“Radically open dialectical behavior therapy (RO DBT) is a truly innovative treatment, developed through translation of neuroscience into clinical practice, integrating various influences from dialectical behavior therapy (DBT), mindfulness-based approaches, emotion, personality and developmental theory, evolutionary theory, and Malamati Sufism. RO DBT is applicable to a spectrum of disorders characterized by excessive inhibitory control or overcontrol (OC). This is the first treatment that directly targets social signaling and nonverbal aspects of communication not only in clients but also in therapists.…This book on the theory and practice of RO DBT, together with the skills training manual that describes the content of skills classes, are excellent guides for clinicians who want to embark in delivering transdiagnostic treatments based on science and clinical practice.”
—Mima Simic, MD, MRCPsych, joint head of the child and adolescent eating disorder service, and consultant child and adolescent psychiatrist at the Maudsley Hospital in London, UK
“A new and comprehensive statement from one of the more creative minds in evidence-based clinical intervention today, RO DBT brings together a contemporary focus on a limited set of key transdiagnostic processes, with new assessment and intervention techniques for moving them in a positive direction. Emphasizing flexibility, openness, connection, and attention to social signaling, RO DBT specifies the details that can matter, from how you arrange your consulting room furniture to how nonverbal cues signal social information. RO DBT seems destined to make an impact on evidence-based care in many corners of clinical work. Highly recommended.”
—Steven C. Hayes, PhD, codeveloper of acceptance and commitment therapy (ACT); Foundation Professor of psychology at the University of Nevada, Reno; and author of Get Out of Your Mind and Into Your Life
“RO DBT offers an intriguing reconceptualization of traditional views of internalizing and externalizing disorders, and provides the clinician with valuable new tools to address a number of problems that have been particularly resistant to standard CBT approaches. I will definitely include RO DBT theory and techniques in my graduate-level intervention class. I know beginning clinicians in particular will be grateful to have a systematic way to approach these slow-to-warm-up clients who are difficult to establish rapport with. Their early termination from therapy and failure to respond to traditional approaches often leaves clinicians befuddled and critical of their own skills. RO DBT provides a compassionate way for clinicians to view this type of resistant client, as well as to work on some areas that are likely to benefit them. A very welcome addition to any clinician’s toolbox.”
—Linda W. Craighead, PhD, professor of psychology and director of clinical training at Emory University, and author of The Appetite Awareness Workbook
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books
Copyright © 2018 by Thomas R. Lynch
Context Press
An imprint of New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Figure 6.3, “Prototypical Emotional Expressions,” from Keltner, D., Young, R. C., & Buswell, B. N. (1997). “Appeasement in human emotion, social practice, and personality.” Aggressive Behavior, 23(5), 359–374. Copyright © 1988 by Wiley. Used with permission.
Images in figure 6.5, “Polite Smile vs. Genuine Smile,” © Vladimir Gjorgiev and Monkey Business Images/Shutterstock.
Figure 6.12, “Subtle, Low-Intensity Social Signals Are Powerful,” from EMOTIONS REVEALED: RECOGNIZING FACES AND FEELINGS TO IMPROVE COMMUNICATION AND EMOTIONAL LIFE by Paul Ekman, copyright © 2003 by Paul Ekman. Used by permission of Paul Ekman.
Lines from “A Man and a Woman Arguing” from THE ESSENTIAL RUMI by Jalal al-Din Rumi, translated by Coleman Barks. Copyright © 1997 by Coleman Barks. Used by permission.
Illustrations on pages 163, 164, and 168 by Henrietta Hellard
Cover design by Amy Shoup; Acquired by Catharine Meyers; Edited by Xavier Callahan; Indexed by James Minkin
All Rights Reserved
Library of Congress Cataloging-in-Publication Data
Names: Lynch, Thomas R. (Professor of clinical psychology), author.
Title: Radically open dialectical behavior therapy : theory and practice for treating disorders of overcontrol / Thomas R. Lynch.
Description: Oakland, CA : New Harbinger Publications, Inc., [2018] | Includes bibliographical references and index.
Identifiers: LCCN 2017040500 (print) | LCCN 2017042252 (ebook) | ISBN 9781626259294 (pdf e-book) | ISBN 9781626259300 (ePub) | ISBN 9781626259287 (hardcover : alk. paper)
Subjects: | MESH: Behavior Therapy--methods | Compulsive Personality Disorder--therapy | Self-Control--psychology
Classification: LCC RC489.B4 (ebook) | LCC RC489.B4 23 (print) | NLM WM 425 | DDC 616.89/142--dc23
LC record available at https://lccn.loc.gov/2017040500
Key Terms xi
Introduction 1
Overview of Core RO DBT Tenets 1
Overview of the Book’s Contents 2
In RO DBT, Silliness Is No Laughing Matter 4
1. Radical Openness and Disorders of Overcontrol 7
Self-Control: Can You Have Too Much of a Good Thing? 7
Basic Postulates of RO DBT 11
Treatment Development and Efficacy Research 19
2. A Neurobiosocial Theory for Disorders of Overcontrol 33
A Novel Neuroregulatory Model of Socioemotional Functioning 33
A Biosocial Theory for Disorders of Overcontrol 46
Social Signaling: A Novel Mechanism of Change 66
3. Assessment Strategies 69
Assessing Overcontrol: A Conceptual Framework 69
Common Errors and Problematic Assumptions 70
The OC Diagnostic Protocol: Diagnosing Overcontrol, Step-by-Step 76
Future Directions 83
4. Overview of Therapy Assumptions, Structure, and Targets 85
RO DBT Core Assumptions 86
Overview of Treatment Structure and Targets 88
5. Maximizing Client Engagement 97
Enhancing Client Engagement via the Physical Environment 97
Enhancing Client Engagement via Orientation and Commitment 100
Commitment Problems Unique to Overcontrol 137
Enhancing Engagement Through Sequencing 140
6. Social Signaling Matters: Micromimicry, Mirror Neurons, and Social Connectedness 145
Social Bonds, Mimicry, and Mirror Neurons 146
One Size Does Not Fit All 149
Eye Contact 149
The “Deer in the Headlights” Response 151
Heat-Off Strategies 153
Heat-On Strategies 155
Therapeutic Use of Cooperative Social Signaling 156
The Therapist as Tribal Ambassador 161
Managing Maladaptive OC Social Signaling 170
Tribe Matters 175
7. Radical Openness and Self-Enquiry: Personal Practice, Therapeutic Modeling, Supervision, and Team Consultation 177
Openness Is Tribal Glue 178
Openness, Collaboration, and Compliance 180
Openness, Tribes, and Learning 181
One Secret of Healthy Living Is the Cultivation of Healthy Self-Doubt 184
What Is Radical Openness? 186
Practicing Self-Enquiry and Outing Oneself 190
RO DBT Team Consultation and Supervision 192
Using a Consultation Team to Enhance Supervision and Treatment Outcomes 198
8. The Therapeutic Alliance, Alliance Ruptures, and Repairs 209
The RO DBT Therapeutic Stance 209
The Therapeutic Alliance 211
Alliance Ruptures and Repairs 213
Prevention of Premature Treatment Dropout 223
9. Treatment Targeting and Intervention: Prioritizing Social Signaling 229
Kindness First and Foremost 230
Radically Open Living: Developing a Life Worth Sharing 232
Structuring Sessions with the RO DBT Treatment Target Hierarchy 233
Targeting In-Session Social Signaling: Basic Principles 240
Monitoring Treatment Targets with Diary Cards 257
Valued Goals, Themes, and Targets 267
From Targeting to Intervention: An Overview of Treatment Strategies 270
10. Dialectical and Behavioral Strategies 297
Why Dialectics? 297
Behavioral Principles and Strategies 327
11. Final Remarks, Practical Questions, and Treatment Adherence 371
Some Commonly Asked Questions 371
Final Remarks 373
Appendix 1: Assessing Styles of Coping: Word-Pair Checklist 377
Appendix 2: The Clinician-Rated OC Trait Rating Scale 381
Appendix 3: The Overcontrolled Global Prototype Rating Scale 385
Appendix 4: RO DBT Semistructured Suicidality Interview 401
Appendix 5: Targeting Indirect Social Signals: In-Session Protocol 405
Appendix 6: Setting the Stage for Effective RO DBT Chain Analysis: In-Session Protocol 415
Appendix 7: Using RO DBT Chain and Solution Analysis: Principles and In-Session Protocol 419
Appendix 8: RO DBT Adherence: A Self-Assessment Checklist 433
Endnotes 453
References 461
Index 493