Dialectical Behavior Therapy

SUMMARY

This chapter provides an overview of Dialectical Behavior Therapy (DBT), an evidence-based outpatient treatment developed for suicidal women with borderline personality disorder (BPD), and since adapted for other settings and populations. The chapter introduces the biosocial theory of the etiology of BPD and how DBT addresses each aspect of the disorder. It further describes the theoretical foundations of DBT in behaviorism, Zen and dialectics. The reader learns about DBT structures of treatment and what client behaviors are targeted in each stage of treatment. Finally, the chapter uses a clinical case example to illustrate how a therapist would get started with a new client using DBT.     

Addressing Wife Abuse in Mexican Immigrant Couples: Challenges for Family Social Workers

SUMMARY

In blended families, the two parents have a unique challenge to develop a united front (“WE”) in the face of “us” and “them” thinking. Without such a united front, the children will naturally manipulate the situation and further divide the blended family. The key to successful step-parenting is the development of a solid “WE” between two parents so that the whole family works together as a unit. Practical suggestions are given for development of this united front so that step-parenting can become a positive experience.     

Borderline Personality Disorder and Adolescence

SUMMARY

This chapter addresses many of the potential challenges clinicians face when working with adolescents with BPD. First, we present the diagnostic issues related to an adolescent population. Second, we review issues related to the families, peers, and larger systems (e.g., schools) that reciprocally influence the adolescent and the treatment. Third, we discuss specific treatment concerns and propose solutions, including how to effectively manage therapists' own reactions to working with this population. Many of the clinical vignettes and suggested interventions in this chapter derive from our experience working in an outpatient adolescent Dialectical Behavior Therapy (DBT) program. As described later in this book, DBT is an evidence-based treatment effective for suicidal multi-problem individuals with promising data published with suicidal adolescents diagnosed with borderline features (Rathus & Miller, 2002).     

Reliability and validity of a new psychometric inventory of childrearing difficulties for evaluating child abuse risk in Japan

Abstract

Child abuse can occur in any family and requires early preventive measures. Here, a new psychometric inventory was developed for detecting child abuse risk based on parental psychological characteristics reported via a self-administered questionnaire by Japanese parents of children below elementary school age (n?=?370). Reliability and validity were tested using factor analysis and examined for correlations with related criteria and Cronbach’s α coefficients. Inventory factors were “Abandonment anxiety” (9 items; α?=?.899), “Anxiety due to lack of confidence” (13 items; α?=?.868), “Suspicion” (5 items; α?=?.832), and “Perfectionism” (7 items; α?=?.793). This inventory will provide a basis for assessing risk of childrearing difficulties and thus child abuse risk for specialists working with Japanese parents.     

Neurobiological Causes of Addiction

Abstract

Neurobiology and molecular genetics are contributing heavily to a new understanding of the causes of chemical dependence (“addiction”). Willful chemical abuse is a problem that continues to produce significant societal costs including accidents, medical expenses, and family suffering. Pathological chemical dependence, on the other hand, is being recognized as a true medical disease that is also devastating, but in different ways. There is strong evidence in animals and humans that chemical dependence involves a dysregulation of the pleasure pathway (the “medial forebrain bundle”), located in the mesolimbic portion of the brain. Dopamine is one of the medial forebrain bundle's major neurotransmitters. In this paper, we provide a research-based model for the causes of chemical dependence and its treatment, and integrate this information with classic Twelve Step treatment programs.     

Growing Up in a “WE” Family

SUMMARY

When couples choose to parent as a unit (the couple as WE) rather than as autonomous individuals, they and their children both benefit. The current article details some ways that parents can further expand their “couple as WE” into a “family as WE” with active parents and socially perceptive children. The article also discusses ways that family members can start and maintain a family dialogue.     

Borderline personality disorder: nursing interventions using dialectical behavioral therapy

Psychotherapeutic treatment of people with borderline personality disorder (BPD) is one of the greatest challenges confronting mental health professionals today. Clients with BPD are often difficult for nurses to work with, perhaps due to a lack of understanding of the underlying dynamics of the disorder. This article describes effective treatment strategies for BPD with a central focus on dialectical behavioral therapy (DBT). In typical mental health settings, nurses can effectively implement interventions using the concepts of DBT to help people with BPD build effective coping strategies and skillful behavioral responses for improved quality of life.     

Measuring the Influence of Social Context Referents in Substance Abuse Treatment: An Instrument Validation Study

ABSTRACT

This paper introduces a newly developed assessment tool, the Ecological Assessment of Substance abuse Experiences (EASE) that has been designed to measure the influence of social context referents (i.e., family, peers, and community) on clients' attitudes and outcome beliefs related to substance abuse and recovery. An initial exploratory factor analysis was conducted with a small sample of adult treatment-seekers (N =103) to identify its underlying factors and to examine the instrument's item-factor fit. Items clustered onto four orthogonal factors: “belonging-recovery,” “belonging-drugs/alcohol,” “disconnect-recovery,” and “attitudinal congruence-recovery.” Preliminary findings suggest that socio-emotional outcome beliefs and attitudes about drug use and recovery behaviors, as related to family, peers, and community contexts, may be significant areas to address during routine assessment practices that may lead to more comprehensive and contextually appropriate treatment plans.     

An Evidence-Based Approach to Managing Suicidal Behavior in Patients with BPD

SUMMARY

This review will suggest an evidence-based approach to managing suicidal patients with borderline personality disorder (BPD). Many principles currently used in practice have little basis in empirical data. And some approaches used to manage chronic suicidality, particularly the emphasis on “safety,” may actually be counter-productive.     

Learning from Experience in Family Support Programs

ABSTRACT

The paper describes three related California family support program initiatives representing field experiments in program development and policy related to reducing adverse outcomes for vulnerable families through replicating known “best practices” models. The ways in which the three initiatives were affected by the context of implementation are used to demonstrate the difficulty both of identifying the “best” program models and the need for leadership at all levels in order to develop programs and policies, which achieve the intended effects.     

The Role of Social Workers in the Treatment of Addictions

Abstract

This article describes the history of social workers' involvement in the treatment of addictions in the United States. Beginning with Mary Richmond, the “mother of social casework,” social workers have played an increasingly important role in the treatment of individuals with alcohol and other drug problems and of their family members. Today, social workers are important players not only in program development, administration, and treatment of chemical addictions, but also in “process” addictions, such as eating disorders and gambling. Moreover, social workers are increasingly involved in addictions research and policy arenas.     

Pathogenic and Protective Relations in Alcoholic Families (I): Development of the Ritual Invasion Scale

ABSTRACT

Family of origin daily routines and celebratory rituals may serve to protect offspring from the harmful effects of parental drinking. However, parental alcoholism may disrupt these positive rituals, and this “invasion” has been proposed as a mechanism for transmitting risk to offspring. This paper describes the development of a “Ritual Invasion Scale” which may facilitate research and treatment applications with these families.     

Biological Underpinnings of Borderline Personality Disorder

SUMMARY

Biological understanding of a personality disorder is best achieved by examining the disorder's component dimensions, which for borderline personality disorder include impulsive aggression and affective instability. Current biological research into BPD aims to identify the neurotransmitters and brain regions implicated in each of these key domains. Because of advancing technologies and analytic strategies, structural and functional neuroimaging are at the forefront of such efforts. Structural neuroimaging, primarily in the form of magnetic resonance imaging (MRI) scans, gives information about the anatomy of the brain, while functional neuroimaging, primarily functional MRI (fMRI) and positron emission tomography (PET) scans, gives information about brain activity and neurotransmitter systems at the molecular level. BPD neuroimaging studies to date have implied the involvement of several neurotransmitter systems, principally serotonin, along with dysfunction of select brain regions, including the prefrontal cortex and amygdala, suggesting a “dualbrain pathology”: “hyperarousal-dyscontrol syndrome.” However, the exact mechanisms of all these putative etiologies remain unknown.     

Family Social Work: The Past and the Present

SUMMARY

It is easy to blame the dysfunction of a family member on his or her behavioral patterns. I use the title, “It's the Relationship, Stupid!” not to talk down to family therapists, but to remind myself that the source of dysfunction is usually family relationships, especially the marriage relationship. This article gives several case studies for practical application of therapy techniques that focus on developing the “WE” of the family unit. One practical technique that I developed is a communication typology. The married couple (and family members) are divided into “Painters” and “Pointers.” This typology explains much of the conflict and mis-communication that leads to the breakdown of the “WE.” This article also presents dysfunction within the individual as a relationship problem and introduces the concept of the “spirit” of the individual as expressing the relationship the person has with self.     

Confronting Myths and Stereotypes About Borderline Personality Disorder

SUMMARY

The clinician treating a patient with borderline personality disorder (BPD) is often faced with complicated challenges, from making and communicating an accurate diagnosis, to implementing an appropriate, informed plan for treatment. Myths and stereotypes about BPD, and the individuals who may carry the diagnosis, likely complicate effective recognition and treatment of the disorder. BPD has been a controversial diagnosis among clinicians since its inception, and it is poorly understood among the general public. Pressures to avoid an explicit exploration of the diagnosis stemming from myths and stereotypes about the disorder can come from a number of sources, including other clinicians, family members and patients themselves. The results of minimizing or ignoring the contribution of borderline pathology may be detrimental. Clinical decisions based on outmoded thinking about diagnosis, prognosis, treatment efficacy, and availability of resources may deny patients optimal care. Integrating current findings into consideration of a BPD diagnosis and design of appropriate treatment, free of misconceptions about the condition, may help limit the untoward effects associated with failure to appreciate elements of borderline personality.     

Coping and Regulating Emotions: A Pilot Study of a Modified Dialectical Behavior Therapy Group Delivered in a College Counseling Service

Abstract

Objective: To analyze the efficacy of a pilot program, aimed at treating college students with borderline personality disorder (BPD) using short-term, modified group dialectical behavior therapy at an Australian college counseling service (CCS). Participants: Seventeen enrolled college students aged between 18 and 28 (76.5% female), with a diagnosis of BPD completed the program between November 2009 and November 2010. Methods: Participants attended 8 2-hour group therapy sessions, held at the CCS during semester. Participants were assessed for levels of depression, anxiety, BPD traits, and coping strategies, at commencement and completion of the program. Results: There was a reduction in symptoms of depression and BPD traits, and an increase in adaptive coping skills, including problem solving, and constructive self-talk. There was no reduction in anxiety. Conclusions: The findings indicate promise for short-term treatment of college students with BPD. Implications and limitations are discussed, with emphasis on replication with a control group.     

Common and Specific Learnings for a Graduate of a School of Social Work

Abstract

Developing new scholarship on women is a recognized need in social work education. It can be furthered by applying a “gender lens” to the knowledge of the relationship between women and the welfare state. Reflecting historical concerns about providing public aid to the able-bodied male pauper and the impact of relief on the work ethic, social welfare literature has focused on male recipients while generalizing its findings to women. As a result, the story of the female pauper remains largely untold. This paper suggests that the relationship between women and the welfare state is shaped by a “family ethic” that in many ways parallels the work ethic known to shape the relationship between the welfare state and men. The family ethic is defined and applied to major income maintenance programs: public aid and social security. This article suggests foci for change.