Response: Innovations and Implementation

Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for border­ line personality disorder. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality dis­ order. 1993. Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. significance of antisocial personality disorder in cocaine-dependent patients entering continuing care. Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. Mardell Gavriel: At Walden House, we use dialectical behavior therapy (DBT) skills training and strategies with a wide range of clients, although we don't implement the whole package. As we practice it, embrac­ ing a dialectic way of thinking means avoid­ ing rigid notions, understanding that it's all right to feel more than one way about some­ thing, and being cognitively fluid and cre­ ative in one's thinking. The clinician may help the patient connect to both poles of his ambivalence about drugs. On one hand, the client wants recovery and recognizes that drugs have been problematic in his life, and on the other, he has real urges to use because drugs have been his survival strategy for a long time. Both of those rationales are equally true; what the dialectic recognizes is that both can yield useful insights. Helen Sackler: The authors' football anal­ ogy illustrating the dialectic (Dimeff and Linehan, 2008) is similar to the way we rou­ tinely talk to substance abusers. In the anal­ ogy, the quarterback always has the goal of scoring, but he knows he can't score on every play. On most plays, he just has to try to push the ball downfield. To our patients, we say, " What's going to make your life worth living a year, 2 years, 5 years down the road? Keep your eyes on the prize, but work a day at a time. " Gavriel: One reason the DBT model has been fairly easy to implement in substance abuse treatment is that, philosophically, it integrates well with other existing models. To a great extent, the DBT skills are the same ones that underlie many of the cur­ ricula that are traditionally taught in sub­ stance abuse treatment—stress tolerance, emotional regulation, relapse prevention, and so on. Staffers find that DBT training reinforces and …