Dialogical exposure therapy

Domain VI · Brief, integrative, trauma, hypnosis & coaching · Willi Butollo, Regina Karl, Julia König · Munich (LMU)

What it is

Dialogical exposure therapy (DET; German: Dialogische Traumatherapie / Dialogische Exposition) is an outpatient PTSD treatment developed by Willi Butollo and colleagues (Regina Karl, Julia König, Rita Rosner, Maria Hagl) at the psychotherapy and trauma outpatient clinic of LMU Munich. The authors…

Format

• Only then, and only if the patient wishes, bring the original traumatic relationship into the session as role-play.
• Treatment start (manual Ch. 3). Start of trauma therapy; inclusion and exclusion criteria; therapist behaviour; session sequence and division; and "telling the traumatic experience – narrative confrontation". Diagnosis covers PTSD criteria, course and comorbidity. The trials enrolled adult…

Who practises it, and how they are trained or regulated

• Setting and dose. Individual outpatient therapy. In the RCT (141 adult outpatients) the length was flexible, with a maximum of 24 sessions. In the pilot, 25 outpatients started and 21 completed. Dialogical exposure was also tested in a controlled trial with traumatically bereaved Bosnian women (Hagl, Powell, Rosner & Butollo 2015). Only the bibliographic record of that trial is drawn on, so its format and dose are…
• Version followed: Butollo & Karl (2012), Dialogische Traumatherapie: Manual zur Behandlung der Posttraumatischen Belastungsstörung (Klett-Cotta, Leben Lernen 256). This is the manual used in the LMU Munich trials (pilot 2014, RCT 2016). Unverified warning. The manual's publicly available parts are the publisher's reading sample (front matter, full table of contents, Vorwort, Prolog and the start of Chapter 1); the…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• 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?
• 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

• Overload. Keep the steps small.
• Lingering shame about aggression.
• Expression without containment. Always close.
• Acceptance heard as condoning. Clarify the difference.
• Guilt-driven rumination. Address guilt directly (4.10).

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.