CHAPTER 10 Commitment and Commitment Strategies

Created: 2022-03-25

INTRO

"TRY" VERSUS "DO": THE SPIRIT OF COMMITMENT IN DBT

CONTRIBUTIONS FROM THE BEHAVIORAL PARADIGM

CONTRIBUTIONS FROM THE ACCEPTANCE PARADIGM

Commitment Is Transient in Its Nature

Commitment Is Perfect Just as It is

CONTRIBUTIONS FROM THE DIALECTICAL PARADIGM

Commitment Is Interdependently Linked to All Systemic Factors

Commitment Is Constantly Changing: It Is in Constant Motion

Commitment Is Transactional(Just as Identity Is Transactional)

DBT'S FORMAL COMMITMENT STRATEGIES

  1. Weighing the pros and cons: selling commitment
    1. 전념하지 못하는 이유에 대해 비판단적 태도로 호기심을 갖고 물어봄(달리 말해, 전념의 cons)
    2. 환자의 설명을 이해하고 반영함
    3. 이후 현재 행동을 포기하는 것의 장점은 없을지 물어봄(전념의 pros)
  2. Highlighting the freedom to choose in the absence of alternatives
    1. I highlight that the patient always has the freedom to choose to do DBT, or not; other times I highlight that there do not seem to be any good alternatives. Even if, from the patient’s viewpoint, there is a lack of freedom of choice about what to do with his life at this point in time, making DBT the only viable alternative, the therapist wants to help him arrive at the place where his decision to enter DBT is voluntary.
    2. 교정 시설처럼 내담자가 치료 이행 명령을 받은 경우: 자발적인 선택이어야 DBT의 효과가 있고, 치료에 참여할지 말지는 환자의 판단에 달려 있음. 치료를 안 받는 선택을 하게 될 시, 그 결과에 대해서도 책임을 지게 됨을 강조함.
  3. Foot in the door and door in the face
    1. 전념의 수준을 어느 정도로 잡을 것인지에 대해서는 환자마다 다르고, 치료자-환자가 생각하는 적절한 전념 수준이 다를 때는 협상이 필요함.
  4. Eliciting prior commitments and connecting them to the present one
    1. 일종의 고전적 조건형성임. 과거 전념에 성공했던 상황과 현재 전념이 요구되는 상황 간의 연결점을 만들어서 동기 향상시킴
    2. I asked her if she had ever done something in her life after thinking it would be impossible to do it. -> 자식을 위해 결단력을 발휘해 원하는 바를 이뤄낸 경험이 있음. 그러한 결단을 자신에게 적용해 볼 것을 요청함.
  5. Taking the devil’s advocate position
    1. The patient is ambivalent about committing, and the tension between the request to commit and the reluctance to commit is palpable.
    2. In the course of the conversation, the tension seems to be lessened as the patient claims to have adopted the commitment.
    3. The therapist does not trust that the patient’s statement of commitment fully integrates the level of difficulty.
    4. 이런 상황에서 왜 행동을 그만두는지 이해할 수 없다는 식으로 물어봄으로써, 환자 스스로 전념하려는 자신의 태도를 변호하고, 그 과정에서 전념의 pros를 생각해 볼 수 있게 함.
  6. Shaping successive approximations to commitment

CONCLUDING COMMENTS