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Article
Publication date: 1 August 2004

Kirsty Talkes and Allison Tennant

This paper has been written following an influential therapeutic encounter that we experienced while working with an emotionally distressed woman. The barriers that can…

Abstract

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.

Details

The British Journal of Forensic Practice, vol. 6 no. 3
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 1 May 2003

Stuart Wix

A forensic service in Pueblo, Colorado, USA has successfully introduced a dialectical behaviour therapy (DBT) model of cognitive behavioural therapy which has been an…

Abstract

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.

Details

The British Journal of Forensic Practice, vol. 5 no. 2
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 24 January 2011

Catrin Morrissey and Bridget Ingamells

Dialectical behaviour therapy (DBT) (Linehan, 1993) is a comprehensive psychological treatment that was first developed for suicidal individuals with a diagnosis of…

Abstract

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.

Details

Journal of Learning Disabilities and Offending Behaviour, vol. 2 no. 1
Type: Research Article
ISSN: 2042-0927

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Article
Publication date: 13 February 2017

Samantha Russell and Belinda Siesmaa

Dialectical behaviour therapy (DBT) has been widely used in a number of different settings with published outcomes and literature supporting its validity and efficacy…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Practical implications

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.

Originality/value

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.

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Article
Publication date: 16 September 2011

Margaret Charlton and Eric J. Dykstra

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Originality/value

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

Details

Advances in Mental Health and Intellectual Disabilities, vol. 5 no. 5
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 13 June 2016

Paula Johnson and Michaela Thomson

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…

Abstract

Purpose

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.

Design/methodology/approach

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).

Findings

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.

Originality/value

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.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 7 no. 2
Type: Research Article
ISSN: 2050-8824

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Article
Publication date: 5 March 2020

Christopher Patterson, Jonathan Williams and Robert S.P. Jones

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…

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Abstract

Purpose

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.

Design/methodology/approach

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

Findings

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.

Originality/value

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.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 14 no. 3
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 4 August 2021

Toni King, Joanna Dawson, Francess SmilleyAnderson and Richard Taylor

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.

Abstract

Purpose

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.

Design/methodology/approach

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

Findings

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.

Originality/value

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.

Details

Mental Health and Social Inclusion, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2042-8308

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Article
Publication date: 29 April 2014

Aubrey Baillie and Sean Slater

The purpose of this paper is to reflexively examine the challenges of implementing a community dialectical behaviour therapy (DBT) service for adults with intellectual…

Abstract

Purpose

The purpose of this paper is to reflexively examine the challenges of implementing a community dialectical behaviour therapy (DBT) service for adults with intellectual disabilities (ID) and describes the practical lessons learned about how to maximise the effectiveness of DBT with this client group.

Design/methodology/approach

A brief overview of DBT is provided and reference is made to literature which highlights the potential benefits of providing a DBT service to clients with an ID. This is followed by a discussion of the clinical presentation of the clients receiving DBT in the service that is the focus of this case study. Using a reflexive approach, a detailed discussion follows of the challenges faced in implementing a community DBT service for the clients served.

Findings

Solutions to a variety of challenges faced in four years of service delivery are described, key lessons learned are highlighted, together with issues meriting further research.

Research limitations/implications

This case study and its implications are limited to community DBT services. Another limitation is that, although outcome data have been collected over the past two years, the dataset is not yet large enough to draw statistical conclusions.

Practical implications

The paper describes adaptations to treatment structure and strategy which the authors believe are necessary to improve treatment outcomes in community DBT services for adults with ID. In particular, the practical experience suggests that a didactic approach to teaching DBT skills is not effective and should be replaced by the “community of learners” approach that involves the trainer contingently responding to client input. Pre-set lesson plans inhibit the trainers’ ability to respond contingently.

Originality/value

The existing literature on providing a DBT service for people with an ID has principally focused on providing a rationale for providing this type of intervention, and on assessing outcomes. Given that this is still a relatively new type of provision for this client group, a detailed examination of process issues is called for.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 8 no. 3
Type: Research Article
ISSN: 2044-1282

Keywords

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Article
Publication date: 18 December 2019

Ella Hancock-Johnson, Charlotte Staniforth, Lucy Pomroy and Kieran Breen

Dialectical behaviour therapy (DBT) aims to reduce emotional dysregulation and engagement in less adaptive behaviours for adults with mixed disorders of conduct and…

Abstract

Purpose

Dialectical behaviour therapy (DBT) aims to reduce emotional dysregulation and engagement in less adaptive behaviours for adults with mixed disorders of conduct and emotions (MDCE). However, there is limited evidence available for the effectiveness of DBT skills training for adolescents with MDCE who are resident within a secure impatient setting. The paper aims to discuss these issues.

Design/methodology/approach

A retrospective study investigated changes in aggressive and self-injurious behaviours in 22 adolescents within a secure inpatient mental health setting with MDCE who had completed one cycle of DBT skills training. Changes in symptomatic problems, behavioural and social impairment were also investigated in 17 of the 22 participants who completed the DBT skills training cycle.

Findings

There were statistically significant decreases in the frequencies of engagement in total aggressive and deliberate self-harm behaviours after the DBT skills training cycle. There was a significant improvement in symptomatic and behavioural impairment, but not in social impairment.

Practical implications

The findings of this study suggest that DBT skills training may be beneficial for behavioural and symptomatic outcomes in adolescent inpatients with MDCE.

Originality/value

This study provides preliminary evidence for the effectiveness of DBT skills training for adolescents with MDCE within a secure inpatient setting. Additional studies are required to investigate the clinical benefits of specific aspects of DBT for individual patients.

Details

Journal of Forensic Practice, vol. 22 no. 1
Type: Research Article
ISSN: 2050-8794

Keywords

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