Thomas R. Lynch - Radically Open Dialectical Behavior Therapy: Theory and Practice for Treating Disorders of Overcontrol

Radically open dialectical behavior therapy (RO DBT) is a truly innovative treatment, developed through translation of neuroscience into clinical practice, integrating various influences from dialectical behavior therapy (DBT), mindfulness-based approaches, emotion, personality and developmental theory, evolutionary theory, and Malamati Sufism. RO DBT is applicable to a spectrum of disorders characterized by excessive inhibitory control or overcontrol (OC). This is the first treatment that directly targets social signaling and nonverbal aspects of communication not only in clients but also in therapists.This book on the theory and practice of RO DBT, together with the skills training manual that describes the content of skills classes, are excellent guides for clinicians who want to embark in delivering transdiagnostic treatments based on science and clinical practice.

Mima Simic, MD, MRCPsych, joint head of the child and adolescent eating disorder service, and consultant child and adolescent psychiatrist at the Maudsley Hospital in London, UK

A new and comprehensive statement from one of the more creative minds in evidence-based clinical intervention today, RO DBT brings together a contemporary focus on a limited set of key transdiagnostic processes, with new assessment and intervention techniques for moving them in a positive direction. Emphasizing flexibility, openness, connection, and attention to social signaling, RO DBT specifies the details that can matter, from how you arrange your consulting room furniture to how nonverbal cues signal social information. RO DBT seems destined to make an impact on evidence-based care in many corners of clinical work. Highly recommended.

Steven C. Hayes, PhD, codeveloper of acceptance and commitment therapy (ACT); Foundation Professor of psychology at the University of Nevada, Reno; and author of Get Out of Your Mind and Into Your Life

RO DBT offers an intriguing reconceptualization of traditional views of internalizing and externalizing disorders, and provides the clinician with valuable new tools to address a number of problems that have been particularly resistant to standard CBT approaches. I will definitely include RO DBT theory and techniques in my graduate-level intervention class. I know beginning clinicians in particular will be grateful to have a systematic way to approach these slow-to-warm-up clients who are difficult to establish rapport with. Their early termination from therapy and failure to respond to traditional approaches often leaves clinicians befuddled and critical of their own skills. RO DBT provides a compassionate way for clinicians to view this type of resistant client, as well as to work on some areas that are likely to benefit them. A very welcome addition to any clinicians toolbox.

Linda W. Craighead, PhD, professor of psychology and director of clinical training at Emory University, and author of The Appetite Awareness Workbook

Publishers Note

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought.

Distributed in Canada by Raincoast Books

Copyright 2018 by Thomas R. Lynch

Context Press

An imprint of New Harbinger Publications, Inc.

5674 Shattuck Avenue

Oakland, CA 94609

www.newharbinger.com

Figure 6.3, Prototypical Emotional Expressions, from Keltner, D., Young, R. C., & Buswell, B. N. (1997). Appeasement in human emotion, social practice, and personality. Aggressive Behavior, 23(5), 359374. Copyright 1988 by Wiley. Used with permission.

Images in figure 6.5, Polite Smile vs. Genuine Smile, Vladimir Gjorgiev and Monkey Business Images/Shutterstock.

Figure 6.12, Subtle, Low-Intensity Social Signals Are Powerful, from EMOTIONS REVEALED: RECOGNIZING FACES AND FEELINGS TO IMPROVE COMMUNICATION AND EMOTIONAL LIFE by Paul Ekman, copyright 2003 by Paul Ekman. Used by permission of Paul Ekman.

Lines from A Man and a Woman Arguing from THE ESSENTIAL RUMI by Jalal al-Din Rumi, translated by Coleman Barks. Copyright 1997 by Coleman Barks. Used by permission.

Illustrations on pages 163, 164, and 168 by Henrietta Hellard

Cover design by Amy Shoup; Acquired by Catharine Meyers; Edited by Xavier Callahan; Indexed by James Minkin

All Rights Reserved

Library of Congress Cataloging-in-Publication Data

Names: Lynch, Thomas R. (Professor of clinical psychology), author.

Title: Radically open dialectical behavior therapy : theory and practice for treating disorders of overcontrol / Thomas R. Lynch.

Description: Oakland, CA : New Harbinger Publications, Inc., [2018] | Includes bibliographical references and index.

Identifiers: LCCN 2017040500 (print) | LCCN 2017042252 (ebook) | ISBN 9781626259294 (pdf e-book) | ISBN 9781626259300 (ePub) | ISBN 9781626259287 (hardcover : alk. paper)

Subjects: | MESH: Behavior Therapy--methods | Compulsive Personality Disorder--therapy | Self-Control--psychology

Classification: LCC RC489.B4 (ebook) | LCC RC489.B4 23 (print) | NLM WM 425 | DDC 616.89/142--dc23

LC record available at https://lccn.loc.gov/2017040500

Acknowledgments vii

Key Terms xi

Introduction 1

Overview of Core RO DBT Tenets 1

Overview of the Books Contents 2

In RO DBT, Silliness Is No Laughing Matter 4

1. Radical Openness and Disorders of Overcontrol 7

Self-Control: Can You Have Too Much of a Good Thing? 7

Basic Postulates of RO DBT 11

Treatment Development and Efficacy Research 19

2. A Neurobiosocial Theory for Disorders of Overcontrol 33

A Novel Neuroregulatory Model of Socioemotional Functioning 33

A Biosocial Theory for Disorders of Overcontrol 46

Social Signaling: A Novel Mechanism of Change 66

3. Assessment Strategies 69

Assessing Overcontrol: A Conceptual Framework 69

Common Errors and Problematic Assumptions 70

The OC Diagnostic Protocol: Diagnosing Overcontrol, Step-by-Step 76

Future Directions 83

4. Overview of Therapy Assumptions, Structure, and Targets 85

RO DBT Core Assumptions 86

Overview of Treatment Structure and Targets 88

5. Maximizing Client Engagement 97

Enhancing Client Engagement via the Physical Environment 97

Enhancing Client Engagement via Orientation and Commitment 100

Commitment Problems Unique to Overcontrol 137

Enhancing Engagement Through Sequencing 140

6. Social Signaling Matters: Micromimicry, Mirror Neurons, and Social Connectedness 145

Social Bonds, Mimicry, and Mirror Neurons 146

One Size Does Not Fit All 149

Eye Contact 149

The Deer in the Headlights Response 151

Heat-Off Strategies 153

Heat-On Strategies 155

Therapeutic Use of Cooperative Social Signaling 156

The Therapist as Tribal Ambassador 161

Managing Maladaptive OC Social Signaling 170

Tribe Matters 175

7. Radical Openness and Self-Enquiry: Personal Practice, Therapeutic Modeling, Supervision, and Team Consultation 177

Openness Is Tribal Glue 178

Openness, Collaboration, and Compliance 180

Openness, Tribes, and Learning 181

One Secret of Healthy Living Is the Cultivation of Healthy Self-Doubt 184