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This paper has been written following an influential therapeutic encounter that we experienced while working with an emotionally distressed woman. The barriers that can get in the way of providing a structured therapeutic approach are discussed. The paper focuses on dialectical behaviour therapy as a treatment model, and discusses how the concept of ‘dialectics’ provide an over‐riding context for case conceptualisation (Linehan, 1993). The dialectical dilemmas and powerful dynamics that can be enacted between individuals, teams and patients in their endeavours to cope with distress will be illustrated. The dialectical philosophy is described and elaborated upon, providing a framework for the synthesis of clinical interpersonal encounters and metaphorical concepts of a therapy seesaw. The paper discusses how these ideas can guide us in our work with emotionally distressed individuals.

A forensic service in Pueblo, Colorado, USA has successfully introduced a dialectical behaviour therapy (DBT) model of cognitive behavioural therapy which has been an integral part of the therapeutic programme since the mid‐1990s. The introduction of DBT to a forensic patient population has resulted in improvement of service user involvement with therapy, a possible solution to addressing staff burn‐out and a potential mode of treatment to encompass a range of diagnostic categories.DBT is a psychological intervention to help change an individual's distorted cognitions and assist the development of coping strategies. The emphasis of DBT in this instance is upon treating life‐threatening behaviour exhibited by patients in a forensic setting. A quasi‐experimental study comparing DBT with treatment as usual, conducted over a 20‐month period, helped this service to validate the therapy as an appropriate form of treatment for this patient population.

Dialectical behaviour therapy (DBT) (Linehan, 1993) is a comprehensive psychological treatment that was first developed for suicidal individuals with a diagnosis of borderline personality disorder. The model has successfully been used to address violence and aggression in a forensic setting (Evershed et al, 2003). The National High Secure Learning Disability Service (NHSLDS) piloted an adapted DBT programme suitable for men with mild learning/intellectual disabilities in 2004, and the programme has been developed over a period of six years. This paper describes the rationale for development of the programme, how the programme has evolved, the major modifications to mainstream DBT that it incorporates, and the challenges that remain.

Autism spectrum conditions (ASC) and borderline personality disorder (BPD) have overlapping symptom profiles. Dialectical behaviour therapy (DBT) is an established treatment for self-harm and BPD, but little research has investigated the outcomes of DBT for ASC populations. This exploratory service evaluation aims to investigate the outcomes of a comprehensive DBT programme for adolescents with a diagnosis of emerging BPD and a co-occurring ASC diagnosis as compared to those without an ASC diagnosis.

Differences from the start to end of treatment in the frequency of self-harming behaviours, BPD symptoms, emotion dysregulation, depression, anxiety, the number of A&E attendances and inpatient bed days, education and work status, and treatment non-completion rates were analysed for those with an ASC diagnosis, and compared between those with an ASC diagnosis and those without.

Significant medium to large reductions in self-harming behaviours, BPD symptoms, emotion dysregulation and inpatient bed days were found for those with an ASC diagnosis by the end of treatment. There were no significant differences between those with an ASC and those without in any outcome or in non-completion rates. These findings indicate that DBT may be a useful treatment model for those with an ASC diagnosis, though all results are preliminary and require replication.

To the best of the authors’ knowledge, this is the first study to report the outcomes of a comprehensive DBT programme for adolescents with an ASC diagnosis, and to compare the changes in outcomes between those with a diagnosis and those without.

Despite some advances in the assessment and treatment of autism spectrum disorder (ASD), there remains a paucity of intervention and research literature in treating adults with ASD. There is growing evidence supporting a relationship between the core features of ASD and emotion dysregulation. There is an overlap between ASD and borderline personality disorder (BPD) characteristics such as emotional dysregulation, sensory issues and social skills deficits. This paper aims to explore the applications of dialectical behaviour therapy (DBT) concepts and skills in treating ASD individuals who display challenging or offending behaviours. The similarities in characteristics between ASD and BPD and the core issue of emotion dysregulation hold promise in the utility of DBT with ASD.

This is a conceptual paper that includes a case vignette.

A DBT-informed treatment approach using the adaptations and reconceptualization, i.e. risky mind–wise mind outlined in this paper, can be considered promising in addressing issues for ASD individuals, particularly those with challenging and/or offending behaviours. DBT incorporates different elements of applied behaviour analysis, cognitive behavioural therapy, mindfulness skills, sensory-based treatments, psychosocial interventions and emotion regulation skills, which makes it a more cohesive and integrated approach to treatment. The authors assert that DBT can be considered a more integrated, strengths-based, habilitative and trauma-informed approach which can be promising in its application to address challenging behaviours or offending in ASD individuals.

It is recommended that research be carried out to evaluate the effectiveness of adapted DBT programs in treating ASD individuals presenting with challenging and/or offending behaviours. Future research can focus on evaluating the effectiveness of the different DBT concepts and skills and the different DBT modules to determine which components of the program are particularly useful for this client group.

Treatment manuals have already been developed for clients with intellectual disability and developmental disabilities who exhibit challenging and/or offending behaviour; hence, it is recommended that modifications be made to make it more applicable and appropriate for ASD individuals. Modifications should address ASD-specific issues (e.g. black and white thinking, cognitive rigidity, sensory issues, impaired theory of mind, emotion dysregulation issues, social skills deficits and anxiety issues). The use of DBT has much wider implications regarding addressing comorbid mental health conditions and personality issues in this client group.

There are limited psychological interventions that prove to be useful for individuals with ASD with complex presentations and challenging or offending behaviours. This paper discusses the application of adapted DBT concepts and skills that appear to be promising in the treatment of this client group.

Dialectical behaviour therapy (DBT) has been widely used in a number of different settings with published outcomes and literature supporting its validity and efficacy. What is less understood is DBT’s application to forensic populations. The purpose of this paper is to qualitatively explore the experiences of high risk and adult male forensic clients (diagnosed with borderline personality disorder (BPD) and antisocial personality disorder (ASPD)) in a forensic adapted version of DBT.

Six clients who had completed four modules of DBT and individual therapy engaged in semi-structured interviews which were transcribed and analysed using thematic analysis.

The findings identified emerging themes relating to group processes and treatment outcomes. Specifically, the importance of motivation, shared learning, professionalism, reinforcement and reflection in creating a positive experience of DBT were identified. In addition clients identified feeling supported, a sense of belonging, personal achievement, increased knowledge and skills application as being part of their experience of DBT.

Whilst efforts were made to manage limitations, potential confounders include the impact of the researcher’s direct involvement in the facilitation of DBT and the small sample size.

This study provides support for the use of DBT with forensic males diagnosed with ASPD and BPD and the importance of the group component to the treatment modality. It emphasises the importance of group cohesion and the development of interpersonal factors including feeling supported, sense of belonging and a sense of achievement.

This paper provides a unique contribution to the understanding of the application of DBT with forensic male clients with personality disorder. It is the first known study to use qualitative methods to explore forensic male clients’ experiences of group and individual DBT. This paper provides insight into the key themes of clients’ experiences of DBT. These identified themes lend support to the importance of motivation of clients and the experience of shared learning, reinforcement and reflection. Furthermore, feeling supported, having a sense of belonging and a sense of personal achievement were identified as key to the positive experience of clients.

This paper aims to present preliminary findings regarding the types of adaptations made to dialectical behavior therapy (DBT) and their effectiveness in working with a population who have both intellectual disabilities and mental illnesses.

A pilot study conducted with adolescent clients in a day treatment program was completed in an effort to determine the effectiveness of dialectical behavior therapy for special populations (DBT‐SP). The study utilized all three components of DBT, in addition to the normal milieu management techniques. As such, clients received DBT‐SP focused individual therapy, skills training groups using the DBT‐SP skills training manual, and the whole treatment team staff participated in a DBT‐SP supervision/consultation group. Observations of client behavior by staff, client outcome when leaving the program, and daily diary card information was collected.

Although there are a number of issues that must be addressed when providing psychotherapy to individuals with intellectual disabilities and mental illnesses, many psychotherapeutic techniques are effective if they are suitably modified (Bütz et al., 2000; Nezu and Nezu, 1994) as has been found with DBT‐SP.

As with most pilot studies, there are many limitations to the data. While each client serves as his/her own control, there is no random control group as all the youths receive DBT‐SP. Further, DBT‐SP is used in conjunction with other techniques and the study lacks the ability to control for any additional factors in the students' environment that may influence their behavior. In addition, clients enter and leave the program at different times, and so the data gathered can be hard to interpret. Thus, far, the data are suggestive, but not conclusive, regarding the effectiveness of DBT‐SP.

The information in this paper will be useful to therapists providing treatment to clients with intellectual disabilities and mental illnesses.

The purpose of this paper is to explore the lived experiences of staff and service-users regarding the introduction of dialectical behaviour therapy (DBT) into an NHS forensic learning disability (LD) service.

Drawing on data from two recent qualitative research studies, the research team used a case-oriented approach to see beyond original findings to capture the shared experiences of the participants’ journeys, thus giving a deeper insight to the commonalities of the participants’ voices which is rarely reported in the literature (Sandelowski, 2011).

A common set of phenomena became apparent when the cases were analysed, these included: trust, intensity and worthwhile. It is intended this paper gives some opportunity for reflection and shared empathetic responses to the similar experiences discussed.

The case-orientated analysis adds value to the evidence base by highlighting the importance of the qualitative voice of both the staff and service user. This is important because most available literature reflects the process of setting up a team or DBT service, rather than describing the team experience. Equally, most published literature regarding the effectiveness of DBT is not written from the perspective of the people who receive the therapy.

There is growing literature on the application of Dialectical Behaviour Therapy (DBT) with adults with intellectual disabilities (IDs). To draw upon the evidence-base from mainstream approaches, adapted interventions must remain true to their theoretical foundations and retain key components. The purpose of this paper was to establish the extent to which DBT has been adapted for adults with ID, and whether existing adapted protocols can still be considered DBT.

The theoretical underpinnings and key components of DBT were identified. Six DBT studies were critiqued according to these criteria.

In terms of content, only one intervention comprised all necessary elements. All of the remaining interventions included a skills group; two included individual therapy and another two included group consultation. None of the remaining interventions provided 24-h telephone support. Furthermore, none of the studies explicitly described using dialectical strategies.

To the best of the authors’ knowledge, this is the first paper to critically examine the evidence-base for the use of DBT in ID, particularly its fidelity.

This paper aims to explore why a course with similar content feels different when delivered in a Recovery College as compared to an NHS therapy.

It is offered as a case study based on reflections from several perspectives.

This novel approach emphasises predictable factors such as the educational and recovery focussed environment. It also contributes further to thinking around how relationships are differently navigated and developed in Recovery Colleges compared to NHS settings.

The reflections are offered to act as a stimulus to promote wider conversations about how Recovery Colleges effect change, with an emphasis on comparing how relationships and power are influenced for those involved. This paper considers this in relation to the Mechanisms of Action identified in Toney et al., 2018 paper.