Advanced Clinical Skills in Dialectical Behaviour Therapy
Run by School of Human and Behavioural Sciences
20.000 Credits or 10.000 ECTS Credits
Semester 1 & 2
Organiser: Prof Michaela Swales
Overall aims and purpose
This module builds on skills learnt in PHP 4200, Theories & Principles of DBT and PHP 4201, Clinical Applications of DBT. Students will develop more advanced skills in applying the principles of Dialectical Behaviour Therapy to Individual Cases and in using their DBT Consultation Team to maximum benefit in intervening with individual clients. Students will receive more in-depth teaching in problem-solving and the common problems and errors that impede its effectiveness and in skills and strategies to enhance the functioning of their Consultation Team. As part of the module students will be required to source and attend 10 hours of clinical supervision that will be based on at least a further 10 hours of live clinical material submitted to the supervisor in audio or video format. The supervisor will be subject to course approval.
The course content reviews in more extensive detail the core change-based and acceptance-based strategies of DBT using clinical case material brought to the course lectures. Students will work with their own and each others material to identify skills and deficits in their case conceptualisations and practical execution of DBT in clinical practice. Students will also review the functioning of their DBT Consultation Team and how they can more effectively use the team to improve their clinical skills and outcomes. Outside of formal teaching students will practice applying their new skills learnt in the classroom to their clinical work and will receive feedback on their progress from a clinical supervisor who will review audio or video tapes of sessions to shape the students clinical skills.
Case studies at this level demonstrate competence and accuracy within the targeting of clinical problems. Behavioural and solution analyses are accurate and show a degree of creativity in breadth in the selection and application of solutions. The student demonstrates the capacity to critically evaluate their work and the impact that they have had from others in supervision on their work. Alternative course of action to address problems are explored and commented upon.
Case studies at this level demonstrate an exceptional level of skill and competence in their conceptualisation of the client's difficulties. In addition to highly accurate targeting and behavioural and solution analyses the student has utilized a wide range of strategies demonstrating a command of the therapy. Critical appraisal indicates that the student has a thorough knowledge of the treatment and its application.
For two assessments in this module, the live work sample (DVD) and supervision log, the student can only pass or fail. For the live work sample the clinical session will be rated using the DBT Global Adherence scale. The student must demonstrate a 4.0 or above on this scale to pass this assessment. For the supervision log students can only pass of fail. Students actively participating (bringing live samples of work for review to the supervisor) in the requisite number of supervision hours will pass this component. For the case study that accompanies the DVD the student at this level will demonstrate competence in targeting clinical problems and in conducting behavioral and solution analyses. Minor errors may be evident in these procedures but not such as to adversely affect the clinical outcome of the case. A degree of reflection and critical appraisal is evident and evidence of appropriate use of supervision - both individual and peer is evident.
- Demonstrate skills in the clinical execution of DBT in clinical sessions with clients using the full range of DBT strategies.
2 Demonstrate the capacity to formulate a clinical case using the principles of DBT, including accurate targeting of clinical problems and comprehensive behavioural chain and solution analyses.
4 Critically appraise their clinical work, evaluating its strengths and weaknesses
- Critically evaluate how their clinical intervention was impacted by both the DBT Consultation Team and individual supervision.
Teaching and Learning Strategy
Teaching on the common problems and errors in targeting clinical problems and in participating and using the DBT Consultation Team along with solutions will be reviewed. Students will bring to the seminars their own clinical material and they will work on both their own and the material of other students to apply the learning from the didactic portion of the seminar to their clinical work. Teaching will be delivered in two 2-day residential blocks or via virtual workshops.
Preparation for individual therapy sessions based on the new teaching and on the learning from supervision. Reading relevant texts and attending DBT Consultation Team.
Students will attend a minimum of 10 hours of clinical supervision that will be based on their submission to the supervisor of a further 10 hours of individual therapy that they have conducted in the format of DVD or audio recordings.
- Literacy - Proficiency in reading and writing through a variety of media
- Self-Management - Able to work unsupervised in an efficient, punctual and structured manner. To examine the outcomes of tasks and events, and judge levels of quality and importance
- Exploring - Able to investigate, research and consider alternatives
- Inter-personal - Able to question, actively listen, examine given answers and interact sensitevely with others
- Critical analysis & Problem Solving - Able to deconstruct and analyse problems or complex situations. To find solutions to problems through analyses and exploration of all possibilities using appropriate methods, rescources and creativity.
- Teamwork - Able to constructively cooperate with others on a common task, and/or be part of a day-to-day working team
- Caring - Showing concern for others; caring for children, people with disabilities and/or the elderly
- Self-awareness & Reflectivity - Having an awareness of your own strengths, weaknesses, aims and objectives. Able to regularly review, evaluate and reflect upon the performance of yourself and others
Subject specific skills
- Apply multiple perspectives to psychological issues and integrate ideas and findings across the multiple perspectives in psychology.
- Communicate psychological concepts effectively in written form.
- Communicate psychological concepts effectively in oral form.
- Retrieve and organise information effectively.
- Engage in effective teamwork for the purpose of collaborating on psychological projects.
- Be sensitive and react appropriately to contextual and interpersonal psychological factors.
- Use effectively personal planning and project management skills.
- Work effectively under pressure (time pressure, limited resources, etc) as independent and pragmatic learners.
- Problem-solve by clarifying questions, considering alternative solutions, making critical judgements, and evaluating outcomes.
- Reason scientifically and demonstrate the relationship between theory and evidence.
Resource implications for students
Payment of external experts in DBT for the marking of the live work samples. An additional charge for this module will need to be added for this aspect of the module. Rating of a tape and producing feedback for a therapist would typically cost £125. This could be an additional module fee. Given that the inclusion of this assignment will give exemption from submitting tapes to the professional body accrediting DBT therapists students will tolerate this higher fee. Students will need to fund their accommodation at the residential blocks when teaching is face-to-face: although for many this may be covered by their employer. They will also need to fund their clinical supervision sessions themselves or seek support from their employer. The additional payments for this module will be clearly described to students signing up for the course in all publicity material and on webpages. Before submitting an application students will be asked to confirm that they understand the fee structure for the programme.
Talis Reading listhttp://readinglists.bangor.ac.uk/modules/php-4202.html
Chapman, A. & Farmer (2016). Behavioral interventions in cognitive behavioral treatment. American Psychological Association
Chapman, A & Rozenthal, Z. (2015). Managing therapy-interfering behaviors: Strategies from dialectical behavior therapy. American Psychological Association.
Heard, H.L. & Swales, M.A. (2015). Changing behavior in DBT: Problem-solving in Action. New York: Guilford Press.
Koerner, K. (2012). Doing DBT: A practical guide. New York: Guilford
Swenson C. (2016). DBT Principles in Action. New York: Guilford Press