The Radically Open Dialectical Behavior Therapy Skills Training Manual: A Clinician's Guide for Treating Disorders of Overcontrol

by Thomas R. Lynch

Radically open-dialectical behavior therapy (RO-DBT) is a groundbreaking, transdiagnostic treatment model for clients with difficult-to-treat overcontrol (OC) disorders, such as anorexia nervosa, chronic depression, and obsessive-compulsive disorder (OCD). Written by the founder of RO-DBT, Thomas Lynch, this is the first and only session-by-session training manual to help you implement this evidence-based therapy in your practice.

As a clinician, you re familiar with dialectical behavioral therapy (DBT) and its success in treating clients with emotion dysregulation disorders. But what about clients with overcontrol disorders? OC has been linked to social isolation, aloof and distant relationships, cognitive rigidity, risk aversion, a strong need for structure, inhibited emotional expression, and hyper-perfectionism. And yet perhaps due to the high value our society places on the capacity to delay gratification and inhibit public displays of destructive emotions and impulses problems linked with OC have received little attention or been misunderstood. Indeed, people with OC are often considered highly successful by others, even as they suffer silently and alone.

RO-DBT is based on the premise that psychological well-being involves the confluence of three factors: receptivity, flexibility, and social-connectedness. RO-DBT addresses each of these important factors, and is the first treatment in the world to prioritize social-signaling as the primary mechanism of change based on a transdiagnostic, neuroregulatory model linking the communicative function of human emotions to the establishment of social connectedness and well-being. As such, RO-DBT is an invaluable resource for treating an array of disorders that center around overcontrol and a lack of social connectedness such as anorexia nervosa, chronic depression, postpartum depression, treatment-resistant anxiety disorders, autism spectrum disorders, as well as personality disorders such as avoidant, dependent, obsessive-compulsive, and paranoid personality disorder.

In this training manual, you ll find an outline of RO-DBT, including history, research, and how it differs from traditional DBT. You ll also find a session-by-session RO-DBT outpatient treatment protocol, with sections that outline the weekly, one-hour individual therapy sessions and weekly two-and-a-half hour skills training classes that occur over a period of approximately thirty weeks. This includes instructor guidelines and user-friendly worksheets.

The feasibility, acceptability, and efficacy of RO-DBT is evidence-based and informed by over twenty years of translational treatment development research. This important manual along with its companion book, Radically-Open Dialectical Behavior Therapy (available separately), distills the essential components of RO-DBT into a workable program you can start using right away to improve treatment outcomes for clients suffering with OC.

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Genres: Psychology, Nonfiction, Mental Health, Self Help, Reference, Textbooks, Social Work

648 pages, Paperback

Published February 2, 2018

Reviews

[Thomas · Rating 3 out of 5]

Overall appreciated this book’s novel take on issues of overcontrol, for clients who struggle with cognitive rigidity, always needing structures and plans, and relentless perfectionism that may inhibit relational satisfaction and overall wellbeing. I liked how the author took into account how society can glorify overcontrol such as through rewarding people who delay gratification and who invest so much of themselves in work. I research eating disorders and see how the themes of overcontrol especially relate to anorexia nervosa.

The main downside which other reviewers have also noted is that the book is extremely long and I’m not sure all the content actually related to the central issues of overcontrol. I also thought the lack of attention paid to issues of culture and social oppression and how those factors may motivate or affect a desire for control was a bit egregious. Finally, there was an amatonormative assumption that desiring romance is indicative of honoring one’s true desires which felt off-putting to me. An interesting extension of traditional DBT nonetheless.

[Shelley Diamond · Rating 3 out of 5]

This book is not what I thought it was going to be. I assumed that his concept of "overcontrol" referred to people who overthink everything and try to control everything and everyone in their lives. That's sort of/part of what he is describing but he's really focusing on people who overcontrol their emotions, are shut down emotionally, and cut off from social interaction that would regulate the way they think and feel.

This book is over 500 pages. The author seems to overthink everything himself because the minutiae in this book is overwhelming. The first 7 chapters (200 pages) are overly elaborate and unnecessarily long. Chapters 8, 9, and 10 and the appendices are the most useful. But I suspect most of what he presents would be rejected by many patients who have this problem. It's just too impractical in practice to do what he suggests is necessary.

I'm sure there are some therapists who could follow through with his approach. However, I think many therapists and patients would ultimately be frustrated by this complicated system. I suspect it took him years to write this book and he probably put far more effort into this than most people are going to get out of it.

[Vaughn · Rating 4 out of 5]

I was first introduced to RO-DBT by my colleague who uses this treatment modality in her therapy work at an eating disorder rehabilitation clinic. I'll have to check out the skills manual that comes as an add-on to this textbook but even by itself this book is great. The best parts of this textbook are the summaries at the end of each chapter and the written tables throughout the chapters. Some of the visual diagrams in the text were just goofy but I loved the written tables because they separated the difference between core concepts, such as the difference between overcontrolled/undercontrolled clients and healthy self-doubt vs. unhealthy self-doubt. I've found DBT very useful for undercontrolled clients who seek therapy to learn better emotional regulation, but for clients who struggle with perfectionism, RO-DBT is a perfect (haha) variation to use instead. It makes total sense how one of the core tenants of RO-DBT is a therapist who uses humor in appropriate ways because perfectionists struggle with taking themselves too seriously. I really wish DBT, along with this variation RO-DBT, were included in my grad school curriculum, because DBT's skills, strategies, and coping mechanisms are so great for real world applications and sustaining positive changes in the long-term. Books like this are what every therapist should pursue after grad school because there are way too many therapists who are only as good as the year they graduated. To any therapists who might be reading this, make sure to always keep learning, growing, and honing your therapy skills in order to best serve your clients!

[Spencer H · Rating 4 out of 5]

As a treatment manual I felt this one was well laid out and comprehensive. Some parts were a bit repetitive but given the length of material to be covered that was actually helpful for getting things to stick. I found there was a lot of sample dialogue (my favourite part of manuals because it gives me a sense of what the therapy actually sounds like) and clinical examples. As with most novel psychotherapy modalities, there is a sense of dogma that pervades the book and makes you feel like a monster if you don't plan to follow the proscribed format exactly as it is in the book. I could have done without that, but I can appreciate the reasoning behind it. Though the authors make a good case for having a specific type of therapy for overcontrolled patients, some of the concepts were so similar to DBT as to be a bit redundant, and there were a few times where I actually thought straightforward DBT got it better (for example I think the concept of wise mind is still a far easier model for most clients, and can easily be adapted to those who spend more time in rational mind).

I think this will be a helpful framework for some of my narcissistic and OCPD clients and I hope I can find a training course in the next few years to actually solidify some of the techniques for practical use.

[Hugh Simonich · Rating 5 out of 5]

Lynch does a thorough job in explaining what RO DBT is and how it is practiced. His main points are emphasized and repeated throughout. He has assessments in the back for both the client and the therapist, and the book is coupled with the Skills Training Manual, just as thick, but equally as important. He explains theory and practice with detail and clarity.

This is for clinicians who treat disorders related to over-controlled (OC) tendencies, but the underlying basic assumption - that we evolved as a hyper-cooperative species in tribes that use various verbal and non-verbal social signals to convey nuanced and meaningful emotional expressions to establish and maintain cooperative relationships with others, particularly those who are non-related - can be applied to all therapeutic modalities. RO DBT focuses treatment on maladaptive social signaling and ties treatment with the client’s personal values and goals. It is in line with all other empirical and process based therapies with the emphasis on social signaling (defined as basically any overt behavior done in a social setting) and with an understanding to the OC personality type.

I enjoyed reading this and would recommend, even if you don’t intend to practice to the letter, exactly how it is written and structured for each session. It’s deepened my theoretical understanding and has good practical tips for treatment-resistant clients who tend to strongly avoid.

[Chantelle J. · Rating 4 out of 5]

This week was a very upsetting time in my life personally. Honestly, I can't remember the last time I had a panic attack so bad I dropped to the floor, unable to control my breathing. I was so utterly disappointed on a Friday afternoon that my brain felt so eclipsed by the harassment I had to experience. Leading to google searching ways to stop myself from "overthrowing" pathetic I know. Anyway, I stumbled upon many articles about the word "overthinking" and, of course, this book 500ish pages later. As my mind seemed to feel calmer this now noon hour Iam given alot to think about. For in the past, I have felt that way of having someone bully me & I felt as if I was like a victim. Reminding myself to return to the present day the here and now moment Iam simply greatful for such a wonder of a read.

[Little Moon · Rating 5 out of 5]

I read this and applied the practices and activities in it during the hardest time of my life and it helped me a ton. I can't recommend it enough especially if you meet the criteria for being overcontrolling

[Fergar · Rating 5 out of 5]

I assume, without having verified, that the somewhat low scores that some readers have assigned are from people without training as clinical psychologists, therapists or psychiatrists; for the right people, the book is excellent.

[Kasandra · Rating 5 out of 5]

Nobody enjoys a manual but they are very important to read and this one is groundbreaking. Looking forward to piloting an RO DBT program in my practice.

[Caroline · Rating 5 out of 5]

Not the easiest therapy not the easiest of books but essential if you provide RO. Sometimes this is the therapy that is so effective I am so glad it’s available.

[Joana Pancada · Rating 3 out of 5]

Intense. Lots of information to digest.

[Betsy Myers]

I won this book via Goodreads First Reads. I am an ECE administrator and I look forward to adding this book to the lending library for parents and staff at my school.