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THE GUILFORD PRESS
DBT® PrinciPles in AcTion
DBT®
Principles
in Action
Acceptance, Change, and Dialectics
Charles R. Swenson
foreword by Marsha M. Linehan
The Guilford Press
New York London
Copyright © 2016 The Guilford Press
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information that is complete and generally in accord with the standards of practice that
are accepted at the time of publication. However, in view of the possibility of human
error or changes in behavioral, mental health, or medical sciences, neither the author,
nor the publisher, nor any other party who has been involved in the preparation or
publication of this work warrants that the information contained herein is in every
respect accurate or complete, and they are not responsible for any errors or omissions
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Library of Congress Cataloging-in-Publication Data
Names: Swenson, Charles R., author.
Title: DBT principles in action : acceptance, change, and dialectics /
Charles R. Swenson.
Description: New York : The Guilford Press, [2016] | Includes bibliographical
references and index.
Identifiers: LCCN 2015049503 | ISBN 9781462526727 (hardback : acid-free paper)
Subjects: LCSH: Dialectical behavior therapy. | BISAC: MEDICAL / Psychiatry /
General. | SOCIAL SCIENCE / Social Work. | PSYCHOLOGY / Psychotherapy /
Counseling.
Classification: LCC RC489.B4 S94 2016 | DDC 616.89/142—dc23
LC record available at http://lccn.loc.gov/2015049503
DBT is a registered trademark of Marsha M. Linehan.
About the Author
Charles R. Swenson, MD, is Associate Clinical Professor of Psychia-
try at the University of Massachusetts Medical School and maintains a
private practice in psychiatry and psychotherapy with adults, families,
and adolescents in Northampton, Massachusetts. He has over 25 years
of experience in the practice, supervision, training, and implementa-
tion of dialectical behavior therapy (DBT) in a wide range of mental
health systems in Canada, the United States, and Europe. Dr. Swenson
was the first professional authorized by Marsha M. Linehan to deliver
intensive DBT training, is cofounder of the International Society for
the Improvement and Teaching of DBT (ISITDBT), and has published
numerous articles and book chapters on DBT. He is a recipient of the
Cindy J. Sanderson Outstanding Educator Award from ISITDBT and
is a Distinguished Life Fellow of the American Psychiatric Association.
His website is www.charlesswenson.org.
v
Foreword
c
harlie Swenson called me in 1987 for the first time. I was con-
ducting the first randomized controlled trial of dialectical behavior ther-
apy (DBT) and continuing to fine-tune the treatment, which at that point
did not exist outside of my lab at the University of Washington. Charlie
explained that he was a psychiatrist in New York, an Associate Profes-
sor of Psychiatry at Cornell University Medical School, and that he was
the director of a long-term inpatient treatment unit for individuals with
severe personality disorders. His mentor and medical director was Otto
Kernberg, a psychoanalyst widely known for his theories on personality
disorders. Charlie’s treatment program was based on Kernberg’s treat-
ment model, now known as transference-focused psychotherapy (TFP).
Having learned about my work from a colleague, Charlie asked
if he and his wife, Meredith, a clinical psychologist, could visit me in
Seattle and learn about DBT. At that stage, as the developer of an as-yet-
unpublished treatment approach for suicidal individuals, I was shocked
that a psychiatrist who was head of a highly respected treatment program
at a famous New York hospital would stop everything to visit a nobody
psychologist simply because someone else had told him that she had the
most effective treatment for the clients he was treating. Very unusual, I
must say. More importantly, he had enormous humility and provided
passionate care for his patients. I invited Charlie and Meredith to my lab,
and they soon visited for about a week. Given his psychoanalytic treat-
ment background, I was even more impressed by Charlie’s willingness
to open his eyes to a very different model, based on behaviorism, Zen,
and dialectics. After their visit, Charlie went on to develop an inpatient
vii
viii Foreword
treatment program based entirely on DBT. This was no small task, as I
had developed a treatment that was entirely outpatient. Charlie’s was the
first DBT inpatient program, and served as the inpatient DBT model for
many years to come.
While I was on sabbatical at Charlie’s hospital and program, as I
wrote my DBT treatment manual, I visited his unit each day and worked
with him and his staff and patients. Charlie had become a believer in
DBT, a monumental change for a psychoanalyst. Along with his team,
Charlie was one of 20 therapists in the very first 10-day DBT intensive
training in 1993. He eventually began his own intensive trainings, which
he has done ever since. When I did my first training program with him,
I found that he not only knows the treatment but is also a very effective,
creative, compassionate, and charismatic teacher of DBT. By now, he is
a teacher’s teacher, a model for other experts in how to make DBT clear
and accessible to experts and practitioners at all levels. When my students
and I decided to found the International Society for the Improvement and
Teaching of DBT (ISITDBT), Charlie was right there with us and was the
program director for the first 2 years of its annual conference, in 1996
and 1997. In 2003, Charlie received the first Cindy J. Sanderson Out-
standing Teacher Award bestowed by ISITDBT. For the past 20 years, he
has played a huge role in the implementation of DBT across a range of
treatment settings throughout North America and Europe.
Having done all of this for thousands of students in workshops, sem-
inars, consultations, and supervisions, Charlie has now put it together for
readers of this book, DBT Principles in Action: Acceptance, Change, and
Dialectics. There is no book out there quite like this: clear, deep, compel-
ling, and at times funny. It is true to the model of DBT and at the same
time personal, seeming as if you are in a supervision with him. I’m sure it
will strengthen your practice of DBT, wherever you may be.
Marsha M. Linehan, PhD, aBPP
Professor and Director
Behavioral Research and Therapy Clinics
University of Washington
