Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

27. Dialectical Behavior Therapy 627For example, if a client is feeling guilty for disagreeing with a friend, the oppositeaction skill would be to teach the client to ask him- or herself first whetherthe behavior was egregious according to his or her own values. If the disagreementwas done in a manner inconsistent with the client’s values (e.g., disrespectfullyand judgmentally disagreeing), then a repair (e.g., apology) would besuggested as a way to lower justified guilt. However, if the disagreement did notviolate the client’s values and guilt was unjustified (i.e., respectfully and nonjudgmentallydisagreeing), then the client would be instructed not to repair butto repeat the behavior (i.e., effective opinion giving) multiple times. As the clientlearns that giving opinions does not always result in negative outcomes,over time, the unjustified guilt response to disagreeing effectively would extinguish.Interpersonal EffectivenessBecause chaotic interpersonal relationships are a key characteristic of BPD, thedevelopment of interpersonal skills is crucial. This skill module teaches clientshow to identify factors interfering with interpersonal effectiveness, challengecommon cognitive distortions associated with interpersonal situations, anddetermine the appropriate level of intensity for making requests or saying “no” agiven situation. Specific guidelines for being taken seriously, attending to relationships,and preserving self-respect are taught, and clients are instructed topractice developing new interpersonal skills based on these guidelines in a widevariety of situations, including frequent rehearsal and role playing during groupand individual sessions. When teaching interpersonal effectiveness in DBT-SUD, the specific skills taught are designed to avoid drug-using contexts (e.g.,drug refusal interpersonal skills) and to respond effectively when such contextscannot be avoided (e.g., craving tolerance skills).Individual TherapyIndividual therapy sessions with a DBT-SUD therapist are typically 50–60 minutesonce per week. The individual therapist provides psychoeducational informationto the client early in treatment, including handouts that describe thepros and cons of participating in DBT-SUD compared to other treatments andfacts about drug addiction. However, a primary function of individual therapy isto develop and maintain client motivation to overcome obstacles to change. Avalidating environment is created, whereby clients are treated with compassionand acceptance in the context of targeting behavioral change. Factors interferingwith progress in treatment are discussed, preventing problems that mightinterfere with the development of new skills and helping clients remain intreatment despite urges to dropout. Episodes of emotional dysregulation fromthe previous week are discussed in light of skills that could have been used. In