Read Online Dialectical Behavior Therapy for Binge Eating and Bulimia by Debra L. Safer, Christy F. Telch, Eunice Y. Chen - Free Book Online
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enhances commitment by emphasizing the client’s choice to do whatever he or she wishes while highlighting the lack of effective alternatives.
Treatment Team Consultation Strategies The primary strategy here is a weekly meeting of therapists. The purposes of these team consultation meetings are (1) to review and evaluate adherence to the proto— col; (2) to “treat the therapist” by providing a nonjudgmental environment for each therapist to observe and describe his or her own behavior, thoughts, and feelings regarding the week’s sessions and for other team members to provide nonjudgmental feedback, validation, and suggestions for change; and (3) to discuss how best to handle any therapy-interfering behaviors on the part of any group members or clients receiving individual therapy.
Structural Strategies
Treatment is structured or organized around the specifc targets outlined in the treatment target hierarchy (Chapter 3, Appendix 3.2). The targets include both problem eating behaviors that must stop and the skills that must be learned in order to accomplish this. By orienting clients to the skills being taught and how to use them, the therapist bridges the gap between the client’s goal of stopping binge eating and the client’s learning of the new skills. For example, the therapist might say: “OK—so this is what you can do when you’re feeling depressed if you don’t want to feel that way. Opposite action means doing the opposite of what your mood is telling you to do. So the opposite of depression—which tells you to withdraw and to stay inactive—is getting active.” Therapists give clear instructions as to how clients can apply the skills being taught rather than assuming that clients possess this ability.
26
DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA
STRUCTURE OF GROUP SESSIONS
As described briefy, this adapted treatment combines elements of the functions of two distinct modalities in standard DBT: individual psychotherapy (enhance— ment of motivation) and group skills training (acquisition/strengthening of new skills).2 With much to accomplish, each 2-hour weekly group session should start on time, whether or not all group members are present. Therapists begin by greet— ing the group. If a group member arrives late or has missed a previous session, she or he is asked to briefy state what occurred as part of her or his turn during the homework review. This attention to behavior that interferes with receiving treatment is very important, and absences or late arrivals should not be ignored. But after this brief attention, therapists should move on. If a group member is not present and is expected, one of the cotherapists may call to check in and encourage the client to attend the group. With clients who are repeatedly absent or late, group leaders should use their judgment and may wish to address this privately with the group member in a brief phone call or an in-person meeting. If necessary, a chain analysis will be performed targeting this therapy-interfering behavior.
Homework Review: Diary Cards and Chain Analyses
Chapter 3 discusses the structure of the homework review in greater detail. Briefy, the frst half of each session (50 minutes for group sessions, 25 minutes for individual sessions) is devoted to a review of the past week’s skills practice and chain analyses conducted on targeted behaviors. In the group format, each group member should have about 5 minutes to report on her or his use of the new skills and to describe specifc successes or diffculties in applying the skills to replace problem eating behaviors. The therapists check with each group member to make sure she or he can explain what skills were used, how she or he used them, and whether they were effective. Group members should be encouraged to help one another iden— tify solutions to problems encountered in applying the skills and to “cheerlead” the efforts each fellow group member
Treatment Team Consultation Strategies The primary strategy here is a weekly meeting of therapists. The purposes of these team consultation meetings are (1) to review and evaluate adherence to the proto— col; (2) to “treat the therapist” by providing a nonjudgmental environment for each therapist to observe and describe his or her own behavior, thoughts, and feelings regarding the week’s sessions and for other team members to provide nonjudgmental feedback, validation, and suggestions for change; and (3) to discuss how best to handle any therapy-interfering behaviors on the part of any group members or clients receiving individual therapy.
Structural Strategies
Treatment is structured or organized around the specifc targets outlined in the treatment target hierarchy (Chapter 3, Appendix 3.2). The targets include both problem eating behaviors that must stop and the skills that must be learned in order to accomplish this. By orienting clients to the skills being taught and how to use them, the therapist bridges the gap between the client’s goal of stopping binge eating and the client’s learning of the new skills. For example, the therapist might say: “OK—so this is what you can do when you’re feeling depressed if you don’t want to feel that way. Opposite action means doing the opposite of what your mood is telling you to do. So the opposite of depression—which tells you to withdraw and to stay inactive—is getting active.” Therapists give clear instructions as to how clients can apply the skills being taught rather than assuming that clients possess this ability.
26
DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA
STRUCTURE OF GROUP SESSIONS
As described briefy, this adapted treatment combines elements of the functions of two distinct modalities in standard DBT: individual psychotherapy (enhance— ment of motivation) and group skills training (acquisition/strengthening of new skills).2 With much to accomplish, each 2-hour weekly group session should start on time, whether or not all group members are present. Therapists begin by greet— ing the group. If a group member arrives late or has missed a previous session, she or he is asked to briefy state what occurred as part of her or his turn during the homework review. This attention to behavior that interferes with receiving treatment is very important, and absences or late arrivals should not be ignored. But after this brief attention, therapists should move on. If a group member is not present and is expected, one of the cotherapists may call to check in and encourage the client to attend the group. With clients who are repeatedly absent or late, group leaders should use their judgment and may wish to address this privately with the group member in a brief phone call or an in-person meeting. If necessary, a chain analysis will be performed targeting this therapy-interfering behavior.
Homework Review: Diary Cards and Chain Analyses
Chapter 3 discusses the structure of the homework review in greater detail. Briefy, the frst half of each session (50 minutes for group sessions, 25 minutes for individual sessions) is devoted to a review of the past week’s skills practice and chain analyses conducted on targeted behaviors. In the group format, each group member should have about 5 minutes to report on her or his use of the new skills and to describe specifc successes or diffculties in applying the skills to replace problem eating behaviors. The therapists check with each group member to make sure she or he can explain what skills were used, how she or he used them, and whether they were effective. Group members should be encouraged to help one another iden— tify solutions to problems encountered in applying the skills and to “cheerlead” the efforts each fellow group member
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