ABSTRACT
As a cognitive-behavioural treatment, DBT recognizes that skills learnt in therapy do not automatically transfer from one environment (therapy) to another (clients’ non-therapy life). Effecting this transition requires rigorous planning and frequent rehearsal. The intensity and lability of the clients’ emotional responses frequently leads to significant environmental dependency in terms of skills utilization. For example, the client who can negotiate an interpersonal conflict
successfully when emotionally calm may be at a loss for words in the presence of moderate affect. To compensate for this environmental dependency, DBT devotes an entire modality to generalization. In most of the empirically validated versions of the treatment telephone consultation fulfils this function (see Chapter 11). DBT teams may utilize other modalities applicable to their setting. For example, in-patient milieu staff may provide in vivo skills coaching to address problems on the unit as they arise. In applications of the treatment for clients dually diagnosed with BPD and substance dependence, DBT case managers may enter the clients’ natural environments to provide coaching in specific skills (McMain et al., 2007).
