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

632 V. TREATMENTS FOR ADDICTIONSTABLE 27.5. Dialectical Strategies Used in Dialectical Behavior Therapy1. Acceptance and change-focused interventions2. Nurturing the patient and demanding that patients help themselves3. Being stable and persistent, as well as flexible4. Highlighting patient’s strengths and deficits5. Structuring session with an agenda, and responding to in-session patient behaviors asthey occur6. Highlighting both ends of continua, and making synthesizing statements7. Pointing out paradoxes when present (e.g., patient’s behavior, therapeutic process)8. Using metaphors9. Playing the devil’s advocate10. Extending the seriousness or implications of patient’s communication11. Helping patient activate “wise mind”12. Helping make lemonade out of lemons13. Allowing natural changes in therapyNote. Adapted from Linehan (1993a, p. 206). Copyright 1993 by The Guilford Press. Adapted by permission.change problem behaviors. This approach probably helps reduce therapist burnout,and also helps ensure a validating and warm therapeutic environment. Inaddition, dialectical strategies are used in a manner that is often unpredictableto the client, and when any specific strategy does not help bring about new clientbehavior, another strategy is used.Telephone ConsultationClients with BPD and substance abuse problems experience a profound sense ofsuffering. Between treatment sessions, there often are times when emotionalpain (e.g., shame) and dysregulation occur, or events transpire that historicallyhave prompted drug use. To reduce the effects of emotional dysregulation in theclient’s natural environment, to prevent substance abuse, and, more broadly, toenhance generalization of skills, clients are encouraged to contact their individualtherapists on an ad hoc basis for brief telephone consultation between sessions.On the one hand, because these individuals may experience unrelentingcrises, therapists observe personal limits associated with telephone consultation.Clients call for help in implementing skills in necessary situations, ideallybefore crises occur. On the other hand, many DBT-SUD clients, particularlythose who are less attached to their therapists, will infrequently use the telephonefor skills coaching. As a result, some clients not only are encouraged tocall but also will be asked to practice calling their therapist between sessions. Inall consultation calls, therapists assess for immediate danger and provide appropriateassistance if the client is deemed to be in imminent danger of harminghim- or herself or others.