its first chapter offers a clear overview of DBT. More important, its second chapter is a gold mine of practical information about whether to adopt the full (and quite extensive) DBT protocol and components, or whether to adapt elements of the philosophy or components to one's particular setting or client population. The costs and benefits are clearly laid out and often tabled....Each chapter is consistent in its format and sections, and the book is formatted in an attractive and very readable style....The coeditors have made careers of consulting and training very widely across different populations and settings. Their own practical experience shows through not only in their own chapters but also in those of the other authors in this edited volume....The final chapter on evaluating your DBT program is also written in such a simple, practical, and user-friendly way that it goes a long way toward encouraging even the most research-averse clinician or administrator to evaluate his or her work as a clinical scientist. This is a text to be used by clinicians, administrators, and students alike. It does what it advertises in its title. It clearly and practically offers guidelines for applying dialectical behavior therapy in clinical practice as it is applied across a range of disorders and settings. Well done!”


“A pragmatic volume that discusses current advances in dialectical behavioral therapy and presents practical applications for a wide range of complex problems....An excellent resource for clinicians....It is an excellent introduction to the important advances in clinical practice.”

Bulletin of the Menninger Clinic

“The authors of this edited text make compelling arguments for the use of DBT across the many treatment settings. The text is easy to read and would be relevant to those practitioners unfamiliar with DBT as well as those who may already be quite conversant with the approach. Many of the chapters feature reproducible handouts for use with clients. Given the comprehensive nature of this text, it would be a useful addition to any counseling professional's library, and it is an absolute must for any practitioner interested in DBT or as a useful addition to an advanced counseling theories course....An invaluable reference for any practitioner who is interested in learning more about DBT.”

The Family Journal

“Endorsed by Marsha Linehan, this timely and very useful book is aimed explicitly at current or aspiring DBT practitioners seeking to adopt or adapt the approach for working with various diagnostic groups in either hospital or community settings, including those working with people with substance use disorders. The editors, Linda Dimeff and Kelly Koerner, both experienced DBT consultants and practitioners, succeed in achieving their overarching goal of presenting a concise set of information about the applications of DBT that draws on the first-hand clinical experience of clinicians and programme directors to inform practitioners and highlight ways to avoid or, alternatively, to overcome creatively common pitfalls and problems....This book is highly recommended and is likely to find an appreciative audience among practitioners seeking to understand DBT and its clinical applications.”

Drug and Alcohol Review

“The well-organized nature of this book is immediately apparent....This is a well-written, practical book for clinicians seeking to expand their knowledge and use of DBT....This book will help to enrich the clinician's delivery of DBT with practical advice from authors with nearly two decades of experience....5 Stars!”

Doody's Review Service

“Learning DBT changed my life. DBT concepts and skills take my clinical work to a completely new level. I urge clinicians who are eager to learn more about DBT, and how to adapt it to their clinical setting, to read this book. Contributors are leading DBT practitioners and researchers, and their work in this volume expands and extends this amazing therapy.”

—Jacqueline B. Persons, PhD, Director, Oakland Cognitive Behavior Therapy Center

“This book is a great resource for anyone and everyone interested in using DBT. Written by accomplished clinician-researchers, it tackles situational pragmatics and the thorny issues of program fidelity. It is well organized, lucidly written, and easily digested. Students of cognitive-behavioral therapies will learn a great deal from this text, as will seasoned clinicians, including those thinking of starting a DBT program. Like DBT itself, the volume is thoughtful, provocative, and oriented toward real-world problem solving.”

—Robert L. Trestman, PhD, MD, Departments of Medicine and Psychiatry and Director, Center for Correctional Mental Health Services Research, University of Connecticut Health Center

“Dimeff and Koerner have assembled an excellent group of authors to translate DBT theory into real-word practice. Each chapter details the process for using DBT with specific populations and deals with the day-to-day issues confronting practitioners. This is an excellent text for graduate instructors who want to teach evidence-based practices to their students, as well as for clinicians who have longed for practical advice on how to start and maintain a successful DBT program. It is also an excellent guidebook for payors who need to understand what a DBT program should look like and how to assess its value.”

—George Smart, LICSW, Vice-President of Clinical Operations, Massachusetts Behavioral Health Partnership

“When I first heard Marsha Linehan speak on DBT, I felt that she had saved me 20 years of figuring things out on my own. This book leads the next wave, bringing the accumulated practical wisdom of several 'first adopters' of DBT who have successfully adapted this principle-based, flexible approach to unique settings and populations. Those wishing to develop services for patients with multiple problems can jump-start their fledgling programs and avoid common pitfalls, all the while staying true to the empirical base of the treatment.”

—Elizabeth B. Simpson, MD, Director, Dialectical Behavior Therapy Program, Massachusetts Mental Health Center

“DBT is one of the most important advances in clinical practice in the last two decades. What began as a specific intervention for borderline personality disorder is in the process of evolving into a major approach that can be applied to a wide range of patients across multiple settings. This book impressively demonstrates this evolution, providing a resource that will be of value to therapists and students alike. I highly recommend it.”

—Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University

Table of Contents

1. Overview of Dialectical Behavior Therapy, Kelly Koerner and Linda A. Dimeff

2. Adopt or Adapt?: Fidelity Matters, Kelly Koerner, Linda A. Dimeff, and Charles R. Swenson

3. Implementing Standard Dialectical Behavior Therapy in an Outpatient Setting, Kathryn A. Comtois, Cedar R. Koons, Soonie A. Kim, Sharon Y. Manning, Elisabeth Bellows, and Linda A. Dimeff

4. Dialectical Behavior Therapy on Inpatient Units, Charles R. Swenson, Suzanne Witterholt, and Martin Bohus

5. Implementing Dialectical Behavior Therapy in Residential Forensic Settings with Adults and Juveniles, Robin A. McCann, André Ivanoff, Henry Schmidt, and Bradley Beach

6. Dialectical Behavior Therapy for Individuals with Borderline Personality Disorder and Substance Dependence, Shelley McMain, Jennifer Sayrs, Linda A. Dimeff, and Marsha M. Linehan

7. Dialectical Behavior Therapy and Eating Disorders, Lucene Wisniewski, Debra Safer, and Eunice Chen

8. Dialectical Behavior Therapy with Families, Alan E. Fruzzetti, Daniel A. Santisteban, and Perry D. Hoffman

9. Dialectical Behavior Therapy for Adolescents, Alec L. Miller, Jill H. Rathus, Anthony P. DuBose, Elizabeth T. Dexter-Mazza, and Arielle R. Goldklang

10. Dialectical Behavior Therapy for Depression with Comorbid Personality Disorder: An Extension of Standard Dialectical Behavior Therapy with a Special Emphasis on the Treatment of Older Adults, Thomas R. Lynch and Jennifer S. Cheavens

11. Dialectical Behavior Therapy for Assertive Community Treatment Teams, Sarah K. Reynolds, Randy Wolbert, Gwen Abney-Cunningham, and Kimberly Patterson

12. Evaluating Your Dialectical Behavior Therapy Program, Shireen L. Rizvi, Maria Monroe-DeVita, and Linda A. Dimeff

About the Editors

Linda A. Dimeff, PhD, is Chief Scientific Officer at Evidence-Based Practice Institute, Inc.; Institute Director at Portland DBT Institute; and Clinical Faculty in the Department of Psychology at the University of Washington. Since 1994, Dr. Dimeff has collaborated closely with Marsha M. Linehan to develop and evaluate an adaptation of DBT for substance-dependent individuals with borderline personality disorder; to produce DBT training materials for clinicians; and to train, consult, and supervise clinicians in their practice of DBT. She has worked with public and private sector systems throughout the world in their efforts to implement DBT. Dr. Dimeff is a recipient of the Cindy J. Sanderson Outstanding Educator Award from the International Society for the Improvement and Teaching of DBT.

Kelly Koerner, PhD, is a clinical psychologist and an expert clinician, clinical supervisor, and trainer in DBT. She is Creative Director of the Evidence-Based Practice Institute, which provides online communities and continuing education for practitioners who strive to combine science and compassion in their work. Dr. Koerner has served as Director of Training for Marsha Linehan’s research investigating the efficacy of DBT for suicidal and drug-abusing individuals with borderline personality disorder, Creative Director for Behavioral Tech Research, Inc., and cofounder and first CEO of Behavioral Tech, LLC, a company that provides training in DBT. She is on the clinical faculty in the Department of Psychology at the University of Washington and maintains a consulting and psychotherapy practice in Seattle.


Gwen Abney-Cunningham, LMSW, Interact of Michigan, Kalamazoo, Michigan

Bradley Beach, BA, Echo Glen Children's Center, Snoqualmie, Washington

Elisabeth Bellows, MD, Behavioral Medicine Clinic of the Peninsula, Redwood City, California

Martin Bohus, MD, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany

Jennifer S. Cheavens, PhD, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina

Eunice Chen, PhD, Department of Psychiatry, University of Chicago Medical Hospitals, Chicago, Illinois

Kathryn A. Comtois, PhD, Harborview Medical Center, Seattle, Washington

Elizabeth T. Dexter-Mazza, PsyD, Department of Psychology, University of Washington, Seattle, Washington

Anthony P. DuBose, PsyD, Dialectical Behavior Therapy Center of Seattle, Seattle, Washington

Linda A. Dimeff, PhD, Behavioral Tech Research, Inc., Seattle, Washington

Alan E. Fruzzetti, PhD, Department of Psychology, University of Nevada-Reno, Reno, Nevada

Arielle R. Goldklang, PsyD, Cognitive and Behavioral Consultants of Westchester, LLC, White Plains, New York

Perry D. Hoffman, PhD, National Education Alliance for Borderline Personality Disorder, Rye, New York

André Ivanoff, PhD, Columbia University School of Social Work, New York, New York

Soonie A. Kim, PhD, Portland DBT Program, Portland, Oregon

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

Cedar R. Koons, MSW, LISW, Santa Fe DBT Consultation, Santa Fe, New Mexico

Marsha Linehan, PhD, Department of Psychology, University of Washington, Seattle, Washington

Thomas R. Lynch, PhD, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, and Department of Psychology and Neurosciences, Duke University, Durham, North Carolina

Sharon Y. Manning, PhD, Behavioral Tech, LLC, Behavioral Tech Research, Inc., Chapin, South Carolina

Robin A. McCann, PhD, Colorado Mental Health Institute, Pueblo, Colorado

Shelley McMain, PhD, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Alec L. Miller, PsyD, Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York

Maria Monroe-DeVita, PhD, The Washington Institute for Mental Illness Research and Training, University of Washington, Seattle, Washington

Kimberly Patterson, MSW, Allegheny HealthChoices, Inc., Pittsburgh, Pennsylvania

Jill H. Rathus, PhD, Department of Psychology, Long Island University, Brookville, New York

Sarah K. Reynolds, PhD, Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Shireen L. Rizvi, PhD, Department of Psychology, New School for Social Research, New York, New York

Debra Safer, MD, Department of Psychiatry, Stanford University Medical Center, Stanford, California

Daniel A. Santisteban, PhD, Center for Family Studies, University of Miami, Miami, Florida

Jennifer Sayrs, PhD, Dialectical Behavior Therapy Center of Seattle, Seattle, Washington

Henry Schmidt, PhD, Washington State Juvenile Rehabilitation Administration, Olympia, Washington

Charles R. Swenson, MD, Department of Psychiatry, University of Massachusetts Medical School, and private practice, Northampton, Massachusetts

Lucene Wisniewski, PhD, Cleveland Center for Eating Disorders, Beachwood, Ohio

Suzanne Witterholt, MD, Anoka-Metro Regional Treatment Center, Anoka, Minnesota

Randy Wolbert, MSW, Interact of Michigan and Western Michigan University School of Social Work, Kalamazoo, Michigan


Psychotherapists in a range of settings, including clinical psychologists, psychiatrists, and clinical social workers, as well as advanced students in these areas.

Course Use

May serve as a text in graduate-level courses and clinical practica.