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Abuse. See Maltreatment
Academic difficulties, 20, 53, 108
Acceptance strategies
as a core element to DBT, 41
dialectical strategies and, 54, 56–59
problem-solving strategies and, 159–160
in therapy process, 38
validation strategies and, 59–61
Walking the Middle Path module of skills training and, 238–239
Acculturation, invalidating environments and, 43
Active passivity versus apparent competence dialectical dilemma, 97t, 101–103, 103t
Affect, 43, 49–50
Age, 23t, 83–84
Agenda setting, 132, 154, 157, 159–160
Aggression, 14, 17
Alcohol use. See Substance use and abuse
Analogy, use of in treatment, 57
Anger, 36t, 132
Anxiety, 13, 43
Anxiety disorders, 121–124
Assessment, 117, 245–252. See also Suicide risk assessment
Audiotape of sessions, 175
Authoritarian control, 106–107, 110, 191
Authoritative parenting, 107–110, 108t, 191
Autonomy, 113–115, 115t
Beck Depression Inventory—II (BDI-II), 119t,122–123
Behavior. See also Therapy-interfering behaviors
adolescents at highest risk, 24t
dysregulation of, 36t, 54
in-session dysfunctional behavior, 171–174, 172t
pathologizing normative behaviors versus normalizing pathological behaviors dialectical dilemma, 110–113, 112t
prevalence rates regarding suicide attempts and, 7–8
problem-solving strategies and, 61–66
quality of life and, 53
as a risk factor, 14
validation strategies and, 59–61
Walking the Middle Path module of skills training and, 239
Behavioral analyses. See also Chain analysis
active passivity versus apparent competence dialectical dilemma, 102
assessing progress and, 247–248
DBT program implementation and, 266t
diary cards and, 143
family members and, 189, 191–193
homework compliance and, 240
lack of progress and, 250
motivation and, 239–240
during the pretreatment stage, 46
problem-solving strategies and, 62–63, 160–161, 162t, 163–165, 164f
skills training and, 158–159
suicide risk assessment and, 124–127, 126t
therapy-interfering behaviors and, 51, 52
Behavioral skills, 54, 124–127, 126t, 190
Behaviorism, 298–302, 314–316
Beliefs, dysfunctional, 57–58, 63, 167–168
Biosocial theory, 39–40, 41–44, 136–138, 219
Bipolar disorder, 13, 28
Borderline personality disorder and behavioral patterns
assessments and, 119t
biosocial theory and, 42
dialectical dilemmas and, 96–97
evaluations of DBT for, 31–32
invalidating environments and, 42–43
nonsuicidal self-injurious behavior and, 9
overlap with suicidal behaviors, 25–27
problem-solving strategies and, 61–66
as a risk factor, 15
setting up a DBT program and, 85
Borderline personality disorder and behavioral patterns (cont.)
suicide risk assessment and, 121–124
therapist availability and, 76
therapy-interfering behaviors and, 50–52
trust and, 222–223
validation strategies and, 59–61
why employ DBT with, 36t
Brief treatment, 92–94, 144, 243–244
Canceling sessions, as a therapy-interfering behavior, 50
Capabilities of therapist, 72t, 77–82
Capability enhancing, 72t, 73–75, 74t
Case conceptualization, 39–40
Case management strategy, 68–70, 69t
Chain analysis, 62–63, 66, 124–127, 126t
Change, motivation, 71–73, 72t Change strategies
as a core element to DBT, 41
dialectical strategies and, 54, 56–59
problem-solving strategies and, 61–66, 63–66, 159–160, 165–170, 166f, 166t
in therapy process, 38
Cheerleading strategies, 61, 148, 174–175, 196
Child PTSD Symptom Scale, 121
Childhood abuse. See Maltreatment
Childrearing. See Parenting
Children’s Global Assessment Scale (CGAS),119t, 123
Cigarette smoking, 8
Client-centered therapy, 56
Clinical observation, 245
Closing observation, 259
Closure, session-ending strategies, 174–175
Cognitive-behavioral therapy, 29–30, 31–32
Cognitive dysregulation, 54
Cognitive functioning, 35, 36t
Cognitive modifications
DBT program implementation and, 266t
overview, 66
problem-solving strategies and, 63, 166t, 167–168
Cognitive risk factors, 24t
Collaboration in treatment, 118, 131–132, 145
Columbia Suicide History Form, 119
Commitment to treatment. See also Orienting clients to DBT; Pretreatment stage
DBT program implementation and, 127–128, 127t, 266t
family members and, 148–150, 189
introducing format and characteristics of treatment and, 138–139
lack of progress and, 250
multifamily skills training groups and, 223, 225, 226f
obtaining, 144–145
overview, 4, 130–131, 131t
parents and, 204–205
problem-solving strategies and, 170
transition between phases of treatment and, 261–262
treatment planning and, 128
Comorbidity, 13, 15–16, 85
Completed suicide, 8, 17, 251
Conduct disorder, 14, 16
Confidentiality
diary cards and, 143
family members and, 149
multifamily skills training groups and, 218
overview, 206, 207t, 208–209
Confrontational tone in therapy, 67
Confusion about self, 133, 134f, 135
Conners Rating Scale—Revised for parents and teachers, 119t, 123
Consequences, 63, 65–66, 108–109
Consequential thinking, 104–105
Consultation between professionals, 69, 69t. See also Consultation team
Consultation team
assessing progress and, 249
consultation-to-the-patient strategy and, 185–186
family sessions and make-up of, 86
handling completed suicide by a client, 251
meeting structure, 69–70, 76–77, 78
perception of crisis mismatch and, 206
setting up a DBT program and, 86–87
termination and, 262–263
Consultation-to-the-patient strategy
graduate group and, 257–259
overview, 68–69, 69t, 185–186
team meetings and, 79
Contingency management procedures
DBT program implementation and, 266t
dialectical dilemmas and, 102, 109
family members and, 192–193
overview, 64–65
problem-solving strategies and, 63, 166t, 168–170
Contracts, written, 225, 226f
Coping methods, 35, 100–103, 103t
Core Mindfulness Skills module, 229, 230f, 234. See also Mindfulness skills
Crises. See also Unrelenting crises versus inhibited grieving dialectical dilemma
family members and, 194–206, 195t, 205t
suicide risk assessment and, 118
therapist availability and, 76
as a therapy-interfering behavior, 50
unrelenting, 103–104
Crisis-of-the-week syndrome. See Unrelenting crises
Criticism, sensitivity to, 38
Cultural factors, 85–86, 100. See also Ethnicity
DBT diary card. See Diary cards
DBT Skills Rating Scale for Adolescents, 123–124
DEAR MAN interpersonal effectiveness skills, 153–154, 197, 233f, 235–236
Decision-making skills, 104–105
Dependence, 113–115, 115t
Depression
comorbidity and, 15–16
parental, 16–17, 43
pharmacotherapy and, 28–29
as a risk factor, 13
Depressive disorders, 14, 15, 28
Development, normal, 110–113, 112t
Developmental framework, 40
Devil’s advocate strategy, 57–58, 146
Diagnosis, 25–26, 85, 121–124
Diagnostic interviewing, 46
Dialectical dilemmas
active passivity versus apparent competence dialectical dilemma, 101–103, 103t
emotional vulnerability versus self-invalidation dialectical dilemma, 97–101, 101t
family members and, 190–191
fostering dependence versus forcing autonomy dialectical dilemma, 113–115, 115t, 197
handouts for, 305–310
overview, 4, 96–97, 116
pathologizing normative behaviors versus normalizing pathological behaviors dialectical dilemma, 110–113, 112t
polarization between parents, 116
unrelenting crises versus inhibited grieving dialectical dilemma, 103–105, 105t
Walking the Middle Path module of skills training and, 94–95, 237–238, 285–293, 305–310
Dialectical strategies
in-session dysfunctional behavior and, 173–174
overview, 40, 41, 54, 56–59, 266t
team meetings and, 79
Diary cards. See also Homework
assessing progress and, 245–246
behavioral analyses, 62
examples of, 155f, 156f
graduate group and, 255–256
noncompliance with, 152–154
orienting clients to DBT and, 139, 140f, 141f, 142–143
overview, 46, 119t, 123 relevance
of targeted behaviors and, 73
reviewing at the beginning of a session, 152
Discipline, 42, 191
Disruptive behavior disorders, 15–16, 121–124
Dissociation, 36t, 133, 134f, 135
Distal risk factors, 11–12, 12–19, 12t. See also Risk factors
Distress Tolerance module, 214, 232f, 234–235. See also Distress tolerance skills
Distress tolerance skills
clinical tips for teaching, 234–235
handout for, 232f
orienting clients to DBT and, 133, 134f, 135
overview, 74t, 213–215, 215t
unrelenting crises versus inhibited grieving dialectical dilemma, 104–105
Divorce in the family, as a risk factor, 16
Door-in-the-face commitment strategy, 142, 146–147, 170
Dropping out of treatment
commitment to treatment and, 144
decreasing in stage 1 of DBT, 50–52
family members and, 242–243
orienting clients to DBT and, 132
suicide risk assessment and, 125
Drug use. See Substance use and abuse
DSM-IV-TR, 25–27, 54, 121–122
Duration of treatment, 92–94
Dysfunctional beliefs, 57–58, 63, 167–168
Eating disorders and behaviors, 8, 9, 121–124
Emotion Regulation module, 214, 227–228, 231f, 236. See also Emotional dysregulation
Emotional dysregulation
DBT and, 38, 39–40
invalidating environments and, 42–44
multiproblem adolescent and, 1–2
overview, 41–42
risk factors and, 36t
skills training and, 54
Emotional instability, 133, 134f, 135
Emotional regulation skills
clinical tips for teaching, 236
dialectical dilemmas and, 97–98, 104–105
handout for, 231f
orienting clients to DBT and, 133, 134f, 135
overview, 74t, 213–215, 215t
Emotional vulnerability versus self-invalidation dialectical dilemma, 97–101, 97t, 101t
Ending ritual, 175
Engagement, 132. See also Commitment to treatment
Environmental factors
adolescents at highest risk, 23t-24t
behavioral analyses, 62–63
conceptualization of suicidal behaviors and, 35
DBT and, 39–40
invalidating, 42–44, 90, 137
as a risk factor, 11–12
supportive, 72t, 76–77
Ethnicity, 18–19, 23t, 85–86, 100
Excessive leniency versus authoritarian control dialectical dilemma, 98t, 106–110, 108t
Exposure strategies
DBT program implementation and, 266t
multifamily skills training groups and, 244
overview, 65–66
problem-solving strategies and, 63, 166t, 167
Extending strategy, 58
Family. See also Family members in treatment; Parents
assessing the feasibility of DBT and, 127–128, 127t
conflict, 133, 134f, 135, 189–190, 212, 248–249
contingency management and, 65
environment of, 11–12, 16–17, 23t, 123
functioning of, 37, 119t, 122–124, 248–249
history taking and, 16–17, 20–21, 123
orientation and commitment with, 148–150
therapy-interfering behaviors and, 50, 52
treatment agreements and, 143–144
Family behavioral analysis, 191–193. See also Behavioral analyses
Family crisis plan, 193, 196–201
Family members in treatment. See also Family therapy sessions; Multifamily skills training group
confidentiality and, 206, 207t, 208–209
within a DBT framework, 187–188
handling suicidal crisis and, 194–206, 195t, 205t
homework compliance and, 241
overview, 4, 187, 209
setting up a DBT program and, 89–90
telephone consultations and, 193–194
who participates in multifamily skills training groups, 211–212
Family therapy sessions. See also Family members in treatment; Multifamily skills training group
commitment to treatment and, 148–150
consultation team make-up and, 86
handling suicidal crisis and, 194–206, 195t, 205t
importance of, 4
overview, 188–193, 189t
setting up a DBT program and, 90–92
skill generalization and, 75–76
structuring the environment and, 76–77
Feasibility of DBT, 127–128, 127t, 130
Financial considerations in DBT program implementation, 267, 269
Flexibility in treatment, 56
Foot-in-the-door strategy, 146
Fostering dependence versus forcing autonomy dialectical dilemma, 98t, 113–115, 115t, 197
Functional impairment, 20, 36t, 39–40, 45
Gender, 17, 23t, 26, 84–85
GIVE skills, 197, 238–239
Global Assessment of Functioning Scale, 26
Goals, long-term, 53, 135–136, 136f
Goodbye ritual in skills training, 243
Graduate group
model for, 252–259, 253t, 254t, 255t
setting up a DBT program and, 92–94
termination and, 263–264
Graduation ceremony following skills training, 243
Grieving. See also Unrelenting crises versus inhibited grieving dialectical dilemma
Group treatment. See Multifamily skills training group
Handouts, 95, 303–316
Harkavy-Asnis Suicide Survey, 118
Hierarchy of DBT stages and stage targets. See also Stages of therapy
as a core element to DBT, 40
graduate group and, 253–255, 254t
orienting clients to DBT and, 135
overview, 45t
session agenda and, 154
suicide risk assessment and, 126–127, 126t
Highlighting freedom to chose and absence of alternatives commitment strategy, 146–147
Highlighting strategies, 164 Homework. See also Diary cards
compliance with, 240–241
family therapy sessions and, 190
reviewing in sessions, 158, 225, 227
session-ending strategies, 174
Homicidal ideation and behavior, 46–50, 47t
Homosexuality, as a risk factor, 17–18
Humor in therapy, 67, 132
Hypothesis testing, 63, 163–164
Impulsivity
dialectical dilemmas and, 104–105
methods of suicide and, 22
orienting clients to DBT and, 133, 134f, 135
quality of life and, 53
as a risk factor, 14, 15
treatment and, 36t
In-session dysfunctional behavior, 171–174, 172t
Individual sessions
assessing progress and, 247–248
capability enhancing, 73–75, 74t
expressing dissatisfaction within group, 241–242
homework compliance and, 241
in-session dysfunctional behavior, 171–174, 172t
motivation as target in, 71–73, 72t
midsession strategies, 159–161, 160t, 162t, 163–171, 164f, 166f, 166t
overview, 151
session-beginning strategies, 151–154, 155f, 156f, 157–159
session-ending strategies, 174–175
skill generalization and, 75–76
termination and, 263–264
therapy-interfering behaviors and, 51–52
transition between phases of treatment and, 261–262
Inpatient treatment
consultation team make-up and, 87
DBT and, 37
evaluations of, 33
pretreatment stage of DBT and, 130
quality of life and, 53
standards of care and, 30
therapy-interfering behaviors and, 50
Insight, 99–100, 164
Insurance issues, 269
Intent, suicidal, 9–10, 22, 24t, 119, 137
Interpersonal dysregulation, 36t, 53, 54
Interpersonal Effectiveness module, 213–214, 233f, 235–236. See also Interpersonal effectiveness skills
Interpersonal effectiveness skills
clinical tips for teaching, 235–236
DEAR MAN, 153–154
family therapy sessions and, 190
graduate group and, 254
handout for, 233f
orienting clients to DBT and, 133, 134f, 135
overview, 74t, 213–215, 215t
Irreverent communication, 66–68, 132
Lateness to group sessions, 223–224
Length of treatment, 92–94
Life Problems Inventory (LPI), 119t, 122, 124
Life-threatening behaviors, 46–50, 47t, 124–127, 126t. See also Suicidal behaviors
Lifetime Parasuicide Count (LPC), 119, 119t, 120
Limits, observing, 65, 80, 109
Limits of therapy, 52
Maltreatment, 20, 42–43, 120–121, 206, 212, 248–249
Managed care, 267
Manipulative clients, 102
McMaster Family Assessment Device (FAD),119t, 123
Medication issues, 28–30, 87, 159
Mental disorders
adolescents at highest risk, 24t, 25
assessments and, 119t, 122–124
case conceptualization and, 39–40
conceptualization of suicidal behaviors and, 35
nonsuicidal self-injurious behavior and, 9
prevalence rates regarding suicide attempts and, 7–8
quality of life and, 53
as a risk factor, 12–13, 15–16
treatment and, 28–30
Metaphor, use of in treatment, 57, 173, 240
Middle path, 56, 65. See also Walking the Middle Path module of skills training
Millon Adolescent Clinical Inventory, 15
Mindfulness skills
clinical tips for teaching, 229, 234
dialectical dilemmas and, 102, 104–105
emotional regulation skills and, 214, 236
graduate group and, 255
handout for, 230f
orienting clients to DBT and, 133, 134f, 135
overview, 74t, 78, 213–215, 215t
skills training and, 225, 227
specific exercises, 275–284
Minority youth, 100. See also Ethnicity
Modeling, 24t, 51–52
Mood disorders, 17, 28–29, 121–124
Motivation of therapist, 72t, 77–82
Motivation to change
assessing the feasibility of DBT and, 127–128, 127t
lack of, 42, 50–52
multifamily skills training groups and, 239–240
overview, 37
as a target in DBT, 71–73, 72t
Multifamily skills training group. See also Skills training
commitment to treatment and, 148–150
content and schedule, 213–215, 215t, 216t, 217t
handling completed suicide by a client, 251
open versus closed format of, 212–213
orientation and technique, 216–225
overview, 187–188
reviewing at the beginning of individual sessions, 158–159
strategies for handling concerns in, 239–243
termination or transition from, 262
who participates in, 211–212
Multiproblem adolescent
borderline personality disorder and, 26–27
emotional dysregulation and, 1–2
suicide risk assessment and, 125–126
why employ DBT with, 35–37, 36t
Multisystemic therapy (MST), 32–33
Neglect. See Maltreatment
Noncompliance, treatment
DBT and, 37
decreasing in stage 1 of DBT, 50–52
diary cards and, 143, 152–154, 245–246
homework, 240–241
orienting clients to DBT and, 132
suicide risk assessment and, 125
Nonsuicidal self-injurious behavior (NSIB)
brief treatment and, 92
conceptualization of suicidal behaviors and, 35
confidentiality and, 149, 206
decreasing in stage 1 of DBT, 46–50, 47t
evaluations of treatment for, 32–33
graduate group and, 256
motivation to change and, 73
overview, 2–3, 8–10
prevalence rates regarding suicide attempts and, 8
suicide risk assessment and, 118–124, 119t
telephone consultations and, 176–178, 179t, 180t
treatment and, 28
Orienting clients to DBT. See also Commitment to treatment; Pretreatment stage
biosocial theory, 136–138
DBT program implementation and, 266t
diary cards and, 139, 140f, 141f, 142–143
family members and, 148–150, 204–205
family therapy sessions and, 189
goal planning, 135–136, 136f
introducing format and characteristics of treatment, 138–139
multifamily skills training groups and, 220–224, 228
overview, 4, 130–131, 131t
problem identification, 133, 134f, 135
problem-solving strategies and, 170
reviewing treatment agreements, 143–144
therapeutic alliance and, 131–132
transition between phases of treatment and, 261–262
treatment planning and, 128 Overreactivity, 42, 43, 137
Parasuicidal behaviors. See Nonsuicidal self-injurious behavior (NSIB)
Parental psychopathology, 11–12, 16–17, 212
Parenting. See also Parents
assessing progress and, 248–249
excessive leniency versus authoritarian control dialectical dilemma, 106–110, 108t
family therapy sessions and, 190
fostering dependence versus forcing autonomy dialectical dilemma, 113–115, 115t
polarization between parents, 116
Parents. See also Family; Parenting
conflict with, 104
excessive leniency versus authoritarian control dialectical dilemma, 106–110, 108t
limit setting and, 80
perception of crisis mismatch, 201–205, 205t
polarization between, 116
therapy-interfering behaviors and, 50, 52
who participates in multifamily skills training groups, 211–212
Pathologizing normative behaviors versus normalizing pathological behaviors dialectical dilemma, 98t, 110–113, 112t
Peer socialization, 108
Peers
considering role of in self-injurious behaviors, 48
emotional processing and, 104
graduate group and, 253
invalidating environments and, 99
quality of life and, 53
suicide in social milieu and, 20–21
suicide-related expectancies, 49
therapy-interfering behaviors and, 51–52
Personality disorders, 9, 15, 25–27, 121–124
Pharmacotherapy, 28–30, 87, 159
Physical abuse. See Maltreatment
PLEASE MASTER skills, 227–228
Posttraumatic stress disorder, 9, 13, 121
Practice exercises. See Homework
Pretreatment stage. See also Commitment to treatment; Orienting clients to DBT
commitment to treatment and, 4
Montefiore Program for Suicidal Adolescents, 89t
overview, 44, 45–46, 45t, 47t, 130–131, 131t
Prevalence rates regarding suicide attempts, 7–8
Privacy, 143, 206, 207t, 208–209
Problem identification
orienting clients to DBT and, 133, 134f, 135
overview, 163–164
Problem-solving skills
acceptance and change strategies and, 159–160, 160t
building awareness and acceptance of the problem, 161, 162t, 163–165, 164f
conceptualization of suicidal behaviors and, 35
dialectical dilemmas and, 102, 114–115
generating, evaluating, and implementing solutions, 165–171, 166f, 166t
graduate group and, 257–259
lack of progress and, 250
multifamily skills training groups and, 221
overview, 61–66
skill generalization and, 75–76
treatment and, 36t
Program issues
administrative support, 265, 267–269
financial issues, 267, 269
implementation and, 265, 266t
overview, 5, 265
staff issues, 269–274
training of staff members, 271–274
Progress, lack of, 249–251
Proximal risk factors, 11–12, 12t, 19–22. See also Risk factors
Psychoeducational format, 75, 112–113, 196,204–205
Psychopathology, assessments and, 119t, 122–124. See also Mental disorders
Psychopathology, parental, 11–12, 16–17, 212
Punishment, 42, 65
Quality-of-life-interfering behaviors, 53, 73, 124–127, 126t
Reasons for Living Inventory for Adolescents(RFL-A), 119t, 120
Reciprocal communication, 66–68, 169
Referrals, perception of crisis mismatch and, 205–206
Reinforcement, 64–65, 176, 192–193, 240–241
Relationships, 36t, 43–44, 49, 53
Resistances, 58–59, 132
Risk assessment. See Suicide risk assessment
Risk factors
adolescents at highest risk, 22, 23t-24t, 25
challenges in determining, 11–12
distal risk factors, 12–19
family crisis plan and, 196, 197, 201
overview, 12t
proximal risk factors, 19–22
suicide risk assessment and, 118–124, 119t
treatment and, 36t
Rules, group, 223–224
Scale for Suicide Ideation, 118
Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), 14, 119t, 122
Self-blame, 100
Self, coherent sense of, 43–44
Self-concept, 99–100
Self-consciousness, 103–104
Self-determination, 110, 191
Self-disclosure of the therapist, 67, 169
Self dysregulation, 36t, 54
Self-esteem, parenting and, 108
Self-harming behaviors, parental, 43
Self-injurious behaviors, 2–3, 48, 179t, 256
Self-invalidation, 99–100. See also Emotional vulnerability versus self-invalidation dialectical dilemma
Self-regulation, 35, 43–44
Self-reinforcement, 95, 109
Self-reliance, parenting and, 108
Self-report measures, 118–120, 119t, 122, 122–123. See also Suicide risk assessment
Semistructured clinical interviews, 121
Sensitivity, 13, 43
Setting of therapy, therapy-interfering behaviors and, 52
Sexual abuse. See Maltreatment
Sexual behavior, 8, 53, 224
Sexual orientation, 17–18, 23t
Shame, 167, 234
Skill acquisition, 37, 64
Skill generalization, 37, 64, 72t, 75–76
Skill strengthening, 64
Skills training. See also Multifamily skills training group
brief treatment and, 94
capability enhancing, 73–75, 74t
clinical tips for, 229, 230f-233f, 234–237
content and schedule, 213–215, 215t, 216t, 217t
DBT program implementation and, 266t
family members and, 149
graduate group and, 256–257
handling completed suicide by a client, 251
including family members in, 89–90, 187–188
overview, 64, 210
pretreatment stage of DBT and, 46
problem-solving strategies and, 63, 165–166, 166t
reviewing at the beginning of individual sessions, 158–159
session structure, 225, 227–229
during stage 1 of DBT, 54
strategies for handling concerns in, 239–243
termination or transition from, 262
transition between phases of treatment and, 261–262
Walking the Middle Path module of skills training, 94–95
who should conduct, 210–211
Social learning, 11–12, 20–21, 39–40
Socioeconomic status, 19, 100
Solution analysis
active passivity versus apparent competence dialectical dilemma, 102
DBT program implementation and, 266t
lack of progress and, 250
problem-solving strategies and, 63–66, 165
skills training and, 158–159
Soothing strategies, 174–175, 196, 234–235
Staff issues in program implementation, 269–274
Stage 1 of DBT. See also Targets in DBT
family therapy sessions and, 189–190
Montefiore Program for Suicidal Adolescents, 89t
multifamily skills training groups and, 243–244
orienting clients to DBT and, 135–136, 136f
overview, 45t, 46–54, 47t
suicide risk assessment and, 124–127, 126t
Stage 2 of DBT, 244. See also
Stages of therapy Stages of therapy, 44–54, 45t, 47t. See also Stage 1 of DBT
Stressful life events
adolescents at highest risk, 23t
invalidating environments and, 43
as a risk factor, 11, 19–20
suicide risk assessment and, 123
transactional model and, 40
Structured Clinical Interview for DSM-IV Axis II Personality Disorders, BPD module (SCID-II), 119t, 121–122
“Stuck” therapy, 249–251
Substance use and abuse
emotional processing and, 104
gender differences in suicide rates and, 17
methods of suicide and, 22
overview, 8
parental, 43, 248–249
quality of life and, 53
as a risk factor, 14–15
substance use disorders, 9, 14, 15–16, 16–17, 121–124
as a therapy-interfering behavior, 51
Suicidal behaviors
biosocial theory and, 41–42
decreasing in stage 1 of DBT, 46–50, 47t
defining, 2–3, 8–11
evaluations of treatment for, 32–33
family members and, 194–206, 195t, 205t
graduate group and, 256
motivation to change and, 73
overlap with borderline personality disorder, 25–27
parental, 43
as a risk factor, 12
telephone consultations and, 176–178, 178–185, 179t, 180t
Suicidal ideation
confidentiality and, 206
decreasing in stage 1 of DBT, 46–50, 47t, 48–49
defining, 9, 10–11
graduate group and, 256
Suicidal Ideation Questionnaire (SIQ), 118–119, 119t
Suicidal intent, 9–10, 22, 24t, 119, 137
Suicidal Intent Scale, 119
Suicidal threats, family crisis plan and, 200–201 Suicide attempt
brief treatment and, 92
decreasing in stage 1 of DBT, 46–50, 47t
defining, 8–9
gender differences in, 17
suicidal ideation and, 11
Suicide Attempt Self-Injury Interview (SASII), 119–120, 119t
Suicide, completed, 8, 17, 251
Suicide risk assessment. See also Assessment
assessing feasibility of DBT, 127–128, 127t
assessing progress and, 252
overview, 117
stage 1 target behaviors, 124–127, 126t
suicide/NSIB risk and mental disorders, 118–124, 119t
telephone consultations and, 178–185, 179t, 180t
treatment planning and, 128, 129f
Symptom Checklist-90—Revised (SCL-90-R), 26, 119t, 123
Take-home practice exercises. See Homework
Targets in DBT
assessments and, 117
family therapy sessions and, 189–190
graduate group and, 253–255, 254t
orienting clients to DBT and, 135
overview, 46–54, 47t
pretreatment stage of DBT and, 130, 131t
prioritizing, 71–82, 72t, 74t
suicide risk assessment and, 124–127, 126t
Team, consultation. See Consultation team
Team meeting. See Consultation team
family members and, 92, 193–194
graduate group and, 253
overview, 175–185, 179t, 180t
setting up a DBT program and, 88
skill generalization and, 75–76
Termination of treatment
as a form of contingency management, 65
graduate group and, 93–94
multifamily skills training groups and, 243–244
overview, 4–5, 256–264
Therapeutic relationship
boundaries and, 80
contingency management and, 168–170
dialectical strategies and, 56
emotional state of client and, 157
orienting clients to DBT and, 131–132
pretreatment stage of DBT and, 130–131, 131t
treatment agreements and, 143–144
validation strategies and, 59–61
Therapist
availability of, 76
contingency management and, 65
handling completed suicide by a client, 251
perception of crisis mismatch between parent and, 203–205, 205t
stance of, 132, 168–169, 188
therapy-interfering behaviors and, 52
treatment agreements and, 143–144
who should conduct skills training, 210–211
Therapy-interfering behaviors
assessing progress and, 246–247
decreasing in stage 1 of DBT, 50–52
diary cards and, 152–154
graduate group and, 254
in-session dysfunctional behavior, 171–174, 172t
motivation to change and, 73
multifamily skills training groups and, 242
skills training and, 75
suicide risk assessment and, 124–127, 126t
therapist availability and, 76
Training of DBT staff, 271–274
Transactional process
as a core element to DBT, 41
family members and, 192–193
invalidating environments and, 43–44
multifamily skills training groups and, 219
orienting clients to DBT and, 137
overview, 39–40
Treatment. See also Treatment strategies
borderline personality disorder and, 27
direct, 30–33
indirect by treating associated disorders, 28–30
overview, 28
theoretical orientation to, 40
Treatment agreements, 143–144
Treatment for Adolescent with Depression Study (TADS), 29–30
Treatment goals, 44–54, 45t, 46, 47t
Treatment history, 125
Treatment planning
assessments and, 117, 121, 128, 129f
family crisis plan and, 197–200
suicidal behaviors and, 180t
Treatment strategies. See also Treatment
active passivity versus apparent competence dialectical dilemma, 102–103
case management strategies, 68–70, 69t
dialectical strategies, 54, 56–59
emotional vulnerability versus self-invalidation dialectical dilemma, 100–101, 101t
excessive leniency versus authoritarian control dialectical dilemma, 107–110, 108t
overview, 54, 55f, 56–70, 69t
pathologizing normative behaviors versus normalizing pathological behaviors dialectical dilemma, 111–113, 112t
problem-solving strategies, 61–66
setting up a DBT program and, 82–85, 87–88, 89t
stylistic strategies, 66–68
unrelenting crises versus inhibited grieving dialectical dilemma, 104–105
validation strategies, 59–61
Treatment targets. See Targets in DBT
Troubleshooting, 142–143, 170–171, 197
Trust, 222–223
Unrelenting crises versus inhibited grieving dialectical dilemma, 97t, 103–105, 105t
Validation
DBT program implementation and, 266t
family crisis plan and, 196
family therapy sessions and, 190
handouts for, 311–313
invalidating environments and, 42–43
lack of progress and, 250
multifamily skills training groups and, 219
orienting clients to DBT and, 137
overview, 59–61
perception of crisis mismatch between parent and child, 202–203
problem-solving strategies and, 159–160, 161, 162t, 163–165, 164f
Walking the Middle Path module of skills
training and, 94–95, 238–239, 293–298, 311–313
Vulnerability, 41–42, 97–99, 100–101. See also Emotional vulnerability versus self-invalidation dialectical dilemma
Walking the Middle Path skills
brief treatment and, 93
content of, 285–302
family crisis plan and, 197
family therapy sessions and, 190
handouts for, 303–316
orienting clients to DBT and, 133, 134f, 135
overview, 65, 74–75, 74t, 94–95, 237–239, 238t