Read Online Dialectical Behavior Therapy for Binge Eating and Bulimia by Debra L. Safer, Christy F. Telch, Eunice Y. Chen - Free Book Online Page B
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skills, and commit to the plan to overcome obstacles to skills practice (including self-criticism for lack of practice) for the upcoming week. Therapists must be careful not to join in punishing or criticizing the client but help her or him to recommit to practice. Therapists should describe and validate any successes described, as well as failures. This may mean validating how diffcult it can be to use the skills under extremely stressful condi— tions. If therapists are judgmental about group members’ diffculties, clients may feel free to share only successes.
Therapists may suggest to clients who repeatedly fail to practice the skills that they use the chain analysis form to analyze this problem. In other words, lack of skills practice is the targeted problem (treatment-interfering behavior) analyzed in detail via a chain analysis. Conducting a chain analysis is a skilled behavior in and of itself, and helping clients to develop this skill is key to adaptive behavior.
Therapists must search for and praise every small approximation of using the skills. For example, therapists can distinguish between the client’s attempts to use the skills and the outcome. Praise should be offered for effort, followed by helping
28
DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA the client analyze what happened, what interfered, and how the client can be more effective with the use of skills the next time.
Therapists should watch for any clients who always use the same skill. In such cases, remind clients that the objective is to develop the ability to use each skill. Once a skill is learned, clients can choose not to use it. But experience with all the skills allows clients to make informed decisions about whether or not a particular skill is best for them given the circumstances.
In summary, problems that come up in the homework review can be addressed by briefy:
1. Formulating hypotheses about the possible factors involved in producing the problem behavior.
2. Generating skills solutions by asking, “What skills could you have used here?”
3. Encouraging group members to commit to trying out the skills solutions suggested.
In our research setting, at the end of the review of skills practice, therapists collect any diary cards, homework sheets, chain analyses, and so forth.
Break
During 2-hour group sessions, a 5-to 8-minute break should take place after the homework review to allow group members to use the restroom, get a drink of water, stretch, and so forth. Inform the group members that the second half of the session will begin promptly to allow a full hour during which instruction and practice of the new skills can take place.
Skills Instruction
In general, teaching each skill involves: 1. Providing an explanation or rationale for including the skill in this treat-ment program—that is, explaining to clients why this skill is being taught, why it is important, and how it is relevant to clients’ goals of stopping binge eating and gaining control over problem eating behaviors.
2. Skill acquisition—describing the skill and specifc steps for learning the skill.
3. Skill strengthening—demonstrating how to practice the skill and providing opportunities to practice that skill during the group sessions.
4. Skill generalization—providing suggestions for using skills during daily life. Therapists should enlist clients in generating ideas about how skills can be used to replace binge eating and other problem behaviors when emo-tions are dysregulated.
The teaching of skills is facilitated by the use of handouts and homework mate— rials. The idea is to make learning the skills relevant to clients’ lives. To make sure
Orientation for Therapists
29
group members are active and involved in the discussion, therapists should ask questions that check for skill comprehension and to enlist ideas for skill utilization. To facilitate comprehension, therapists should focus on making a few key points, using the
Therapists may suggest to clients who repeatedly fail to practice the skills that they use the chain analysis form to analyze this problem. In other words, lack of skills practice is the targeted problem (treatment-interfering behavior) analyzed in detail via a chain analysis. Conducting a chain analysis is a skilled behavior in and of itself, and helping clients to develop this skill is key to adaptive behavior.
Therapists must search for and praise every small approximation of using the skills. For example, therapists can distinguish between the client’s attempts to use the skills and the outcome. Praise should be offered for effort, followed by helping
28
DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA the client analyze what happened, what interfered, and how the client can be more effective with the use of skills the next time.
Therapists should watch for any clients who always use the same skill. In such cases, remind clients that the objective is to develop the ability to use each skill. Once a skill is learned, clients can choose not to use it. But experience with all the skills allows clients to make informed decisions about whether or not a particular skill is best for them given the circumstances.
In summary, problems that come up in the homework review can be addressed by briefy:
1. Formulating hypotheses about the possible factors involved in producing the problem behavior.
2. Generating skills solutions by asking, “What skills could you have used here?”
3. Encouraging group members to commit to trying out the skills solutions suggested.
In our research setting, at the end of the review of skills practice, therapists collect any diary cards, homework sheets, chain analyses, and so forth.
Break
During 2-hour group sessions, a 5-to 8-minute break should take place after the homework review to allow group members to use the restroom, get a drink of water, stretch, and so forth. Inform the group members that the second half of the session will begin promptly to allow a full hour during which instruction and practice of the new skills can take place.
Skills Instruction
In general, teaching each skill involves: 1. Providing an explanation or rationale for including the skill in this treat-ment program—that is, explaining to clients why this skill is being taught, why it is important, and how it is relevant to clients’ goals of stopping binge eating and gaining control over problem eating behaviors.
2. Skill acquisition—describing the skill and specifc steps for learning the skill.
3. Skill strengthening—demonstrating how to practice the skill and providing opportunities to practice that skill during the group sessions.
4. Skill generalization—providing suggestions for using skills during daily life. Therapists should enlist clients in generating ideas about how skills can be used to replace binge eating and other problem behaviors when emo-tions are dysregulated.
The teaching of skills is facilitated by the use of handouts and homework mate— rials. The idea is to make learning the skills relevant to clients’ lives. To make sure
Orientation for Therapists
29
group members are active and involved in the discussion, therapists should ask questions that check for skill comprehension and to enlist ideas for skill utilization. To facilitate comprehension, therapists should focus on making a few key points, using the
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