Table Of Content“For those already familiar with the original version of DBT: D istinctive Features, the
second edition fulfils the same function of simplifying and clarifying the theoretical
concepts underlying the therapy. The same practical summary of the treatment compo-
nents are there, with clinical examples to demonstrate the main points. This revised ver-
sion brings the research evidence up to date, including reference to DSM-5, and some
thought provoking discussion on full-program DBT versus skills-only interventions.
This book is the perfect accompaniment to Linehan’s own manuals, either to facilitate
understanding for new students, or to provide condensed summaries for the more expe-
rienced therapist. Every practitioner of DBT will benefit from reading it.”
– Christine Dunkley, PhD, Honorary Lecturer, University of B angor, Chair of the
Society for DBT of the UK and Ireland, co-author of Teaching Clients to Use Mindful-
ness Skills and Using Mindfulness Skills in Everyday Life
“I am always impressed by the superb job the authors do of clearly outlining the essen-
tial features of a complex treatment like DBT in an accessible manner. This is a great
contribution that will increase the reach of DBT.”
– Tony DuBose, PsyD, Chief Training Executive, Linehan Institute/Behavioral Tech
“Swales and Heard have done it again – a classic text no DBT practitioner should be
without. Therapists will find their clear explanations and clinical examples provide a
refreshing insight into the art and application of DBT. This engaging book, by two
exceedingly well-informed and renowned authors, leads us on a journey of discovery
from the principles that underpin DBT to the details of how to apply it in practice. Their
discussion of generating, selecting and implementing solutions alone makes it the go-to
book for all DBT practitioners and essential reading for those curious to find out more.”
– Maggie Stanton, PhD, Consultant Clinical Psychologist and Clinical Lead,
Honorary Lecturer, University of Southampton, co-author of Teaching Clients to Use
Mindfulness Skills and Using Mindfulness Skills in Everyday Life
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Dialectical Behaviour
Therapy
Dialectical Behaviour Therapy (DBT) is a psychotherapeutic approach used to
treat individuals with complex psychological disorders, particularly chronically
suicidal individuals with borderline personality disorder (BPD). The therapy
articulates a series of principles that effectively guide clinicians in responding
to problematic behaviours. Treated problems include, among others, attempt-
ing suicide, bingeing, purging, using illegal drugs and behaviours that directly
impede the treatment.
Dialectical Behaviour Therapy: Distinctive Features highlights theoretical
and practical features of the treatment using extensive clinical examples to dem-
onstrate how the theory translates into practice. This updated edition reviews
recent modifications to the structure of the treatment and considers more recent
research evidence for both the biosocial theory underpinning the treatment and
treatment efficacy. The book provides a clear overview of a complex treatment.
The book will be of interest to clinicians wanting to develop their knowledge
about the treatment, prior to formal training; postgraduate students in mental
health seeking to learn how to conceptualize complex problems; DBT trained
clinicians who require a useful précis of the treatment with clinical examples;
and clients about to embark upon this treatment. This book provides a clear and
structured overview of a complex treatment. It is written for both practising clini-
cians and students wishing to learn more about DBT and how it differs from the
other cognitive behaviour therapies.
Michaela A. Swales is a Reader in Clinical Psychology on the North Wales Clini-
cal Psychology Programme, Bangor University and a consultant clinical psychol-
ogist with Betsi Cadwaladr University Health Board. She is the Director of the
British Isles DBT Training Team and co-author of Changing Behavior in DBT.
Heidi L. Heard is the co-author of Changing Behavior in DBT. She is a senior
trainer for BehavioralTech, USA and an international consultant and supervisor
in Dialectical Behaviour Therapy. She has written extensively about DBT and
borderline personality disorder.
CBT Distinctive Features
Series Editor: Windy Dryden
Cognitive behaviour therapy (CBT) occupies a central position in the move towards
evidence-based practice and is frequently used in the clinical environment. Yet there
is no one universal approach to CBT and clinicians speak of first-, second-, and even
“third-wave” approaches.
This series provides straightforward, accessible guides to a number of CBT methods,
clarifying the distinctive features of each approach. The series editor, Windy Dryden
successfully brings together experts from each discipline to summarize the 30 main
aspects of their approach divided into theoretical and practical features.
The CBT Distinctive Features Series will be essential reading for psychotherapists,
counsellors and psychologists of all orientations who want to learn more about the
range of new and developing cognitive behaviour approaches.
Titles in the series:
A Transdiagnostic Approach to CBT Using Method of Levels Therapy by Warren
Mansell, Timothy A. Carey and Sara J. Tai
Acceptance and Commitment Therapy by Paul E. Flaxman, J.T. Blackledge and
Frank W. Bond
Beck’s Cognitive Therapy by Frank Wills
Behavioural Activation by Jonathan W. Kanter, Andrew M. Busch and Laura C. Rusch
CBASP as a Distinctive Treatment for Persistent Depressive Disorder by James P.
McCullough , Jr., Elisabeth Schramm and J. Kim Penberthy
Cognitive Behavioural Couple Therapy by Michael Worrell
Compassion Focused Therapy by Paul Gilbert
Constructivist Psychotherapy by Robert A. Neimeyer
Dialectical Behaviour Therapy 2nd Edition by Michaela A. Swales and Heidi L. Heard
Functional Analytic Psychotherapy by Mavis Tsai, Robert J. Kohlenberg, Jonathan W.
Kanter, Gareth I. Holman and Mary Plummer Loudon
Metacognitive Therapy by Peter Fisher and Adrian Wells
Mindfulness-Based Cognitive Therapy by Rebecca Crane
Narrative CBT by John Rhodes
Rational Emotive Behaviour Therapy 2nd Edition by Windy Dryden
Schema Therapy by Eshkol Rafaeli, David P. Bernstein and Jeffrey Young
Single Session Integrated CBT by Windy Dryden
Trial Based Cognitive Therapy by Irismar de Oliveira
For further information about this series please visit
www.routledgementalhealth.com/CBT-Distinctive-Features/book-series/DFS
Dialectical Behaviour
Therapy
Distinctive Features
Second Edition
MiChaela a. SwaleS anD
heiDi l. hearD
Second edition published 2017
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group,
an informa business
© 2017 Michaela A. Swales and Heidi L. Heard
The right of Michaela A. Swales and Heidi L. Heard to be identified
as author of this work has been asserted by them in accordance with
sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other
means, now known or hereafter invented, including photocopying and
recording, or in any information storage or retrieval system, without
permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
First edition published 2008 by Routledge
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Names: Swales, Michaela A., 1965- author. | Heard, Heidi L., author.
Title: Dialectical behaviour therapy : distinctive features / Michaela A.
Swales and Heidi L. Heard.
Description: Second edition. | London; New York: Routledge, 2017. |
Includes bibliographical references and index.
Identifiers: LCCN 2016006268 | ISBN 9781138942738 (hbk) |
ISBN 9781138942745 (pbk) | ISBN 9781315544540 (ebk)
Subjects: LCSH: Borderline personality disorder–Treatment. |
Dialectical behavior therapy.
Classification: LCC RC569.5.B67 S93 2017 | DDC 616.85/852–dc23
LC record available at http://lccn.loc.gov/2016006268
ISBN: 978-1-138-94273-8 (hbk)
ISBN: 978-1-138-94274-5 (pbk)
ISBN: 978-1-315-54454-0 (ebk)
Typeset in Times New Roman
by Deanta Global Publishing Services, Chennai, India
To our parents
Pat and Eric Brookes, Tom Swales, Margaret and
Jerry Heard
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Contents
Introduction xi
Acknowledgements xv
Part 1 The DiSTinCTiVe TheOreTiCal
FeaTUreS OF DBT 1
1 Principle-driven treatment 3
2 Integrative treatment 9
3 Dialectical principles 13
4 Emphasis on the primacy of affect 21
5 Transactional biosocial theory 25
6 Learning theory I: classical conditioning 29
7 Learning theory II: operant conditioning 33
8 A behavioural approach to diagnosis 37
9 Zen principles 41
Part 2 The DiSTinCTiVe PraCTiCal
FeaTUreS OF DBT 45
10 Implementing treatment modalities to fulfil
programme functions 47
11 Coaching on the phone 53
12 Consulting in a team 57
ix
