Clinical Applications of DBT
Run by School of Psychology
30 Credits or 15 ECTS Credits
Semester 1 & 2
Organiser: Prof Michaela Swales
Overall aims and purpose
This module follows on from the principles taught in ‘Theory and Principles of DBT’ during which the structure of the treatment is outlined. Participants, as part of a clinical team, develop a DBT programme within their own setting according to the structure as outlined. This process requires identification of a target population, constructing a programmatic target hierarchy, identifying modalities of treatment to fulfil the five functions of a comprehensive DBT programme, organising and delivering at least one of these modalities in clinical practice and participating in the preparation of a presentation about the developed programme. Students will work in their clinical team to develop and deliver a DBT programme. Students will also learn principles of consulting to mental health practitioners seeking to deliver DBT by observing presentations of other students work and the feedback provided by course tutors. Students will also reflect and modify their own programme in the light of feedback from the course team.
Students will further develop skills in conceptualising clinical cases within a DBT framework. This will encompass the identification of a treatment hierarchy in behavioural terms, the capacity to conduct behavioural and solution analyses of target behaviours on both clients and themselves and to identify opportunities to increase the effectiveness of solutions.
The case presentation is a competent demonstration of the application of a DBT conceptualisation to clients’ problems. Comprehension of the biosocial theory is evident and organisation of presenting problems in a target hierarchy is clear and mostly accurate. The chain and solution analysis is comprehensive demonstrating a range of different solutions for problematic links in the chain. The evaluation of the treatment assesses the differential impact of solutions employed. There is evidence of consultation with the wider consultation team.
The chain and solution analysis is comprehensive demonstrating a range of different solutions for problematic links in the chain. The conceptualization is clear and mostly accurate and solutions are accurately matched to links. The evaluation demonstrates an understanding of the application of the principles of the treatment to the therapist.
The implementation log indicates participation in multiple modalities of the treatment (3 or more). The activities and learning points are well described. The reflection indicates that the candidate is thoughtful and accurate in their application of the principles of the treatment and where they may need to work on developing their skills. Candidates participating in only two modalities (e.g. Consultation Team and Skills Group would need to demonstrate very high level skills in their description of learning points and reflection to achieve this grade)
Case presentations at this level show excellence in their DBT conceptualisation of target problems and in the case as a whole. Answers demonstrate a detailed understanding of the application of the biosocial theory to clients’ difficulties and specify accurately clients’ presenting problems in the format of a behaviourally specified DBT target hierarchy. The chain and solution analysis is detailed and comprehensive using all four change procedures as appropriate and demonstrates a balance of acceptance and change procedures. The evaluation of the treatment assesses the differential impact of solutions used and presents numerical outcome data in addition to a narrative. Clear evidence of the input of the wider Consultation team is evident.
A (70%+) The chain and solution analysis is detailed and comprehensive using all four change procedures as appropriate and demonstrates a balance of acceptance and change procedures. The detail and accuracy of specification of links and selection of solutions demonstrates an excellent grasp of the problem-solving aspects of the treatment. The therapist demonstrates a thorough grasp of how to apply the treatment to him or herself.
The implementation log demonstrates active participation in multiple modalities of the treatment (3 or more). The activities are clearly described and learning points extracted. A wide range of activities is described. There is evidence that the candidate has extensive engagement in the delivery and learning of the therapy. The reflection on the learning points indicates a thorough understanding of the application of the principles of the treatment both in clinical practice and to the therapist and of areas for development.
The case presentation as a whole demonstrates an understanding of DBT principles as they apply to clients’ problems. There is evidence of understanding the relevance of the biosocial theory to clients’ problems. The target hierarchy is well specified although minor errors in behavioural specificity may be evident. The chain and solution analysis demonstrates moderately comprehensive coverage of problematic links and solutions. There is some indication of efforts to evaluate outcomes and of the involvement of the wider consultation team.
The chain and solution analysis demonstrates moderately comprehensive coverage of problematic links and solutions. There is some indication of efforts to evaluate outcomes of the solution analysis.
The chain and solution analysis demonstrates moderately comprehensive coverage of problematic links and solutions. There may be an occasional minor error in conceptualization or solution selection. There is some evidence of implementation and reflective evaluation of the application of the therapy to the therapist.
The implementation log shows participation in multiple modalities of the treatment (minimum 2). Activities and learning points are reasonably clearly described. Reflections indicate that the candidate has some grasp of the important issues in their learning and on areas for future development.
- Demonstrate use of the key principles in the implementation of a DBT programme.
- Conceptualise a clinical case according to DBT principles of behavioural targeting and comprehensive behavioural and solution analyses. i. Apply the principles of behavioural targeting to clinical cases.
ii. Analyse targeted behaviours to identify problematic links in the chain contributing to the onset and maintenance of clinical problems.
iii. Develop comprehensive solution analyses, including skills, cognitive modification, exposure and contingency management, for targeted problems.
iv. Demonstrate a capacity to identify where alternative solutions could be utilised in the treatment of a clinical case.
- Analyse and modify their own behaviour using the principles of the treatment
|CASE STUDY||Case Report||
Written case presentation covering: brief background; stage of treatment; target hierarchy; sample behavioural and solution analysis; summary of treatment of controlling variables; input from Consultation Team; critical appraisal of progress in treatment (all modes).
|CASE STUDY||Written Behaviour & Solution Analysis||
Written behavioural and solution analysis of student's own therapy interfering behaviour
|LOGBOOK OR PORTFOLIO||Implementation Log||
Submisison on an implementation log outlining student's participation and reflective learning in all components of the DBT Programme
Teaching and Learning Strategy
Students work in their work-based learning teams to deliver a therapeutic programme to clients and use this work as the basis for their assignments for the module following detailed feedback on their early implementation efforts.
Throughout the residential or virtual 5 day seminar students present their work and receive consultation and feedback based on their work. Lectures are based on issues raised by students work.
Students are provided with extensive reading lists to enable preparation for the assignments as well as detailed formative feedback during the residential seminar.
- 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
- Information retrieval - Able to access different and multiple sources of information
- 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.
- Presentation - Able to clearly present information and explanations to an audience. Through the written or oral mode of communication accurately and concisely.
- 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.
- Be computer literate for the purpose of processing and disseminating psychological data and information.
- Retrieve and organise information effectively.
- Engage in effective teamwork for the purpose of collaborating on psychological projects.
- 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.
- Be aware of ethical principles and approval procedures.
Resource implications for students
Students must meet etc additional cost of accommodation, subsistence and travel for the 5 day residential seminar. Typically this cost is met by the employer who is supporting the learning. All potential students are aware of these costs before applying for the programme.
Chapman, A. L. & Rosenthal,M.Z. (2016) Managing Therapy-Interfering Behaviour: Strategies from DBT. Washington D.C.: American Psychological Association.
Dimeff, L. & Koerner, K. (2008) Clinical Applications of Dialectical Behaviour Therapy New York: Guilford Press Chapters 1-3.
Farmer, R.F. &Chapman, A.L. (2016). Behavioral interventions in cognitive behavioural therapy: Practical guidance for putting therapy into action. (2nd edition). Washington D.C. :American Psychological Association
Heard, L. & Swales, M. (2015). Changing Behaviour in DBT: Problem Solving in Action. New York: Guilford Press.
Linehan, M.M.(1993a). Cognitive-Behavioural Treatment of Borderline Personality Disorder New York: Guilford Press
Linehan, M. M. (1993). Skills Training Manual for Treating Borderline Personality Disorder New York: Guilford Press.
Pryor, K. (1999). Don’t Shoot the Dog: The New Art of Teaching and Training New York: Bantam Doubleday Dell Pub.
Swales, M.A. & Heard, H.L. (2017). Dialectical Behaviour Therapy: The CBT Distinctive Features Series (W. Dryden Ed.) Second Edition. London: Routledge
Swenson, C. (2016) DBT Principles in Action. New York: Guilford Press
Pre- and Co-requisite Modules
Courses including this module
Compulsory in courses:
- C8DV: PGDip Dialectical Behaviour Therapy year 1 (DIP/DBT)