THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
SCHOOL OF SOCIAL WORK
COURSE NUMBER:
COURSE TITLE:
SEMESTER & YEAR:
INSTRUCTOR:
OFFICE HOURS:
SOWO 769, Section 001
Dialectical Behavioral Therapy: Theory and Practice
Spring, 2015
Marilyn Ghezzi, MSW, LCSW
TTK, 563-C
919-962-6490
mghezzi@email.unc.edu
12-2 Tuesdays or by appointment
COURSE WEBSITE:
is available through https://sakai.unc.edu
COURSE DESCRIPTION: This course provides an introduction to Dialectical Behavior Therapy (DBT),
exploring both its theoretical underpinnings as well as its practical application.
COURSE OBJECTIVES:
1. Understand the theoretical underpinnings of Dialectical Behavior Therapy (DBT), including its roots
in cognitive and behavioral theories, mindfulness and the biopsychosocial model.
2. Understand the characteristics of borderline personality disorder, the basics of the DBT approach for
treating borderline personality, and issues of stigma related to the diagnosis.
3. Using a DBT framework, be able to formulate, articulate and develop a written case plan for a client,
including specific interventions and therapeutic strategies.
3. Develop skills for conducting both individual DBT therapy and the DBT skills group that can be
applied to clients presenting with a variety of mental health issues, including anxiety, depression,
eating disorders, substance use disorders and post-traumatic stress disorder (PTSD).
4. Analyze DBT’s evidence base and applicability to clients presenting with a range of issues,
including different DSM diagnoses as well as diverse characteristics and backgrounds, including age,
disability, ethnicity, GLBT status, race and socioeconomic status.
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5. Evaluate how well DBT fits with social work values and ethics, as well as the current mental health
climate, including issues of social justice such as access to services.
EXPANDED DESCRIPTION:
This course provides an introduction to Dialectical Behavior Therapy (DBT). The aim of this course is
to increase a student’s theoretical understanding of DBT and their ability to apply the model to clients
with a variety of mental health issues, focusing on treating borderline personality disorder. Through
course assignments and in-class activities, students will have an opportunity to practice DBT specific
skills in order to gain confidence in their ability to both recommend and implement these skills in
clinical social work practice.
REQUIRED TEXTS/READINGS:
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York:
The Guilford Press. (Referred to as “textbook” in syllabus)
Linehan, M.M. (2014). DBT skills training manual (2nd ed.). New York: The Guilford Press.
(Referred to as “workbook” in syllabus)
Other assigned readings will be posted on our Sakai site
CLASS ASSIGNMENTS
Refer to description of assignments at the end of this syllabus.
1. Paper or presentation assignment: 30%
2. Final paper: 50%
3. Class Attendance and Participation: 20%
CLASS PARTICIPATION
Class participation counts for 20% of your final grade. Participation is a higher percentage for this class
due to the emphasis on experiential methods. Everyone will receive a standard score of 20 for
participation, in recognition of a norm of attendance, contributions to small group activities and
informed participation in class discussion. Informed participation means that you clearly demonstrate
that you have completed assigned readings and can offer analysis, synthesis and evaluation of written
material. In order to fully participate in and benefit from each class session, students must complete
required readings and come to class prepared to discuss them. Excellent participation also means that
your comments are thoughtful, focused and respectful. Points will be deducted from the base score if
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you miss class, are late, leave early, disappear for long periods on break or are unprepared. Please turn
off cell phones during class.
This class will use a variety of teaching and learning methods to cover the content. These different
methods include: small group activities; role plays; lecture; videos; and class discussions. The
development of a supportive learning environment is fostered by respectfully listening to the ideas of
others, being able to understand and appreciate a point of view which is different from your own,
clearly articulating your point of view, and linking experience to readings and assignments. If you will
not be able to attend a class, it is your responsibility to obtain handouts, information about class
content, and information about announcements, etc., from your classmates. Please do not ask the
instructor to detail “what you missed”.
See grading rubric on page 5 of syllabus for professional conduct/participation.
GRADING SYSTEM
In accordance with the Graduate school, letter grades are assigned to the following numeric ranges:
H = 94 and above
P = 80 to 93
L = 70 to 79
F = 69 and below
SUBMITTING WRITTEN ASSIGNMENTS AND POLICY ON INCOMPLETES AND LATE ASSIGNMENTS
A course grade of “Incomplete” will be given only in extreme extenuating circumstances and in
accordance with SSW and University policy.
All papers and assignments are to be submitted electronically to the Drop Box on our Sakai site and are
due at the beginning of class on the dates noted on this syllabus. Ten percent will be deducted from
your grade for each day that a paper is late. If you have a situation arise that may prohibit you from
completing the assignment on time, any request for an extension on the papers must be done in advance
of the due date (at least 24 hours) for the paper. Approved delays will not affect the grade.
Your cover sheet for the paper should contain your name, PID# and honor code pledge. Do not put
your name in the body of the paper that you submit to Sakai, instead use your PID# as a running head
on each page.
HONOR CODE
The Student Honor Code is always in effect in this course. The Instrument of Student Judicial
Governance (http://instrument.unc.edu/) requires that you vouch for your compliance on all your
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written work. You must write the following pledge in full on each document title page: “I have neither
given nor received any unauthorized assistance on this assignment.” Sign and date it. Please refer to the
APA Style Guide, The SSW Manual, and the SSW Writing Guide for information on attribution of
quotes, plagiarism and appropriate use of assistance in preparing assignments.
POLICY ON ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES
The University of North Carolina – Chapel Hill facilitates the implementation of reasonable
accommodations, including resources and services, for students with disabilities, chronic medical
conditions, a temporary disability or pregnancy complications resulting in difficulties with accessing
learning opportunities.
All accommodations are coordinated through the Accessibility Resources and Service Office. In the
first instance please visit their website http://accessibility.unc.edu, call 919-962-8300 or email
accessibility@unc.edu. Please contact ARS as early in the semester as possible.
USE OF LAPTOPS OR OTHER ELECTRONIC DEVICES
Please turn off all cell phones or other devices that would disrupt the learning environment of the
classroom. Laptops are allowed during lecture only or when being used for a class activity. Laptops
should be closed during class discussion and other activities that do not require the use of a laptop.
APA AND WRITTEN ASSIGNMENTS
The School of Social Work faculty has adopted APA style as the preferred format for papers and
publications. The best reference is the Publication Manual of the American Psychological Association,
Sixth Edition (2009) that is available at most bookstores. The following web site provides additional
information: http://www.apastyle.org/apa-style-help.aspx
Students are strongly encouraged to review the materials on the School of Social Work’s website
http://ssw.unc.edu/students/writing . This page includes numerous helpful writing resources such as
tutorials on understanding plagiarism, quick reference guide to APA, writing tips and ESL materials.
Students are also strongly encouraged to review the section on plagiarism carefully. All instances of
academic dishonesty will result in disciplinary measures pre-established by the School of Social Work
and the University.
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Class Participation Rubric
Class participation is more than mere attendance. It is arriving on time, reading the assigned material, preparing
for class with questions, contributing appropriately to class discussions, doing assignments, and participating in
class activities. The class participation grade is a subjective grade given by the professor. The professor will use
this matrix to determine the class participation grade (modified from Maznevski, M.(1996). Grading Class
Participation. Teaching Concerns. hhtp://www.virginia.edu/~trc/tcgpart.htm).
Grade
Class Participation Criteria
(Carpenter-Aeby, 2001)
F
No effort
0-69
L- 70-79
Infrequent
Effort
Absent
Little or No effort, disruptive, disrespectful.
P 80-88
Moderate
Effort
*
Present, not disruptive (This includes coming in late.)
*
*
Tries to respond when called on but does not offer much.
Demonstrates very infrequent involvement in class.
Demonstrates adequate preparation: knows basic case or reading facts, but
does not show evidence of trying to interpret or analyze them.
*
Offers straightforward information (e.g. straight from the case or reading),
without elaboration or very infrequently (perhaps once a class).
*
Does not offer to contribute to discussion, but contributes to a moderate degree
when called on.
*
P+ 89-93
Good Effort
Demonstrates sporadic involvement.
*
Demonstrates good preparation: knows case or reading facts well, has thought
through implications of them.
*
class.
Offers interpretations and analysis of case material (more than just facts) to
*
Contributes well to discussion in an ongoing way: responds to other students’
points, thinks through own points, questions others in a constructive way, offers and
supports suggestions that may be counter to the majority opinion.
*
H 94-100
Excellent
Effort
Demonstrates consistent ongoing involvement.
*
Demonstrates excellent preparation: has analyzed readings exceptionally well,
relating it to readings and other material (e.g., readings, course material, discussions,
experiences, etc.).
*
Offers analysis, synthesis, and evaluation of material, e.g. puts together pieces
of the discussion to develop new approaches that take the class further.
*
Contributes in a very significant way to ongoing discussion: keeps analysis
focused, responds very thoughtfully to other students’ comments, contributes to the
cooperative argument-building, suggest alternative ways of approaching material and
helps class analyze which approaches were effective.
*
5
Demonstrates ongoing very active involvement.
COURSE OUTLINE
Class One-- March 3




Overview of the course and discussion of syllabus
Understanding borderline personality disorder
Understanding basics of DBT approach
How does DBT fit with social work values and ethics?
Readings:
Linehan textbook: Chapters 1 and 2, pp. 3-65.
Oldham, J.M. (2009). Borderline personality disorder comes of age. American Journal of Psychiatry,
166(5), 509-511. doi:10.1176/appi.ajp.2009.09020262
Gunderson, J. G. (2011). Borderline personality disorder. New England Journal of Medicine, 364(21),
2037-2042. doi:10.1056/NEJMcp1007358
March 10 -- No class- Spring Break
Class Two-- March 17



Understanding experiential avoidance
How do characteristics of borderline personality and the nature of experiential avoidance relate
to the treatment methods of DBT?
Individual therapy in DBT -- what is validation?
Chapman, A.L., Gratz, K.L. & Brown, M.Z. (2005). Solving the puzzle of deliberate self harm: The
experiential avoidance model. Behaviour Research and Therapy, 44 (3), 371-394.
Linehan textbook: Chapters 3 and, pp. 66-119
Crowell, S.E., Beauchaine, T.P., & Linehan,M.M. (2009). A biosocial developmental model of
borderline personality: Elaborating and extending Linehan’s theory. Psychological Bulletin,
135(3), 495-510.
Watch Marsha Linehan video sometime before Class Three – March 24
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https://ctiv.alexanderstreet.com/view/1779085
This link is also on Sakai. Be aware that you may only be able to access this video from one of the
School’s computers or when you are logged into the UNC website on your laptop.
Class Three -- March 24
Bree Kalb, M.A. guest speaker (mindfulness)



Understanding core mindfulness
How does mindfulness help?
Case formulation
Readings:
Linehan textbook: Chapter 5, pp. 120-164
Linehan workbook: Chapter 7, pp. 151- 230 Don’t panic about the length of this reading. Much of it is
reviewing worksheets, giving you teaching notes for the skills training classes, summarizing research
points, so you can skim a lot of it. I just want you to get the general idea and see some examples of
mindfulness activities and explanations.
Koerner, K. (2006). Case formulation in dialectical behavior therapy for borderline personality
disorder. In T. Eells (Ed.), Handbook of Psychotherapy Case Formulation, 2nd ed (p.340-367).
New York: Guilford Press.
Class Four—March 31


Presentation of Emotion Regulation Module
Continued discussion of individual therapy
Readings:
Linehan textbook: Chapters 6 and 7, pp. 165-220.
Linehan workbook: Chapter 9, Emotion Regulation Skills, pp. 318- 415 Again, this is a huge amount of
material, but feel free to skim it and read the parts that are most interesting to you. Look for activities
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you might use with clients right now at your field placement. We will be taught this module by our
presentation groups.
Rosenthal, M., Gratz, K., Kosson, D., Cheavens, J., Lejuez, C., & Lynch, T. (2008). Borderline
personality disorder and emotional responding: A review of the research literature. Clinical
Psychology Review, 28, 75-91.
Class Five—April 7
Case Formulation Paper Due

Presentation of Distress Tolerance module
Readings:
Linehan textbook, Chapters 8 and 9; pp. 221-291
Linehan workbook: Chapter 10, Distress Tolerance Skills, pp. 416- 492. Same caveats noted above
apply to this reading
Class Six—April 14

Presentation of Interpersonal Effectiveness module
Linehan textbook, Chapters 10, 11, 12; pp. 292-398
Linehan workbook: Chapter 8, Interpersonal Effectiveness, pp. 231-317 Same caveats noted above
apply to this reading
Class Seven—April 21


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Evaluation; preparation for final paper
Wrap up
Panos, P. T., Jackson, J. W., Hasan, O., & Panos, A. (2014). Meta-analysis and systematic review
assessing the efficacy of dialectical behavior therapy (DBT). Research on Social Work Practice,
24(2), 213-223. doi:10.1177/1049731513503047
Carmel, A. (2013). Barriers and solutions to implementing dialectical behavior therapy in a public
behavioral health system. Administration and Policy in Mental Health and Mental Health
Services Research, 1-7. doi: 10.1007/s10488-013-0504-6
Supplemental ReadingAllen, D.M., Whitson, S. (2004). Avoiding patient distortions in psychotherapy with borderline
personality disorder patients. Journal of Contemporary Psychotherapy, 34 (3), 211-229.
Bedics, J.D., Korslund, K.E., Sayrs, J.H. & McFarr, L.M. (2013). The observation of essential clinical
strategies during an individual session of dialectical behavior therapy. Psychotherapy, 50(3).
454-457.
Chapman, A. L., Turner, B. J., & Dixon-Gordon, K. L. (2011). To integrate or not to integrate
dialectical behaviour therapy with other therapy approaches? Clinical Social Work Journal,
39(2), 170-179. doi:10.1007/s10615-010-0283-4
Dimeff, L.A. & Koerner, K. (Eds.). (2007). Dialectical behavior therapy in clinical practice. New
York, NY: The Guilford Press.
Kealy, D. & Ogrodniczuk, J.S. (2010). Marginalization of borderline personality disorder. Journal of
Psychiatric Practice, 16(3), 145-154.
Koerner, K. (2012). Doing dialectical behavior therapy: A practical guide. New York: Guilford Press.
(this is an ebook available through UNC library)
Lynch, T.R., Chapman, A.L., Rosenthal, M.Z., Kuo, J.R. & Linehan, M.M. (2006). Mechanisms of
change in Dialectical Behavioral Therapy: Theoretical and empirical observations. Journal of
Clinical Psychology, 62(4), 459-480.
McKay, M., Wood J.C., & Brantley, J. (2007). The dialectical behavior therapy skills workbook:
Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion
regulation and distress tolerance. Oakland, CA: New Harbinger Publications.
Pederson, L. (2013). DBT skills training for integrated dual disorder treatment settings. Eau Claire,
Wisconsin: Premier Publishing and Media.
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Rizvi, S.L. (2010). Treatment failure in dialectical behavior therapy. Cognitive and behavioral
practice, 18, 403-412.
Rizvi, S.L., Welch, S.S., & Dimidjian, S. (2009). Mindfulness and borderline personality disorder. In F.
Didonna (Ed.), Clinical Handbook of Mindfulness (pp.245-257). New York: Springer.
(this is an ebook available through UNC library)
Assignments
First Assignment - Choice of paper or presentation
Presentation option: In this assignment, teach our class for 45 minutes as though we were a DBT
skills training group. Use Linehan’s workbook to learn the lecture points, exercises, discussion points,
etc. for a particular training module. Choose one of the three modules, Distress Tolerance,
Interpersonal Effectiveness and Emotion Regulation to teach to the class. Devise your own examples,
decide how to structure the time, keep us engaged, and clearly convey the material just as you would in
leading an actual skills training group. We will have 6 of these 45 minute presentations spread over our
March 31, April 7 and April 14th classes. Only 6 students can choose this option so if more than 6
students are interested, we will need to draw names out of a hat to determine the 6.
Grading rubric
Elements
Points possible
Clarity of presentation- Student conveyed the material in a clear and
concise manner
Creativity of presentation- Student used creative examples and exercises
to convey the material
Depth of understanding of the material- Student demonstrated a thorough
understanding of the material as evidenced by answers to questions,
examples used, lecture coherence
Engagement- How well did student engage the class during the
presentation
Time limit- Stayed within 45 minute time limit and covered the necessary
material
Total
7
7
7
6
3
30
Paper option: Due on April 7 In this 5-7 page paper, you will choose a client case from your field
placement or other social work practice setting and will conduct a DBT case formulation. In a case
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formulation, assess the presenting problems/symptoms of the case and then explain these
problems/symptoms through a particular theoretical lens. A formulation is a way of understanding your
client’s problem and is informed by the theory with which you are working. This understanding then
guides your treatment plan and treatment targets. In this paper, explain the client’s
symptoms/presenting problems using the DBT theoretical approach.
The paper includes:
1. Presenting problem and brief psychosocial history- In this section of the paper, please
explain client’s presenting problem and history, including information about family of
origin, presenting symptoms and current stressors, any relevant childhood history or history
of trauma. This section should also report the DSM diagnosis. (About 2-3 pages). Please
take steps to ensure client confidentiality by altering or leaving out identifying information.
All client names should be changed.
2. Formulation section: In this section you will describe the symptoms and presenting problem
using DBT as an explanatory model. List the client’s main presenting problems and
symptoms and then explain those problems or symptoms using the DBT model.
If you have not done a case formulation yet in your graduate school career, I will provide
you with additional materials to guide you in this process.
(This section should be about 3-4 pages).
An example of explaining a symptom using the DBT model is given on p. 335 of your Koerner chapter.
I am paraphrasing it as follows: A client Don cuts himself. This would be listed as one of his major
symptoms. In a DBT formulation we know that cutting is a way for clients to get relief from emotional
distress. In order to analyze Don’s specific case, he seeks relief from intense anxiety by cutting himself.
Often after he cuts his parents take care of him and this may in fact perpetuate his cutting behavior.
You might want to further specify what tends to precipitate Don’s cutting episodes, such as fights with
his girlfriend, or flashbacks or feeling incompetent at work, etc. So, formulation is a way of taking the
general theory about why a symptom or problem is happening and adding in client specificity, i.e. Why
is this client having this symptom or problem and why now?
Your paper will not need to include a treatment plan or discussion of treatment. The paper should be 57 pages total and should follow APA guidelines. No references should be needed for the paper.
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Grading Rubric
Elements
1. The presenting problem, history and DSM diagnosis are clear and
thorough.
2. Each of the symptoms and/or presenting problems in the case are
listed with a thorough and clear explanation using the DBT model.
3. The formulation takes into account client specific factors, including
issues of diversity such as age, gender, race, ethnicity, sexual
orientation, etc. Psychosocial history was complete and linked to
formulation.
4. Formulation was thorough, complete and showed critical thinking
about the case.
5. The explanation shows a good understanding of the DBT model.
6. The paper is clearly written with no writing errors and APA
formatting is followed.
Total
Final paper
Point
Possible
6
7
5
6
3
3
30
Due on last day of classes for the semester- Friday April 25th
This final paper is a combination of research and reflection. Students will need to research a topic
related to DBT that fits with their plan of study. Papers should be 7-10 pages and should use at least 5
references that were not on the course syllabus. Additional references from the course syllabus may be
needed.
Topics include: Adapting and applying DBT for a particular population such as older adults,
adolescents, SPMI, incarcerated populations, etc. OR the paper could focus on adapting and applying
DBT for disorders other than borderline personality. These disorders could include PTSD, eating
disorders, substance use disorders, or mood disorders. If you would like to explore a topic not reflected
here, please discuss this with me ahead of time.
You should address the following issues in the paper:
1. Explain the major adaptations or change in emphasis that is needed to use DBT with your population
of interest or disorder. Cite the relevant literature.
2. Review and summarize the research about the efficacy of this adaptation.
3. Given what you know about evidence based practice, how compelling is the research evidence for
this adaptation or application?
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4. Given what you learned about DBT during this course and your review of the literature, what is your
assessment of this adaptation? How well do you think DBT would work for this particular population
or problem. (I am asking for your informed opinion here.) This section should be about one page of the
paper.
Grading Rubric
Criteria
The paper clearly explains what changes are needed to implement DBT with the
population or disorder of focus and cited relevant literature.
There is a clear and comprehensive summary of the relevant efficacy research on this
topic.
There is a thoughtful discussion of the quality of the evidence.
There is a discussion of the student’s view of this adaptation that shows critical
thinking.
At least 5 scholarly resources were used which were not assigned course readings.
The writing was clear with NO errors and APA formatting was used throughout the
paper.
Total
13
Points
possible
14
11
7
8
5
5
50