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date: 25 January 2020

Abstract and Keywords

This chapter reviews the literature on DBT provision in inpatient units and shows that shorter-term DBT programmes tend to focus on the acquisition of a limited repertoire of DBT skills and teach these skills intensively. It also focuses on longer-term DBT programmes that structure the environment with a particular emphasis on managing risk through clear protocols, and provides examples. It discusses how treatment hierarchies need to focus on decreasing behaviours that led to admission and increasing those necessary to effect discharge. It describes common problems to delivering DBT in the milieu, e.g., the ways in which inpatient programmes have to work harder to establish the patient’s life-worth-living off the unit, and to ensure the generalisation of DBT skills to the real world, and offers solutions. Some dialectical dilemmas in inpatient settings mirror those in Rathus and Miller’s adolescent treatment model, and ‘splitting’ of staff can be redefined in behavioural terms, and addressed using DBT principles.

Keywords: Inpatient, risk, milieu, dialectical dilemmas, shorter-term DBT programmes, longer-term DBT programmes, generalization of DBT skills, discharge

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