edited by Linda A. Dimeff and Kelly Koerner; New York, Guilford Press, 2007, 363 pages, $42
Dr. Runnels is a public psychiatry fellow at Columbia University Medical Center and an associate in the Office of the Medical Director, New York State Office of Mental Health, New York City.
Dialectical Behavior Therapy in Clinical Practice is, first and foremost, about dialectical behavior therapy, or DBT, implementation. For those who have had little or no prior exposure to DBT and are primarily interested in learning more about this practice, this book is not an ideal starting place. It is, quite pointedly, aimed toward individuals who are either considering or in a position to influence the establishment of a DBT program. And for its intended audience, this is an excellent resource.
Editors Linda A. Dimeff and Kelly Koerner have devoted their careers in large part to studying and promoting DBT implementation. They have assembled a collection of chapters outlining the potential use for and challenges of implementing DBT across a variety of settings and populations. These settings and populations include outpatient private practice, community-based organizations, inpatient units, prisons, assertive community treatment teams, adolescents and families, individuals with eating and substance abuse disorders, and individuals with comorbid axis I disorders. Each chapter is written by individuals who have extensive firsthand experience implementing and operating DBT successfully in the setting about which they are writing—and the experience shows.
The chapters all follow the same basic format, beginning with limited but compelling evidence highlighting the potential effectiveness of DBT for the target setting or population and moving on to describe how one might augment DBT or go about implementing DBT in a given setting or with a particular population. Within this structure, authors weave in case examples, common pitfalls, and advice on how best to proceed. Additionally, most chapters include detailed tables, specialized diary cards, and algorithms for module and group adaptations that have been used in successful adaptations.
I must disclose here that I didn't attempt to implement a DBT program as part of this review—obviously, the true effectiveness of this book can be measured only by those who use the book to do so. Here I can only estimate that the information contained in each of the specific chapters provides an excellent template for individuals aiming to adapt DBT to their particular situation, and I imagine that the supplemental materials referenced in each chapter are likely to enhance any such efforts. Of all the chapters, only the one that focuses on family treatment seems to require such supplementation.
Most members of the target audience will be interested primarily in the chapters that address their specific needs; indeed, only those who work broadly with program implementation are likely to benefit greatly from reading the entire book. However, I did gain individual nuggets of wisdom from every chapter and encourage those who read it to venture beyond the material focused on just one setting or population. On a final note, I hope this book finds practitioners who have imagined the benefits of having more DBT programs but have never considered starting one. It might just provide the spark needed to transform inspiration into action.