Table of Contents

1. Getting Started in Therapy: Pretreatment and the Life-Worth-Living Conversation
2. Introducing DBT's Three Paradigms
3. The Acceptance Paradigm
4. The Change Paradigm
5. The Dialectical Paradigm
6. The DBT Tree: The Structural Anatomy of DBT
7. Goals, Stages, Targets, and Target Priorities
8. Dialectical Dilemmas and Secondary Targets
9. Case Conceptualization in DBT
10. Commitment and Commitment Strategies
11. Behavioral Chain Analysis
12. Validation
13. Dialectical Strategies
14. Skills and Skills Training
15. Prevention and Treatment of Therapist Burnout
Afterword

About the Author

Charles R. Swenson, MD, is Associate Clinical Professor of Psychiatry at the University of Massachusetts Medical School and maintains a private practice in psychiatry and psychotherapy with adults, families, and adolescents in Northampton, Massachusetts. He has been involved in the practice, supervision, training, and implementation of dialectical behavior therapy (DBT) in a wide range of mental health systems in the United States, Canada, and Europe for the past 25 years. He was the first professional authorized by Marsha M. Linehan to deliver intensive DBT training, is cofounder of the International Society for the Improvement and Teaching of DBT (ISITDBT), and has published numerous articles and book chapters on DBT. Dr. Swenson is a recipient of the Cindy J. Sanderson Outstanding Educator Award from ISITDBT and is a Distinguished Life Fellow of the American Psychiatric Association. His website is www.charlesswenson.com.

Reviews

"[Swenson] is a teacher’s teacher, a model for other experts in how to make DBT clear and accessible to experts and practitioners at all levels….There is no book out there quite like this: clear, deep, compelling, and at times funny. It is true to the model of DBT and at the same time personal, seeming as if you are in a supervision with him."--from the Foreword by Marsha M. Linehan, PhD, ABPP, Professor and Director Emeritus, Behavioral Research and Therapy Clinics, University of Washington; developer of DBT

"Swenson’s evocative clinical storytelling will spark and deepen your own empathy, creativity, and wisdom in therapy's most complex moments. Reading this book is like getting to play a pickup game with a buddy who happens to play professional basketball--the author is approachably humble, amazingly skilled, and he's on your team. Highly recommended."--Kelly Koerner, PhD, Evidence-Based Practice Institute, Seattle, Washington

"Even the most senior DBT therapist will undoubtedly become better after Swenson's DBT master class. Swenson uses clinical vignettes, personal stories, and superb teaching examples that breathe life into the most challenging elements of DBT. Readers will marvel at the abundance of wisdom that Swenson brings to bear in teaching clinicians how to precisely apply DBT principles in difficult situations, including how to capably conduct the 'life-worth-living' conversation with a suicidal client. From one of the leading clinical educators of our time, this book is a tour de force."--Alec L. Miller, PsyD, Cognitive and Behavioral Consultants, LLP, and Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center of the Albert Einstein College of Medicine

"The single best account of DBT principles in practice currently available. It reflects the author’s accumulation of decades of clinical experience, integrated into a compelling package. The book is highly accessible, exceptionally well informed, and clinically valuable for novices as well as experts. I recommend it for anyone wishing to practice or teach DBT."--Peter Fonagy, OBE, FMedSci, FBA, FAcSS, Head, Division of Psychology and Language Sciences, University College London, United Kingdom; Chief Executive, Anna Freud Centre

"This book allows the reader the opportunity to become a virtual member of Swenson's DBT consultation team. I have been lucky to work with Swenson during his brilliant DBT career, and the experience--as well as his gift for teaching--is well captured here."--Perry D. Hoffman, PhD, President, National Education Alliance for Borderline Personality Disorder

"This fantastic, much-needed book reflects Swenson's extensive experience practicing and teaching DBT, as well as his passion for improving therapists' competence in this complex treatment. Students and experienced clinicians alike will find value in this book's clear teaching points and poignant stories."--Shireen L. Rizvi, PhD, ABPP, Graduate School of Applied and Clinical Psychology, Rutgers, The State University of New Jersey

"If you ask for the world's leading DBT teachers, Swenson's name shows up near the very top. He was the first to take up the challenge of adapting DBT to settings such as inpatient units without losing its principles, spirit, and therapeutic power. His deep understanding of DBT principles enables him to balance treatment adherence with flexibility in adapting it to different populations and contexts. This book distills the essentials of two decades of practical wisdom in DBT. It’s a 'must' for every DBT therapist, or anyone who cares for patients with severe emotion dysregulation."--Martin Bohus, MD, Chair, Psychosomatics and Psychotherapy, Heidelberg University, Germany -In his new book…Dr. Charles Swenson shares the formidable clinical wisdom he has acquired through 30 years of clinical practice, teaching, and consulting in the conduct of DBT….This teaching text indeed represents a comprehensive master call in how to take the leap from being an adherent DBT practitioner to becoming a seasoned expert DBT clinician. Another title for this excellent book could have been 'The Art of Doing DBT,' for it provides an overarching synthesis of the concepts that drive in-the-moment clinical decisions about when to apply which DBT strategy. Swenson guides the clinician in developing his or her own personal dialectical sensibility that can inform clinical innovation within the frame of this widely researched, evidence-based treatment for treating suicidal and self-injurious behaviors in individuals diagnosed with borderline personality disorder….The individual chapters can stand alone as excellent resources for teaching, whether it is to instruct regarding treatment engagement with a suicidal patient with borderline personality disorder, working through impasses in treatment, avoiding clinician burnout, or how to conduct a behavioral analysis or understand the clinical application of learning theory and behaviorism to targeting impulsive, destructive behaviors….Given the stigma that the diagnosis of borderline personality disorder carries in the mental health field, Swenson's unswerving validation of and compassion for the extremely challenging patients he has worked with is the most powerful teaching example.--Journal of Psychiatric Practice, 7/1/2017Æ’Æ’The target audience is 'all DBT practitioners, including clinical psychologists, psychiatrists, clinical social workers, mental health counselors, and psychiatric nurses, as well as graduate students and trainees in these fields.' All of these professionals, if actively engaged in DBT, would benefit from this book, as many principles are best understood through application to a therapeutic relationship….It would have been helpful to have this book during my training, as I appreciate the precise and practical way in which it addresses the multiple conflicts and dilemmas that arise during DBT. The author is able to explain complicated matters in terms that are easy to understand and thus apply to patients. I highly recommend this book for anyone who is actively engaged in using DBT.--Doody's Review Service, 11/4/2016

"[Swenson] is a teacher’s teacher, a model for other experts in how to make DBT clear and accessible to experts and practitioners at all levels….There is no book out there quite like this: clear, deep, compelling, and at times funny. It is true to the model of DBT and at the same time personal, seeming as if you are in a supervision with him."--from the Foreword by Marsha M. Linehan, PhD, ABPP, Professor and Director Emeritus, Behavioral Research and Therapy Clinics, University of Washington; developer of DBT

"Swenson’s evocative clinical storytelling will spark and deepen your own empathy, creativity, and wisdom in therapy's most complex moments. Reading this book is like getting to play a pickup game with a buddy who happens to play professional basketball--the author is approachably humble, amazingly skilled, and he's on your team. Highly recommended."--Kelly Koerner, PhD, Evidence-Based Practice Institute, Seattle, Washington

"Even the most senior DBT therapist will undoubtedly become better after Swenson's DBT master class. Swenson uses clinical vignettes, personal stories, and superb teaching examples that breathe life into the most challenging elements of DBT. Readers will marvel at the abundance of wisdom that Swenson brings to bear in teaching clinicians how to precisely apply DBT principles in difficult situations, including how to capably conduct the 'life-worth-living' conversation with a suicidal client. From one of the leading clinical educators of our time, this book is a tour de force."--Alec L. Miller, PsyD, Cognitive and Behavioral Consultants, LLP, and Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center of the Albert Einstein College of Medicine

"The single best account of DBT principles in practice currently available. It reflects the author’s accumulation of decades of clinical experience, integrated into a compelling package. The book is highly accessible, exceptionally well informed, and clinically valuable for novices as well as experts. I recommend it for anyone wishing to practice or teach DBT."--Peter Fonagy, OBE, FMedSci, FBA, FAcSS, Head, Division of Psychology and Language Sciences, University College London, United Kingdom; Chief Executive, Anna Freud Centre

"This book allows the reader the opportunity to become a virtual member of Swenson's DBT consultation team. I have been lucky to work with Swenson during his brilliant DBT career, and the experience--as well as his gift for teaching--is well captured here."--Perry D. Hoffman, PhD, President, National Education Alliance for Borderline Personality Disorder

"This fantastic, much-needed book reflects Swenson's extensive experience practicing and teaching DBT, as well as his passion for improving therapists' competence in this complex treatment. Students and experienced clinicians alike will find value in this book's clear teaching points and poignant stories."--Shireen L. Rizvi, PhD, ABPP, Graduate School of Applied and Clinical Psychology, Rutgers, The State University of New Jersey

"If you ask for the world's leading DBT teachers, Swenson's name shows up near the very top. He was the first to take up the challenge of adapting DBT to settings such as inpatient units without losing its principles, spirit, and therapeutic power. His deep understanding of DBT principles enables him to balance treatment adherence with flexibility in adapting it to different populations and contexts. This book distills the essentials of two decades of practical wisdom in DBT. It’s a 'must' for every DBT therapist, or anyone who cares for patients with severe emotion dysregulation."--Martin Bohus, MD, Chair, Psychosomatics and Psychotherapy, Heidelberg University, Germany -In his new book…Dr. Charles Swenson shares the formidable clinical wisdom he has acquired through 30 years of clinical practice, teaching, and consulting in the conduct of DBT….This teaching text indeed represents a comprehensive master call in how to take the leap from being an adherent DBT practitioner to becoming a seasoned expert DBT clinician. Another title for this excellent book could have been 'The Art of Doing DBT,' for it provides an overarching synthesis of the concepts that drive in-the-moment clinical decisions about when to apply which DBT strategy. Swenson guides the clinician in developing his or her own personal dialectical sensibility that can inform clinical innovation within the frame of this widely researched, evidence-based treatment for treating suicidal and self-injurious behaviors in individuals diagnosed with borderline personality disorder….The individual chapters can stand alone as excellent resources for teaching, whether it is to instruct regarding treatment engagement with a suicidal patient with borderline personality disorder, working through impasses in treatment, avoiding clinician burnout, or how to conduct a behavioral analysis or understand the clinical application of learning theory and behaviorism to targeting impulsive, destructive behaviors….Given the stigma that the diagnosis of borderline personality disorder carries in the mental health field, Swenson's unswerving validation of and compassion for the extremely challenging patients he has worked with is the most powerful teaching example.--Journal of Psychiatric Practice, 7/1/2017ƒƒThe target audience is 'all DBT practitioners, including clinical psychologists, psychiatrists, clinical social workers, mental health counselors, and psychiatric nurses, as well as graduate students and trainees in these fields.' All of these professionals, if actively engaged in DBT, would benefit from this book, as many principles are best understood through application to a therapeutic relationship….It would have been helpful to have this book during my training, as I appreciate the precise and practical way in which it addresses the multiple conflicts and dilemmas that arise during DBT. The author is able to explain complicated matters in terms that are easy to understand and thus apply to patients. I highly recommend this book for anyone who is actively engaged in using DBT.--Doody's Review Service, 11/4/2016