Radically Open Dialectical Behavior Therapy: Theory, Assessment and Case Conceptualization

Treatments for clinical populations characterized by maladaptive overcontrol have not been sufficiently emphasized in behavior therapy theorizing or research. This may be because this client population tends to be understated in their reporting of psychological distress and their social signaling, thus escaping the attention of clinicians and researchers. In contrast, undercontrolled clinical populations emit more pronounced signals and thus they are eye catching. A severely emotionally dysregulated client who publicly self-mutilates is difficult to ignore whereas a client who barely emotes is difficult to notice. In this chapter, we illustrated some of the overlapping components of radically open dialectical behavior therapy (RO DBT) compared with standard DBT as well as the defining and distinctive features of RO DBT. RO DBT pulls from earlier waves of behavior therapy, such as by closely resembling the first wave with its shared emphasis on operant and respondent learning, yet it also shares many third wave components including a biosocial model, dialectics and mindfulness built into the treatment. RO DBT is distinct from most all therapies though with its focus on treating emotional loneliness via social signaling and openness as core mechanisms of therapeutic change.