The application of dialectical behavior therapy to adolescent borderline clients

Turner, Ralph M.; Barnett, Belinda; Korslund, Kathryn E.

doi:10.1002/(sici)1520-6572(199822)4:2<45::aid-sess4>3.0.co;2-7

Cited by 4 publications

(2 citation statements)

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“…Both of these strategies may cause problems if there is therapist allegiance for one TM over another; if the therapists believe more strongly in one treatment than in the other this may well affect their efficacy in carrying out these treatments. Although this may not necessarily have been a problem in the DBT-o vs. CCT trial, because the therapists are described as having “theoretical backgrounds in family-systems, client-oriented, and psychodynamic therapy” ([ 59 ], p. 415), it cannot be excluded that the therapists may have been influenced by the enthusiasm surrounding DBT when it was introduced as a new treatment for BPD in the 1990s, especially in view of the researcher’s (e.g., Turner’s) theoretical allegiance in favor of DBT [ 61 ]. Similar considerations apply to the MBT vs. SCM trial: it cannot be excluded that the therapists may have been influenced by the enthusiasm surrounding MBT when it was introduced as a new treatment for BPD in the 2000s, especially in view of the researchers’ (e.g., Bateman and Fonagy’s) theoretical allegiance in favor of MBT.…”

Section: Discussionmentioning

confidence: 99%

The neglect of treatment-construct validity in psychotherapy research: a systematic review of comparative RCTs of psychotherapy for Borderline Personality Disorder

2016

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BackgroundRandomized controlled trials (RCTs) are considered the best methodology for studying the efficacy of psychotherapy. Optimally an RCT design makes it possible to conclude that if one treatment has a better outcome than another, this is due to the treatment package (TP) as it was implemented in this particular context, rather than other factors beyond the treatment (= high internal validity). Strong internal validity does not, however, provide evidence for the treatment model (TM) that provides the theoretical basis of the TP, because the TP that is tested may differ from the comparison condition in a number of other ways that suggest alternative explanations for the effects. These alternative treatment contrasts represent threats to construct validity of the conclusions. Maximal construct validity requires (1) that the treatments are clearly contrasted on the experimental factors (treatment integrity), and (2) that alternative treatment contrasts can be eliminated. The analysis of alternative explanations is a neglected topic in psychotherapy research. To approach this problem, a methodology for the analysis of treatment contrasts is suggested and tested.MethodsTwo indexes were defined: (1) a Treatment Integrity Index (TII) and (2) an Alternative Treatment Contrast Index (ATCI). This methodological approach was applied to eight comparative RCTs of treatments for Borderline Personality Disorder (BPD), which were coded for a set of treatment contrasts independently by three coders.ResultsThe analysis of the RCTs of treatments for BPD showed that construct validity differed widely between the different studies but was generally low (low TII and ATCI), and that it is therefore difficult to draw causal conclusions from this research. The publication policies of scientific journals in this area seldom require the systematic data relevant to an analysis of alternative explanations of the effects, which is needed to provide evidence for a particular TM.ConclusionsResearch on psychotherapy needs to be refocused from treatment packages (TP) to treatment models (TM). This requires an improved conceptualization of the methodological principles and skills involved, and the development of valid measures of these, but also improved reporting standards concerning treatment-construct validity in scientific journals.Electronic supplementary materialThe online version of this article (doi:10.1186/s40359-016-0151-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The neglect of treatment-construct validity in psychotherapy research: a systematic review of comparative RCTs of psychotherapy for Borderline Personality Disorder

2016

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“…Scheel' s article (this issue) is an excellent illustration of the virtues of a clinical science approach to psychosocial treatment. 1 Many of us have assumed that current empirical basis for dialectical behavior therapy (DBT) has established it as the optimal cognitive-behavioral intervention for borderline personality disordered (BPD) patients (e.g., Turner, Barnett, & Korslund, 1998). Yet, a more thorough-going examination of the extant empirical literature, as Scheel has done, shows that such a conclusion is premature.…”

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confidence: 99%

Understanding dialectical behavior therapy.

Turner¹

2000

Clinical Psychology: Science and Practice

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Scheel (this issue) shows that the effectiveness and mechanism of action of dialectical behavior therapy (DBT) for borderline personality disordered (BPD) patients are not as conclusive or well understood as many have come to believe. Scheel's conclusions are well balanced, and she does point out the strengths of the DBT approach. Most important, Scheel provides clear guidance about the types of studies that need to be conducted to fully establish DBT as the treatment of choice for BPD. Future studies are going to have to forgo the TAU control and use well‐established alternative treatments. Controls for dosage of the treatments, therapists, supervision, and therapeutic allegiance will have to be implemented. In addition, a broader, more representative outcome battery will need to be used. An important virtue of Scheel's review is that it exemplifies the virtues of the clinical science approach to evaluating psychosocial treatment through falsification of hypotheses.

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Evidence-based practice in group work with incarcerated youth

Quinn

Shera

2009

International Journal of Law and Psychiatry

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The application of dialectical behavior therapy to adolescent borderline clients

Cited by 4 publications

References 2 publications

The neglect of treatment-construct validity in psychotherapy research: a systematic review of comparative RCTs of psychotherapy for Borderline Personality Disorder

The neglect of treatment-construct validity in psychotherapy research: a systematic review of comparative RCTs of psychotherapy for Borderline Personality Disorder

Understanding dialectical behavior therapy.

Evidence-based practice in group work with incarcerated youth

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