While it may be premature to say that personality disorders have truly come in from the cold, the past two decades have certainly seen a great deal of progress. A key driver of this change has been the development of new therapeutic approaches, including Dialectical Behaviour Therapy (DBT), which both offers hope of change to individuals once thought of as untreatable and challenges the historical pessimism within services.

Originally developed by Marsha M. Linehan as a specific outpatient treatment for suicidal individuals with borderline personality disorder (BPD), DBT has since been applied to a range of other areas including eating disorders, inpatient units and individuals with BPD and concurrent substance abuse. This text mainly focuses on BPD. The authors of this introductory text are experienced practitioners at the forefront of DBT practice, training and development; Swales is director of the British Isles DBT Training Team, while Heard is a senior trainer and consultant for Behavioural Tech USA, the company set up by Linehan to develop and disseminate DBT.

Rather than a therapy manual, this book is intended as an introduction to DBT and how it differs from other cognitive-behavioural approaches. The text consists of 30 short chapters, each describing a distinctive element of DBT and is split into two parts: theory and practice. In the first, Swales and Heard describe the three main theoretical foundations of DBT (dialectics, behaviourism, and Zen) as well as the DBT model of BPD and its focus on emotions rather than cognitions as key causal variables.

The second part looks at how all of this is applied in practice. Initial chapters consider the main modalities through which the therapy is applied (group skills training, individual sessions, consulting within the team and telephone consultation) and their purpose and relationship to one another. Subsequent chapters summarise methods for structuring treatment overall and within sessions, the main therapeutic techniques (e.g. behavioural analysis, problem solving, cognitive and behavioural change procedures, skills training, motivational enhancement strategies and validation techniques), stylistic strategies (e.g. irreverence) and ways therapeutic ruptures can be addressed.

DBT is a complex therapy that requires practitioners to integrate a number of theoretical ideas and apply a variety of techniques, often in the face of intense emotion and challenging interpersonal situations. Having experienced one of the authors (Heard) in their training and consultation capacity, it was no surprise to see what a good job they have done in describing this complexity in such a clear and concise manner (the text runs to only just over 150 pages). Readers unfamiliar with DBT will emerge at the end with a fair idea of what it looks like, what the ingredients are, and its rationale. Those learning DBT will appreciate this as an adjunct to the original Linehan text (Linehan, Reference Linehan1993), which while excellent is not the easiest of books to read. It would probably be less useful to those already practising with DBT although even after two and a half years of exposure to the model I still found some of the chapters instructive and useful. My one criticism is that I would have liked the history of DBT (i.e. the original reasons Linehan developed it) to have been described at the start rather than part way through the text, though this really is a minor point.