Foote Brad, Van Orden Kim
Am J Psychother. 2016 Dec 31;70(4):343-364. doi: 10.1176/appi.psychotherapy.2016.70.4.343.
Dialectical Behavior Therapy (DBT), created by Marsha Linehan, has been shown to be an effective therapy for the treatment of borderline personality disorder (BPD) and for suicidal and self-harming behavior. Dissociative identity disorder (DID) is a complex post-traumatic disorder which is highly comorbid with BPD, shares a number of clinical features with BPD, and which like BPD features a high degree of suicidality. The DID treatment literature emphasizes the importance of a staged approach, beginning with the creation of a safe therapeutic frame prior to addressing traumatic material; DBT is also a staged treatment, in which behavioral and safety issues are addressed in Stage 1, and trauma work reserved for Stage 2. The authors describe adapting DBT, and especially its techniques for Stage 1 safety work, for work with DID patients. Basic theoretical principles are described and illustrated with a case example.
辩证行为疗法（DBT）由玛莎·莱茵汉创立，已被证明是治疗边缘性人格障碍（BPD）以及自杀和自我伤害行为的有效疗法。分离性身份障碍（DID）是一种复杂的创伤后障碍，与BPD高度共病，与BPD有许多临床特征相同，并且像BPD一样具有高度自杀倾向。DID的治疗文献强调分阶段方法的重要性，即在处理创伤性材料之前先建立一个安全的治疗框架；DBT也是一种分阶段治疗，其中在第1阶段解决行为和安全问题，而创伤治疗则留到第2阶段。作者描述了如何调整DBT，特别是其第1阶段安全工作的技术，以用于DID患者的治疗。文中描述了基本的理论原则并用一个案例进行了说明。
