Advanced DBT-Informed Work with Dysregulation

This is an Advanced course in the DBT-informed practice pathway. It assumes that you already work with the approach at Practitioner level and want complexity, process and supervision-level thinking rather than the method itself, which is what DBT-Informed Practice teaches. What it adds is complex presentations, comorbidity, ruptures and impasses, the research and process literature, and the judgement needed to supervise or lead the work; it revisits the foundations only as far as it needs to before building on them, so it does not repeat the course below.

A caution. Taking an Advanced course without the foundational understanding will make it harder to follow and to complete, and you will get less from it. If you are new to this approach, begin at Foundation; if you hold the foundations but have not yet used the approach with clients, begin with DBT-Informed Practice. Choose the level that matches your existing experience and knowledge.

The DBT-informed practice pathway. For clinicians bringing DBT into individual work: why DBT exists and what its four skills modules are, DBT-informed formulation and the dialectical stance with real clients, then advanced work with dysregulation. It is about practising in a DBT-informed way, not about running skills groups.

• Dialectical dilemmas and secondary targets Three dilemmas organise the presentation beneath the behaviours
• The consultation team: treatment for the treater The team treats the therapist, not the client
• Strategic Intervention in the Dialectical Dilemma: Navigating the 'Yes/No' Trap The 'Yes/No' trap is a secondary target that maintains the dialectical dilemma by preventing the client from moving towards the middle path.
• The Paradox of Engagement: Strategic Management of the 'Yes/No' Trap in Treatment Refusal In the most sophisticated applications of Dialectical Behavior Therapy (DBT) the clinician encounters a paradox that is both a relational impasse and a therapeu…
• Applying the DBT Treatment Hierarchy to Complex Cases: Prioritising Targets, Managing Target Drift, and Integrating Secondary Targets into the Case‑Level Strategy Prioritise the DBT hierarchy: life‑threatening, therapy‑interfering, then quality‑of‑life‑interfering behaviours; Address therapy‑interfering behaviours promptly to protect the therapeutic alliance; Integrate secondary targets only after higher‑order targets are stabilised; Use a dynamic hierarchical case formulation and regular consultation to prevent target drift

• Secondary Target Clusters: Assessment, Formulation and Case‑Level Intervention Self‑invalidation, active passivity and apparent competence constitute the three secondary target clusters that operate as dialectical dilemmas sustaining primary target behaviours.
• Functional and Chain Analysis as the Bridge Between Primary and Secondary Targets in Complex DBT Cases Functional and chain analysis map the precise antecedents, vulnerabilities, and consequences that maintain dysregulated behaviours.
• Advanced Case Conceptualisation: Integrating Primary and Secondary Targets through the Biosocial Model A comprehensive case conceptualisation must map primary and secondary targets onto the biosocial model of emotional vulnerability and invalidation.
• Integrating DBT Skills Modules to Target Secondary Dysregulation: A Structured Approach Map each secondary target onto a functional analysis to identify the most relevant DBT module.
• Overcontrol and the RO-DBT challenge Overcontrol: inhibition, compulsive discipline, distant performed calm

• The dysregulation lens across diagnoses Ask of any behaviour: what is it regulating, at what cost
• The Defectiveness and Shame Schema: The Core of Overcontrol The Defectiveness and Shame schema represents the core internal belief that one is inherently flawed and unlovable, distinct from the abandonment fears seen in undercontrol.
• The Social Connectedness Pathway and the Skill of Opening Up The Social Connectedness pathway focuses on the maintenance of isolation through rigid self-protection strategies rather than emotional dysregulation.
• Radical Acceptance and Compassionate Experiencing in RO‑DBT: Counteracting Overcontrol through Mindful Exposure Radical acceptance in RO‑DBT is a compassionate, mindful exposure to suppressed affect, not mere resignation.
• Assessing Overcontrol: The RO‑DBT Biosocial Model and Clinical Formulation The RO‑DBT biosocial model identifies heightened threat sensitivity, excessive inhibitory control, low reward sensitivity and heightened detail‑focused processing as temperamental drivers of overcontrol.

• Radical Openness: The Core Skill for Overcoming Overcontrol in RO‑DBT Radical openness targets external avoidance, encouraging authentic engagement with people and situations.
• The Therapeutic Relationship in RO‑DBT: Managing Overcontrol and Cultivating Radical Openness Therapeutic validation combined with calibrated corrective feedback helps dismantle the client’s defectiveness schema.
• Integrating RO‑DBT and Standard DBT: A Unified Approach to Dysregulation A unified biosocial formulation captures both under‑control and over‑control patterns, guiding assessment and case conceptualisation.
• Motivation and Commitment in RO‑DBT: Overcoming Resistance in Overcontrolled Clients Motiva