Dialectical Behaviour Therapy And The Duluth Model: Can They Play In The Same Sandbox?

2328 words - 10 pages

Dialectical behaviour therapy (DBT) was developed by Marsha M. Linehan, Ph.D., in the 1980s (Waltz, 2003). It is designed for use in clinical settings with women who engage in potentially life threatening behaviours, many who have a diagnosis of borderline personality disorder but has since been modified to work with other populations that are experiencing emotional dysregulation (Waltz, 2003). It works on the premise of wedding a behaviour change-orientation with an experience validation stance (Waltz, 2003).
Researchers have noted an overlap in men who are abusive and people who have borderline personality disorder (Dutton, 1995a, 1995b; Dutton & Starzomski, 1993; Gondolf & White, ...view middle of the document...

Primary treatment targets for DBT with men who perpetrate spousal violence address decreasing behaviours that are life threatening, therapy interfering, or quality of life interfering and increasing skills (Fruzzetti & Levensky, 2000). Finally, effectiveness outcomes, primarily examining has the participant used violence in the time period, must be assessed after a determined time period, either at the end of group (usually six months) or over a longer time frame (Fruzzetti & Levensky, 2000).
DBT has a defined procedure. It begins with orienting the client to the program and receiving the client’s commitment to change targeted behaviours (Fruzzetti & Levensky, 2000; Waltz, 2003). Initial orientation includes clarifying what abusive behaviour is and that ending abusive behaviour is a goal of treatment (Waltz, 2003). Clients who refuse to commit to treatment are seen as meeting an exclusion criteria but Waltz (2003) notes that this stage can be addressed in pre-treatment interventions. Fruzzetti & Levensky (2000) state it is important that clients be informed that they have a choice in choosing or declining DBT. Orienting continues throughout the program when introducing new interventions (Waltz, 2003).
A key factor in DBT is behaviour analysis (Waltz, 2003). An abusive or violent behaviour (either thoughts or overt behaviors) along with the antecedents and consequence to the behaviour is analyzed (Waltz, 2003). This allows the facilitator and client to look for connections and patterns in his behaviour and to identify skills deficits (Waltz, 2003).
Skills deficits are countered by skills training (Waltz, 2003). This is often done in a group setting (Fruzzetti & Levensky, 2000). Skills around self-management, mindfulness, distress tolerance, emotional regulation, interpersonal effectiveness, and validation and empathy (Linehan, 1993b as cited in Waltz, 2003) are taught with the assumption that difficulty coping with painful emotions leads to negative behaviours, such as violence (Waltz, 2003). Skills must be reinforced outside of group through techniques like telephone coaching or at-home practice exercises (Fruzzetti & Levensky, 2000).
The above mentioned processes are done in a setting of non-judgement and validation (Waltz, 2003). Non-judgement entails being mindful of the impact of judgements on clients and being aware of the client’s humanity (Waltz, 2003). Finally, a focus is put on the negative consequences of the behaviour (Waltz, 2003). Validation can be very difficult because it can be hard to find experiences to be validated in a violent situation and to validate without reinforcing the violence (Waltz, 2003). Small behaviours, such as accurate emotional understanding, can be validated in an effort to use shaping with the client (Fruzzetti & Levensky, 2000).
Finally, to address the intensive nature of DBT work, consultation groups are used (Waltz, 2003). They provide a place for therapists to...

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