What is it about?

When clients say that DBT skills don't work, they are telling the truth. At that moment, whatever they are trying to achieve, the skill is not delivering the required result. DBT therapists can see this as an invitation to assess. If a skill is not working, why not? Is it the wrong skill for the situation? Is there some error in how it is being conducted? Are there some other confounding factors? This paper gives clear guidelines on what to look for and how to help the client get the best out of the skills they are trying to implement. There are some client therapist scenarios that show how the guidelines might be used in practice.

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Why is it important?

There are so many factors that can hinder the effective use of DBT skills, and therapists need to become expert at weeding them out. This article condenses knowledged gained by experienced clinicians into some helpful guidelines to speed the process of assessment. the authors also suggest the addition of another DBT assumption; that whenever clients say the skills don't work, they are telling the truth, putting the onus on the therapist to locate and eradicate the blocks.


It has been really interesting to think about ways in which clinicans can reframe what might be interpreted as 'willfulness' in the client. We hopethat by taking this systematic approach both clients and therapists will feel a sesne of curiosity rather than hopelessness when the skills do not immediately relieve the clients' pain.

Dr Christine Dunkley
Bangor University

Read the Original

This page is a summary of: Principles of Skills Assessment in Dialectical Behavior Therapy, Cognitive and Behavioral Practice, June 2019, Elsevier,
DOI: 10.1016/j.cbpra.2019.05.001.
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