For years I worked in a state hospital and a community mental health center. One thing I noticed early on was that when staff found a client to be difficult or resistant — or even just hard to like — too often they gave a diagnosis of borderline. Sometimes it would happen just because a client made a choice that her therapist didn’t like: Suddenly, the therapist would give a new, unjustified diagnosis. I am grateful to psychologist Marsha Linehan for helping to change this dynamic when she developed a new form of called (DBT) in the late 1980s. Now, this researcher, Zen master, teacher, and therapist has published a new, compassionate book on DBT as well as an accompanying book of worksheets. Some time ago, I visited an adolescent inpatient facility to look at a program for teenagers who had picked up the borderline tag along the way. The facility had incorporated DBT into its program — and even if the diagnosis may have been the same, the tone was markedly different. Instead of “borderline,” staff described the teens as “passionate personalities.” The teens seemed to prefer it. Throughout Linehan’s DBT Skills Training Manual, Second Edition, she talks about using skills such as mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance not just for the clients but for yourself, the mental health practitioner, the teacher of these skills. She goes over the roles, boundaries, and responsibilities of the therapist, skills trainers, case managers, pharmacotherapists, nurses, line staff, and, of course, the client/participant. I am grateful to psychologist Marsha Linehan for. Guilford has published a second edition of Linehan’s DBT Skills Training. DBT Skills Training Manual. University of Oslo. She gives some flexibility to allow for individual differences of participants. Training can be done individually, but Linehan emphasizes group work, and discusses the advantages of open versus closed groups and the need for two trainers (and the role of each). The service is truly wrap-around. This second edition covers and implements the enormous amount of research on DBT since the original volume was published in 1993. Since then, DBT has moved beyond a focus only on borderline and high suicide risk to an effective evidence-based treatment for, treatment-resistant, problem drinking, and many other issues. The 2014 book is much more detailed than the earlier edition, and includes research on the effectiveness of the training. Skills training can also be incorporated into any therapy, whether or not the focus is DBT, and I have begun to use exercises and work from this book in my own practice. Linehan gives a lot of credit to the individuals she has worked with over the years and all that they have taught her.
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