Current approaches in

psychotherapy
 Dialectical Behavioral Therapy - DBT
Ce este DBT?
a cognitive behavioral treatment originally developed to treat
chronically suicidal individuals diagnosed with borderline personality
disorder (BPD),
proposed by Marsha M. Linehan et al., starting in late 1970s (1993),
now recognized as the gold standard psychological treatment for this
population,
research shown it is effective in treating a wide range of other
disorders such as substance dependence, depression, PTSD, & eating
disorders.
3 philosophical positions:
Behavioral science underpins the DBT bio-social model of the
development of BPD,
Zen and contemplative practices underpin DBT mindfulness skills and
acceptance practices,
The dialectical synthesis of a "technology" of acceptance with a
"technology" of change was distinctive for DBT:
"dialectical = a synthesis or integration of opposites (e.g. strategies of
acceptance and change).
 Dialectical Behavioral Therapy - DBT
Difficulties using standard CBT approach with suicidal clients:
Clienii percep focalizarea pe schimbare (implicit n CBT) ca fiind
invalidant (high drop-out rate),
n mod neintenionat, clienii i susin terapeuii (positively reinforce
their therapists) pentru abordri neeficiente i au tendina s-i
penalizeze pentru abordrile eficiente,
Volumul i severitatea real a problemelor prezentate de clieni fac
imposibil utilizarea formatului CBT standard.

DBT propose signifficant changes to standard CBT:

Strategii de acceptare / validare au fost adugate strategiilor de
schimbare din CBT (ex. n raport cu comportamentele
autodestructive),
Dialectical strategies (emphasising on holism and synthesis) were
added,, enable the therapist to blend acceptance and change,
Au fost fcute schimbri semnificative n structura tratamentului, cu
scopul de a soluiona problemele ntmpinate n aplicarea CBT
standard.
 Dialectical Behavioral Therapy - DBT
4 components of DBT:
DBT skills training group
is focused on enhancing clients' capabilities by teaching them behavioral skills. The
group is run like a class where the group leader teaches the skills and assigns homework
for clients to practice using the skills in their everyday lives. Groups meet on a weekly
basis for approximately 2.5 hours and it takes 24 weeks to get through the full skills
curriculum, which is often repeated to create a 1-year program.
DBT individual therapy
is focused on enhancing client motivation and helping clients to apply the skills to
specific challenges and events in their lives. In the standard DBT model, individual
therapy takes place once a week for as long as the client is in therapy and runs
concurrently with skills groups.
DBT phone coaching
is focused on providing clients with in-the-moment coaching on how to use skills to
effectively cope with difficult situations that arise in their everyday lives. Clients can call
their individual therapist between sessions to receive coaching at the times when they
need help the most.
DBT therapist consultation team
is intended to be therapy for the therapists and to support DBT providers in their work
with people who often have severe, complex, difficult-to-treat disorders. The
consultation team is designed to help therapists stay motivated and competent so they
can provide the best treatment possible. Teams typically meet weekly and are
composed of individual therapists and group leaders who share responsibility for each
client's care.
 Dialectical Behavioral Therapy - DBT
Linehan (1993) 5 critical functions of any comprehensive
therapy:
Meninerea i creterea motivaiei de schimbare a clientului,
n mod tipic terapeutul individual
Dezvoltarea capabilitilor clientului,
Skill groups and homework assignments
Asigurarea generalizrii noilor capabiliti ale clientului n
toate contextele relevante,
Phone coaching, in vivo coaching and homework assgnments
Creterea motivaiei terapeutului de a trata clieni simultan
cu dezvoltarea capabilitilor terapeutului i preveniea
epuizrii (burnout),
Weekly consultation team meetings
Structurarea mediului astfel nct tratamentul s poat avea
loc.
Process-Experiential/ Emotion
focused psychotherapy
L. S. Greenberg
 What is PE / EFT?
Process-Experiential/Emotion-Focused Therapy (PE-EFT) is an
empirically-supported, neo-humanistic approach that integrates and
updates person-centered, Gestalt, and existential therapies.
EFTs have been shown to be effective in:
both individual and couples forms of therapy in a number of randomized
clinical trials,
equally or more effective than a Client Centered (CC) empathic treatment,
and a Cognitive Behavioral treatment (CBT) in the treatment of depression.
EFT was found to be more effective in reducing interpersonal problems
than both the CC and CBT,
treating abuse,
resolving interpersonal problems and promoting forgiveness,
one of the most effective approaches in resolving relationship distress.
EFT has more research than any other approach on the process of
change, having demonstrated a relationship between outcome and
empathy, the alliance, depth of experiencing, emotional arousal, making
sense of aroused emotion, productive processing of emotion and
particular emotions sequences.
 Emotion
Premise: emotion is fundamental to the construction
of the self and is a key determinant of self-
organization:
Emotions are an adaptive form of information-processing
and action readiness that orient people to their
environment and promote their well being,
Emotions are seen by contemporary emotion theorists as
significant because they inform people that an important
need, value, or goal may be advanced or harmed in a
situation.
Emotional memories of lived emotional experience
are seen as being formed into emotion schemes:
internal organizations or neural programs making people
react automatically from their emotion systems
Changing the emotion schematic memory structures is
one of the main goals in therapy.
 Emotion
A Dialectical Constructivist View: Integrating Biology and Culture
Integration of reason and emotion is based on an ongoing circular
process of making sense of experience by symbolizing bodily-felt
sensations in awareness and articulating them in language,
thereby constructing new experience:
How emotional experience is symbolized influences what the
experience becomes in the next moment.
Emotion Assessment
A system of process diagnoses in which it is important to make
distinctions between different types of emotional experiences
and expression that require different types of intervention:
Primary emotions are the persons most fundamental, initial reactions
to a situation, such as being sad at a loss.
Secondary emotions are responses to ones thoughts or feelings, such
as feeling angry in response to feeling hurt,
Maladaptive emotions are those old, familiar feelings that occur
repeatedly and do not change, such is a core sense of lonely
abandonment, the anxiety of basic insecurity.
 What is EFT?
2 fundamental treatment principles:
Provision of a therapeutic relationship, &
Person centered, empathetic,
Combined with a more guiding, directive Gestalt style of
engaging in experiments to deepen experience.
Facilitation of therapeutic work:
the therapist guides clients emotional processing in different
ways at different moments
EFT is marker guided and process directive.
Markers = specific problematic emotional processing states that
are identifiable by in-session performances that mark underlying
affective problems, as well as clients current readiness to work
on the problem,
therapists are trained to identify markers of different types of
problematic emotional processing problems and to intervene in
specific ways
 Markers
1) Problematic reactions expressed through puzzlement
about emotional or behavioral responses to particular
situations,
2) An unclear felt sense in which the person is on the surface
of, or feeling confused and unable to get a clear sense of
his/her experience
3) Conflict splits in which one aspect of the self is critical or
coercive towards another aspect,
4) Self-interruptive splits arise when one part of the self
interrupts or constricts emotional experience and
expression,
5) An unfinished business marker involves the statement of a
lingering unresolved feeling toward a significant other such
as the following said in a highly involved manner,
6) vulnerability is a state in which the self feels fragile,
deeply ashamed, or insecure.
 Principles of Emotional Intervention
Awareness
increasing awareness of emotion is the most fundamental overall
goal of treatment,
Emotional Expression
has been shown to be a unique aspect of emotional processing
that predicts adjustment to things such as breast cancer,
interpersonal emotional injuries, and trauma
Regulation
training in the capacity for emotional down-regulation must
precede or accompany utilization of emotion
Reflection
helps people make narrative sense of their experience
Transformation
of primary maladaptive emotions
Corrective emotional experience
have a new lived experience that changes an old feeling