Radically open DBT

Domain II · Behavioural & cognitive · Thomas R. Lynch · 2015

What it is

Radically Open Dialectical Behavior Therapy (RO DBT) is a transdiagnostic treatment developed by Thomas R. Lynch from standard DBT. It is for disorders of overcontrol (OC): chronic or refractory depression, anorexia nervosa, obsessive-compulsive and avoidant personality features, and similar…

Format

• Format (outpatient standard). The standard course runs about 30 weeks:
• weekly individual therapy of about 1 hour;

Who practises it, and how they are trained or regulated

• Version followed: Lynch's published RO DBT (2018 theory-and-practice text and 2018 Skills Training Manual, 30-lesson skills curriculum). I worked from what is reported of these books in the 2015 description by Lynch, Hempel and Dunkley, the REFRAMED trial protocol (Lynch et al., 2015), the 2018 Behavior Therapist special issue, and materials from the RO DBT institute (radicallyopen.net). The two 2018 books…
• Radically Open Dialectical Behavior Therapy (RO DBT) is a transdiagnostic treatment developed by Thomas R. Lynch from standard DBT. It is for disorders of overcontrol (OC): chronic or refractory depression, anorexia nervosa, obsessive-compulsive and avoidant personality features, and similar presentations. OC is described as too much inhibitory self-control. Its features are high threat sensitivity, low reward…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Values stated as rigid rules.
• Forced or premature forgiveness.
• Stalling that turns into avoidance.
• Polished summaries that hide doubts.
• Mislabelling Fatalistic Mind as acceptance.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.