ABSTRACT
DBT differs from traditional contingency management in the degree to which it attends to and uses therapist responses to shape client behaviour. In almost every relationship, individuals respond to each other in ways that, intentionally or unintentionally, change the probability of the other engaging in a given behaviour. Unfortunately, change can easily occur for the worse. Many clients, for example, have a history of receiving desired responses from therapists (e.g. extended session time, more sympathy or soothing, or decreased demands) as a consequence of suicidal communications. Such responses often decrease the behaviour in the short term, but inadvertently reinforce it in the long term. DBT individual therapists
must be acutely aware of how their responses influence clients and use this influence strategically to help clients. In contrast to the last example, many clients have had the experience that stopping suicidal behaviour or decreasing hospitalization has caused therapists to reduce availability, against the clients’ wishes. Aware of this potentially punishing contingency, a DBT therapist generally reverses the contingency and agrees to renew a therapy contract only if the client has decreased target behaviours and increased skills-use during the current contract period.
