Filled with detailed clinical examples, this book expertly breaks down the process of behavioral chain analysis/m-/the critical foundation for assessment and problem solving in dialectical behavior therapy (DBT). Experienced DBT clinician and trainer Shireen L. Rizvi provides knowledge and skills for conducting chains effectively and overcoming obstacles. The chain analysis plays a critical role in case formulation and treatment planning in the earliest stage of treatment and continues to play a critical role throughout treat- ment as a means to understanding and treating behavior. Description: Filled with detailed clinical examples, this book expertly breaks down the process of behavioral chain analysis/m-/the critical foundation for assessment and problem solving in dialectical behavior therapy (DBT).

Format

Häftad (Paperback / softback)

Språk

Engelska

Antal sidor

186

Utgivningsdatum

2019-05-03

Förlag

Guilford Press

Dimensioner

226 x 150 x 18 mm

Vikt

272 g

Antal komponenter

1

ISBN

9781462538904

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Kundrecensioner

• Dialectical Behavior Therapy in Clinical Practice

  This influential work has now been substantially revised with over 60% new material reflecting over a dozen years of research and clinical advances. Leading experts describe innovative ways to use dialectical behavior therapy (DBT) in a wide range...

• Dialectical Behavior Therapy in Clinical Practice, Second Edition

  This influential work has now been substantially revised with over 60% new material reflecting over a dozen years of research and clinical advances. Leading experts describe innovative ways to use dialectical behavior therapy (DBT) in a wide range...

'In her elegantly delivered treatise, Rizvi unpacks the central structural element of DBT individual therapy. With concise, engaging writing, Rizvi highlights the behavior therapy core of DBT and the foundational nature of good assessment. With clarity and precision, she discusses essentials of targeting, illustrates how to examine the function of problem behaviors, and details solution analysis using the various DBT change strategies. She addresses such subtleties as differences between first and repeated chaining of a behavior; chaining urges or the absence of effective behaviors; and differences between micro and macro chains. Through frequent disclosure of her own case experiences and highly instructive client dialogues, and through modeling expert therapist assessment and interventions, Rizvi's indispensable volume positions the clinician for success.'--Jill H. Rathus, PhD, Department of Psychology, Long Island University Post; Cognitive Behavioral Associates, Great Neck, New York 'Rizvi's cogent clinical examples not only vividly teach DBT's key assessment concepts, but also, importantly, model the clinical decision making essential to helping clients with complex problems. This book facilitates the kind of learning that is typically available only through expert supervision. A 'must have' for training clinics.'--Kelly Koerner, PhD, Evidence-Based Practice Institute, Seattle, Washington 'Rizvi discusses an often overlooked but crucial ingredient of any effective intervention--assessment. This is not categorical diagnosis in the DSM tradition, but a thoroughgoing functional analysis of the controlling variables of the patient's problems. Rizvi's substantial clinical and research experience and her compelling, personal writing style make this book an essential source for graduate students, academics, clinical supervisors, and practitioners. The kind of functional analysis intrinsic to DBT is relevant to any cognitive-behavioral intervention.'--Gerald C. Davison, PhD, Department of Psychology, University of Southern California 'Chain analysis is the cornerstone of DBT, as successful treatment depends on accurate assessment of the problem. Through extensive clinical examples, this book richly illustrates the importance of chains as well as strategies for making them effective and engaging. For clients with PTSD, chain analysis will help to identify the factors that are maintaining PTSD as well as the potential role of PTSD as a controlling variable for other problem behaviors. Rizvi's expert tips will be invaluable to both new and seasoned DBT clinicians seeking to master this crucial DBT strategy.'--Melanie Harned, PhD, ABPP, VA Puget Sound Health Care System and Department of Psychiatry and Behavioral Sciences, University of Washington 'This masterful book tells us why and how to use chain analysis in optimal and suboptimal clinical conditions. Rizvi's incisive instructions are beautifully illustrated with vivid, realistic dialogues from therapy sessions. While chains are typically used to assess overt dysfunctional behaviors, Rizvi makes it perfectly clear how to apply them to covert behaviors such as problematic thoughts and action urges. The book offers a sophisticated explanation of how to pivot back and forth between chain analysis and other DBT strategies. Simply put, this book provides the most comprehensive and practical handling of chain analysis available, and should be standard reading for DBT therapists.'--Charles R. Swenson, MD, Department of Psychiatry, University of Massachusetts Medical School

Shireen L. Rizvi, PhD, ABPP, is Associate Professor of Clinical Psychology in the Graduate School of Applied and Professional Psychology at Rutgers, The State University of New Jersey. At Rutgers, she holds affiliate appointments in the Department of Psychology, School of Arts and Sciences, and the Department of Psychiatry, Robert Wood Johnson Medical School. Her research interests include improving outcomes, training, and dissemination of dialectical behavior therapy (DBT) for the treatment of complex and severe problems. Dr. Rizvi is board certified in Behavioral and Cognitive Psychology and in Dialectical Behavior Therapy. She is past president of the International Society for the Improvement and Teaching of DBT and was the Society's Conference Program Chair for 2 years. She has trained hundreds of practitioners from around the world in DBT. Dr. Rizvi is a recipient of the Spotlight on a Mentor Award from the Association of Behavioral and Cognitive Therapies and the Presidential Fellowship for Teaching Excellence from Rutgers.

1. The Basics of the Chain Analysis 2. Guidelines for Client Orientation and Collaboration for Chain Analyses 3. Getting to Know the Target Behavior: Assessing a Problem the First Time 4. Keeping the Client Engaged (and You Too!) 5. Incorporating Solutions into Chains 6. When a Behavior Isn't Changing 7. Chains on Thoughts, Urges, and Missing Behaviors 8. Chain Analyses in Consultation Teams, Skills Training, and Phone Coaching References Index

Dialectical behavior therapy is a cognitive theory-based intervention that has previously demonstrated effectiveness in treating a range of behavioral disorders. However, DBT can be challenging to implement in community-based settings. Little guidance is available on models to evaluate the effectiveness or sustainability of training and implementation efforts. Residential treatment programs have much to gain from introduction of evidence-based practices, but present their own challenges in implementation, including few resources, high staff turnover rates, and lack of flexibility in staff schedules.

We piloted a process evaluation model to assess multi-stage DBT training in five residential programs serving adults with mental health and substance use disorders. The model targets staff and organizational factors associated with successful implementation of evidence-based practices and matches low-resource data collection to the four stages of the DBT training model (Staff Training, Service Design, Implementation, and Maintenance). The evaluation aimed to assess staff knowledge retention post-DBT training, the role of organizational culture in implementation, and the fidelity of services delivered.

In Phase One, administrative and line staff in each program received 24 hours of team-based training, with group facilitators receiving an additional 3 hours of training. Following completion of the initial training, program staff complete a knowledge assessment that includes items on the core components and skills modules of DBT.

In Phase Two, the trainer facilitates the design of DBT service delivery in conjunction with the administrative and supervisory staff. This includes planning for ongoing fidelity monitoring, clarifying staff roles, and ensuring that adequate resources are provided for maintenance. Practical barriers and aspects of organizational culture that may present challenges to successful implementation are assessed.

Staff begin provision of DBT services in Phase Three, including individual skills coaching and group facilitation, along with DBT-informed clinical supervision and staff meetings, and fidelity monitoring activities. The trainer assists in troubleshooting operational and clinical issues, and provides initial intensive fidelity monitoring. The trainer titrates consultation based on the assessed level of service quality and fidelity to the DBT model. The evaluation activities in this phase focus on fidelity assessment, through direct observation of staff facilitating the DBT skills group, and measuring therapeutic alliance with clients.

In the fourth and final phase of implementation, a monthly team consultation meeting brings together staff from the previously-trained programs to enhance and reinforce their DBT skills and knowledge, and to prevent “drift” from the DBT model. These meetings function to extend clinician skills, support motivation, and to monitor burnout. Evaluation activities focused on elucidating the ways in which these team consultation meetings supported staff work with clients and the impact of DBT training on staff retention. Qualitative interviewing was utilized to explore the processes and impact of the meetings, along with analysis of secondary data from the agency human resources department to monitor staff turnover.

One of the main strengths of the evaluation model is that it maximizes the existent resources of a community agency, increasing the feasibility and sustainability of DBT. By matching data collection to each stage of the training and implementation, community providers receive timely feedback that allows them to address common pitfalls in the implementation process. While the lack of standardized instruments available in the published literature specific to DBT implementation represents a significant weakness in our assessment, we outline one example of a low-cost evaluation model to inform implementation of dialectical behavior therapy in residential treatment settings.

Amber M Holbrook
West Chester University, USA

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