Dialectical Behavior Therapy in Clinical Practice

Second Edition
Applications across Disorders and Settings

Edited by Linda A. Dimeff, Shireen L. Rizvi, and Kelly Koerner
Foreword by Marsha M. Linehan

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December 4, 2020
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446 Pages
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This influential work has now been substantially revised with over 60% new material reflecting over a dozen years of research and clinical advances. Leading experts describe innovative ways to use dialectical behavior therapy (DBT) in a wide range of real-world clinical and community settings. The volume provides wise guidance on setting up, running, and evaluating a comprehensive DBT program. It also presents adaptations designed to meet the needs of particular client populations as time- and cost-effectively as possible. Vivid case examples illustrate diverse applications of DBT for helping adults, adolescents, and children reduce suicidal and self-harming behavior; overcome complex, multiple challenges; and build a life worth living.

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

“I am so pleased to see the second edition of this excellent work, which has been a much-tapped resource on my bookshelf over the years! The second edition shares all the excellent qualities of the first—it is theoretically sound, clinically relevant, engaging, and written by preeminent DBT clinicians and researchers. The book covers an even broader diversity of settings and client groups in which DBT is applied, thoroughly showcasing all that we have learned about the treatment in the last decade. Clinicians will find much of value, whether they are at the start of their DBT journey or have worked in the field for a while and want to review and update their programs and practices.”

—Michaela A. Swales, PhD, Consultant Clinical Psychologist and Professor in Clinical Psychology, North Wales Clinical Psychology Program, Bangor University, United Kingdom


“As application of DBT has expanded beyond its original clinical setting, it has moved into settings such as hospital units, residential programs, and the school classroom. This expertly edited second edition comprehensively addresses how DBT has evolved and how to ensure that implementation remains adherent to the treatment. The book builds on essential DBT concepts and applies them effectively to various contexts. This book is an indispensable contribution for therapists who want to develop a deeper understanding of the treatment and for graduate educators who want to teach a comprehensive DBT course.”

—Blaise Aguirre, MD, Medical Director, 3East DBT Continuum, McLean Hospital; Department of Psychiatry, Harvard Medical School


“DBT has earned a unique place in our clinical toolkits due to its rigorous scientific evidence base and its enthusiastic reception among clinicians, other health care decision makers, and clients and their families. This volume offers practical guidance on DBT, grounded in research and clinical experience. Chapters cover implementation issues, strategies for using DBT across diverse settings and populations, approaches for integrating pharmacological treatments and DBT, and training and supervision issues. This book is a 'must' for any clinician interested in DBT; instructors will find it to be a valuable text or supplemental reading for courses on psychotherapy and psychosocial treatment.”

—Joan Asarnow, PhD, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles


“Superbly edited by Dimeff, Rizvi, and Koerner, the second edition of this seminal work is a DBT tour de force. Building on the strong foundation of the first edition, the volume includes nine new chapters related to cutting-edge clinical delivery of DBT. The contributors are a veritable who’s who of DBT science, training, and clinical practice. Marsha Linehan has fundamentally revolutionized our understanding and treatment of suicidal risk, self-harm behaviors, and complex case presentations. This second edition is a worthy testament to Linehan's vision and genius and will prove to be an invaluable resource for students and providers of DBT around the world.”

—David A. Jobes, PhD, ABPP, Professor of Psychology and Director, Suicide Prevention Laboratory, The Catholic University of America

Table of Contents

Foreword, Marsha M. Linehan

I. Overview and Getting Started with DBT

1. Overview of DBT, Kelly Koerner, Linda A. Dimeff, & Shireen L. Rizvi

2. Adopt or Adapt?: Fidelity Matters, Kelly Koerner, Linda A. Dimeff, Charles R. Swenson, & Shireen L. Rizvi

3. Evaluating Your DBT Program, Shireen L. Rizvi, Maria Monroe-DeVita, & Linda A. Dimeff

II. Applications across Settings

4. Implementing Standard DBT in an Outpatient Setting, Linda A. Dimeff, Kim Skerven, Andrew White, Shelley McMain, Katherine Anne Comtois, Cedar R. Koons, Soonie A. Kim, Sharon Y. Manning, & Elisabeth Bellows

5. DBT in Milieu-Based Programs, Charles R. Swenson, Suzanne Witterholt, & Juliet Nelson

6. Applications of DBT in a School-Based Setting, Elizabeth T. Dexter-Mazza, James J. Mazza, Alec L. Miller, Kelly Graling, Elizabeth Courtney-Seidler, & Dawn Catucci

7. DBT in University Counseling Centers, Jacqueline Pistorello & Carla D. Chugani sample

8. DBT in Juvenile Justice Programs, Debra M. Bond, Jesse Homan, & Bradley Beach

9. Comprehensive DBT Forensic and Correctional Programs: Orchids, Not Dandelions, Robin A. McCann & Elissa M. Ball

III. Applications across Populations

10. DBT—Accepting the Challenges of Employment and Self-Sufficiency, Katherine Anne Comtois, Lynn Elwood, Jenna Melman, & Adam Carmel

11. DBT for Individuals with Borderline Personality Disorder and Substance Use Disorders, Linda A. Dimeff, Shelley McMain, Jennifer H. R. Sayrs, Chelsey Wilks, & Marsha M. Linehan

12. Treating Posttraumatic Stress Disorder during DBT: Applying the Principles and Procedures of the DBT Prolonged Exposure Protocol, Melanie S. Harned & Sara C. Schmidt

13. DBT and Eating Disorders, Lucene Wisniewski & Debra L. Safer

14. DBT beyond Stage 1: An Overview of Stages 2, 3, and 4, Cedar R. Koons

15. An Overview of DBT for Preadolescent Children: Addressing Primary Treatment Targets, Francheska Perepletchikova & Donald Nathanson

16. DBT for Adolescents, Alec J. Miller, Jill H. Rathus, Elizabeth T. Dexter-Mazza, Chad S. Brice, & Kelly Graling

17. DBT with Families, Alan E. Fruzzetti, Luciana G. Payne, & Perry D. Hoffman

IV. Special Topics

18. Training and Supervision in Outpatient DBT Programs, Jesse Homan, Jennifer H. R. Sayrs, & Travis L. Osborne

19. Pharmacotherapy Guidelines for Treating Stage 1 DBT Patients, Elisabeth P. Bellows, W. Maxwell Burns, & Chelsy R. Wilks


About the Editors

Linda A. Dimeff, PhD, is Chief Scientific Officer at Jaspr Health (www.jasprhealth.com), 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 dialectical behavior therapy (DBT) for individuals with substance use disorders and 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. She has received over 20 federal grants to facilitate the dissemination of evidence-based therapies and has published over 55 peer-reviewed publications.

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 DBT for the treatment of complex and severe problems. 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. Dr. Rizvi is a recipient of the Spotlight on a Mentor Award from the Association for Behavioral and Cognitive Therapies and the Presidential Fellowship for Teaching Excellence from Rutgers.

Kelly Koerner, PhD, is CEO of Jaspr Health (www.jasprhealth.com) and Clinical Faculty in the Department of Psychology at the University of Washington. Weaving together science, design, and social entrepreneurship, she develops highly collaborative, technology-based solutions to get evidence-based practices (EBPs) to the right point of care. Dr. Koerner has extensive practical experience in supporting individuals and systems as they learn, implement, and sustain EBPs in diverse settings (e.g., from paraprofessionals in juvenile justice facilities, to master’s-level counselors in community mental health and substance abuse treatment centers, to research therapists in academic clinical trials). Most recently, she and her human-centered design team have worked closely with scientists, people with lived experience, and emergency medicine providers to develop a tablet-based application for suicidal people. She maintains an active research program and is a recipient of the Career Achievement Award from the Dissemination and Implementation Science Special Interest Group of the Association for Behavioral and Cognitive Therapies.

Contributors

Sarah Adler, PsyD, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California

Elissa M. Ball, MD, School of Medicine, University of Colorado Health Sciences Center, Denver, Colorado

Brad Beach, BA, Brad Beach DBT, Los Angeles, California

Elisabeth Bellows, MD, private practice, Redwood City, California

Debra M. Bond, PhD, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut

Chad S. Brice, PhD, Cognitive and Behavioral Consultants, LLP, White Plains, New York

W. Maxwell Burns, MD, private practice, Pacifica, California

Adam Carmel, PhD, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington

Dawn Catucci, MSEd, LMHC, Mental Health Counseling for Emotional Well-Being, PLLC, Pleasantville, New York

Carla D. Chugani, PhD, LPC, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Katherine Anne Comtois, PhD, MPH, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington

Elizabeth Courtney-Seidler, PhD, Cognitive and Behavioral Therapies of Ridgefield, PLLC, Ridgefield, Connecticut

Elizabeth T. Dexter-Mazza, PsyD, Mazza Consulting and Psychological Services, PLLC, Seattle, Washington

Linda A. Dimeff, PhD, Jaspr Health, Seattle, Washington; and Portland DBT Institute, Portland, Oregon

Lynn Elwood, LMHC, Greenlake Therapy Group, Seattle, Washington

Alan E. Fruzzetti, PhD, McLean Hospital and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts

Kelly Graling, PhD, Cognitive and Behavioral Consultants, LLP, White Plains, New York

Melanie S. Harned, PhD, ABPP, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington

Perry D. Hoffman, PhD (deceased), National Education Alliance for Borderline Personality Disorder, Mamaroneck, New York

Jesse Homan, PhD, LPC, private practice, Cincinnati, Ohio

Soonie A. Kim, PhD, private practice, Portland, Oregon

Kelly Koerner, PhD, Jaspr Health, Seattle, Washington

Cedar R. Koons, MSW, LCSW, private practice, Dixon, New Mexico

Marsha M. Linehan, PhD, ABPP, Department of Psychology, University of Washington, Seattle, Washington

Shari Y. Manning, PhD, Treatment Implementation Collaborative, Hilton Head, South Carolina

Caitlin Martin-Wagar, PhD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut

James J. Mazza, PhD, School Psychology Program, University of Washington, Seattle, Washington

Robin McCann, PhD, private practice, Colorado Springs, Colorado

Shelley McMain, PhD, Borderline Personality Disorder Clinic, Centre for Addiction and Mental Health Treatment (CAMH), Toronto, Ontario, Canada

Jenna Melman, MSW, LICSW, Greenlake Therapy Group, Seattle, Washington

Alec L. Miller, PsyD, Cognitive and Behavioral Consultants, LLP, White Plains, New York

Maria Monroe-DeVita, PhD, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington

Donald Nathanson, MSW, LCSW-R, private practice, White Plains, New York

Juliet Nelson, PhD, DBT Center of Lawrence, Lawrence, Kansas

Travis L. Osborne, PhD, ABPP, Evidence Based Treatment Centers of Seattle, Seattle, Washington

Luciana G. Payne, PhD, McLean Hospital and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts

Francheska Perepletchikova, PhD, Department of Psychiatry, NewYork–Presbyterian Westchester Behavioral Health Center, White Plains, New York

Jacqueline Pistorello, PhD, Counseling Services, University of Nevada, Reno, Reno, Nevada

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

Shireen L. Rizvi, PhD, ABPP, Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey

Debra L. Safer, MD, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, California

Jennifer H. R. Sayrs, PhD, ABPP, Evidence Based Treatment Centers of Seattle, Seattle, Washington

Sara C. Schmidt, PhD, Behavioral Tech, LLC, Seattle, Washington

Kim Skerven, PhD, Center for Behavioral Medicine, Milwaukee, Wisconsin

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

Andrew White, PhD, Portland DBT Institute, Portland, Oregon

Chelsey R. Wilks, PhD, Department of Psychology, Harvard University, Cambridge, Massachusetts

Lucene Wisniewski, PhD, private practice, Shaker Heights, Ohio

Suzanne Witterholt, MD, Allina Health, Minneapolis, Minnesota

Audience

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

Course Use

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

Doing Dialectical Behavior Therapy: A Practical Guide and Dialectical Behavior Therapy in Clinical Practice: Second Edition: Applications across Disorders and SettingsSpecial package offer: Doing Dialectical Behavior Therapy: A Practical Guide, by Kelly Koerner, offers therapists an accessible introduction to DBT. Dialectical Behavior Therapy in Clinical Practice, Second Edition: Applications across Disorders and Settings, edited by Linda A. Dimeff, Shireen L. Rizvi, and Kelly Koerner, provides wise guidance on setting up, running, and evaluating an effective DBT program.

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Previous editions published by Guilford:

First Edition, © 2007
ISBN: 9781572309746
New to this edition: