Dialectical behavior therapy (DBT) has been shown effective for the treatment of borderline personality disorder (BPD) and other high-risk, suicidal, and diagnostically complex populations. However, little has been written about how to train therapists in DBT's highly structured framework of target hierarchies, behavioral chain analyses, and stylistic strategies. This case study illustrates the utility of a live supervision method known as "bug-in-the-eye" (BITE) in training a novice DBT therapist. "Willow," a 35-year-old Hispanic female with BPD, engaged in 6 months of comprehensive DBT that included 25 individual therapy sessions. BITE supervision was implemented in Sessions 12 through 17. Therapist adherence to DBT was assessed from Sessions 8 to 21. Client and therapist satisfaction with BITE was assessed after Session 21. Results indicate that therapist adherence to DBT increased following the implementation of BITE supervision. In addition, both therapist and client found BITE supervision to be acceptable and minimally intrusive, with the therapist reporting increased confidence in delivering DBT. Furthermore, results indicate that DBT was effective in reducing Willow's suicidal ideation and self-harm urges, decreasing her feelings and displays of intense fear and jealousy, and increasing her independence. Recommendations for implementing live supervision into DBT training settings are provided.Keywords dialectical behavior therapy (DBT), borderline personality disorder (BPD), supervision, training Theoretical and Research Basis for Treatment Dialectical Behavior Therapy (DBT)DBT has gained significant empirical support in randomized controlled trials in the treatment of severe and complex patient populations. DBT was originally developed by Marsha Linehan to treat women with suicidal behaviors and borderline personality disorder (BPD). Since then, DBT has been found to be effective in reducing suicidal and self-harming behaviors, decreasing
Scherb (2014) describes the case of Sonia, a 44-year-old woman with severe and complex presentation of borderline personality disorder, along with diagnoses of bipolar disorder, trichotillomania, borderline intellectual functioning, and obesity. At the end of 10 years of therapy with decreasing frequency, Sonia has made a dramatic recovery from almost all of her presenting symptoms. Scherb's therapeutic approach was based on Fernández-Álvarez's Integrative Psychotherapy Model, which incorporates behavioral, cognitive, and emotional components. In this commentary we look at Sonia's psychopathology and treatment through the lens of Dialectical Behavior Therapy, a highly developed treatment model that has shown impressive success in treating individuals with borderline personality disorder and that also combines behavioral, cognitive, and emotional components. A comparison of a DBT approach to Sonia's case with the approach Scherb actually employed reveals many similarities in proposed treatment strategies, as well as differences in the format and delivery of treatment.Key words: borderline personality disorder; Dialectical Behavior Therapy; case formulation; case study; clinical case study ____________________________________________________________________________ Elena Scherb (2014) describes the case of Sonia, a clinically complex client she treated over the course of ten years at the AIGLE center in Buenos Aires, Argentina. Sonia participated in a longitudinal research study run by Scherb designed to treat severe and multi-problem clients with a history of hospitalization utilizing Héctor Fernández-Álvarez's (1992Fernández-Álvarez's ( , 2001) Integrated Psychotherapy Model. Sonia entered the treatment as a 45-year-old morbidly obese woman who had problems managing her financial situation and her 18-year old mentally retarded son's care. Her family paid for Sonia's apartment and her son's care and, while they supported her financially, Sonia's relationship with her parents was marked by periods of conflict and fighting followed by efforts to take over Sonia's responsibilities and at times hospitalize her. Scherb's guiding model throughout treatment was the Integrated Psychotherapy Model, a model promoting change through addressing dysfunctional schemas through a bio-psycho-social perspective. Scherb and Sonia's agreed-upon treatment plan included individual therapy, family therapy, intensive case management and therapeutic coaching, and medication management, all
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