









































Using Art to Undermine Epistemic 
Injustice in DBT Research

ENGAGE!  |  c r e at i v e  a rts 38

B A I L E Y  &  T R A C E Y  |  U N D E R M I N I N G 
E P I S T E M I C  I N J U S T I C E

Authors 
ELIZABETH BAILY College of Education, Wayne State University 
MONICA W. TRACEY College of Education, Wayne State University

keywords:

Dialectical Behavior Therapy, Activity Theory, Art, 
Epistemic Injustice 

 
abstract
Through participatory arts-based research, 
constructed within the theoretical basis of the 
activity system, participants engaged with 
dialectical behavior therapy (DBT) program 
content to develop a cohesive and meaningful 
project structure and aesthetic. The body of 
literature that explores DBT skills training 
produces epistemic injustice by elevating 
practitioner/researcher perceptions of individual 
progress over participants’ interpretations 
of their own collective experiences. Research 
that relies on practitioners to report on patient 
experiences creates a self-perpetuating cycle 
where individual practitioners do not have the 
tools to regard patients as credible, allowing the 
field to render patients unintelligible. DBT is a 
skills-based psychotherapeutic approach that 
prepares individuals to address problems in 
living that result from the development of mental 
disorders in environments that persistently signal 
that an individual is an unreliable informant of 
their own experience. Arts-based research can 
be employed to disrupt the harmful parallels 
between the development of the disorders DBT 

is intended to treat and the dominant paradigm 
of DBT research. This publication centers on 
the experiences of individuals completing DBT, 
interrupts cycles of harm, and uplifts social 
knowledge construction that emanates from DBT 
skills training communities. 
 

epistemic injustice 
Epistemic injustice is the practice of favoring one 
group’s voice over another in a way that replicates 
and proliferates social, economic, political, and 
structural injustice (Fricker, 2013). Two types of 
epistemic injustice are identified, testimonial and 
hermeneutical. Testimonial injustice occurs when 
a speaker’s voice is dismissed based on aspects of 
the speaker’s identity, causing them to be deemed 
uncredible. Hermeneutical injustice occurs when 
a group is excluded from activities like scholarship 
and journalism that shape the ideas that people use 
to make sense of their lives. When an individual’s 
experiences are vastly different from these ideas, 
the individual is dismissed as unintelligible because 
the listener lacks a framework to understand their 
experiences (Fricker, 2013).

 The opposite of epistemic injustice is 
epistemic justice. Epistemic justice requires 
virtuous hearing, where listeners become aware 
of the impact of power imbalances on how they 
evaluate communication and make compensation 



VO L .  1 ,  I S S U E  2VO L .  4 ,  I S S U E  1

B A I L E Y  &  T R A C E Y  |  U N D E R M I N I N G 
E P I S T E M I C  I N J U S T I C E

ENGAGE!  |  c r e at i v e  a rts 39

for those imbalances (Fricker, 2007). Virtuous 
hearing requires time and the development of 
a micro-climate in which listeners are able to 
move past prejudicial notions of credibility and 
intelligibility (Bourgault, 2020). 
 

dialectical behavioral 
therapy 
Dialectical behavior therapy (DBT) is a skills-
based therapy that is recommended for individuals 
who experience severe problems in living that 
develop in an environment that persistently 
invalidates the individual’s interpretation of their 
own experience (Linehan, 2015). This persistent 
invalidation results in skill deficits in the domains 
of interpersonal interactions, self-regulation of 
emotions and behaviors, toleration of distress, 
and connecting with the present moment. In its 
standard format, DBT includes a group skills 
training component. Skills training groups 
participate in collaborative learning activities 
including role play, discussions, and cooperative 
problem solving (Linehan, 2015).  
 

epistemic injustice in dbt 
research 
Despite the active, collective, and communal 
nature of DBT group skills training, the body of 
literature that explores DBT skills training most 
often reports on individual measures of success 
that are selected, administered, interpreted, 
and reported by practitioners to the exclusion of 
participant voices. This has the effect of elevating 
the perspectives of practitioners over participants, 
developing a paradigm where practitioners 
are upheld as superior informants on program 
outcomes and participant experiences. 

 The second edition of the DBT Skills Training 
Manual employs a summary of 30 randomized 
control trials (RCT) and seven non-randomized 

control trials (Linehan, 2015, p. 17-18, 20-
21). These trials report patient outcomes at the 
individual level using standardized measurements 
administered and interpreted by the treating 
practitioners to assert the effectiveness of DBT. 
This pattern extends to case study literature. 
In a meta-analysis of 48 published English 
language case studies that incorporated DBT skills 
training, practitioner perspectives were the most 
consistently reported metrics of change. 37 case 
studies incorporated practitioner notes on patient 
changes as they were perceived by the practitioner. 
31 case studies included practitioner-selected 
psychometrics as indicators of change, 18 included 
behavioral metrics, and 4 included physiometrics – 
such as changes in patient weight. 22 case studies 
published practitioner interpretations of patients’ 
responses to practitioner-generated follow-up 
interview questions.

Three notable exceptions to the pattern of 
privileging practitioner perspectives are Lustig 
and colleagues (2000), who referenced a piece 
of narrative fiction authored by the participant; 
Heckwolf and colleagues (2014), who described 
patient-generated visual artwork; and McNair 
and colleagues (2016), who assessed participant-
generated repertory grids. Despite these few 
exceptions, this preference towards practitioner 
insights defines a body of literature that holds 
practitioners as more trustworthy and their 
perspectives as more valuable than patients’. 

This pattern is uniquely damaging because 
the disorders that DBT is designed to treat 
often develop in environments that reject the 
individual as a reliable informant of their own 
experience (Linehan, 2015). Research that relies 
on practitioners to report on patient experiences 
creates a self-perpetuating cycle where individual 
practitioners do not have the tools to regard 
patients as credible, allowing the field to render 



ENGAGE!  |  c r e at i v e  a rts 40

B A I L E Y  &  T R A C E Y  |  U N D E R M I N I N G 
E P I S T E M I C  I N J U S T I C E

patients unintelligible (Vosinkel et al., 2021). 
By situating the patient as the primary source 
of knowledge, the inquiry for this publication 
interrupts cycles of injustice by creating a channel 
for social knowledge that emanates from DBT 
skills training communities to flow into academic 
discourse and literature. 
 

foundation for participatory 
research 
The Activity System 
Social knowledge construction is an actively 
constructive process that occurs when groups of 
individuals generate, negotiate, and respond to 
unique configurations of shared understanding 
(Duffy & Cunningham, 1996). Activity theorists 
expand the role of context in social knowledge 
construction to describe learning as a shared 
social endeavor (Engeström, 1987; Leont’ev, 
1978; Vygotsky, 1978b), which is mediated by 
tools and situated within a broader community of 
practice (Barab et al., 2004). Figure 1 illustrates the 
relationship between the interactive components 
of the activity system described by activity theory 
(Engeström, 1987, p. 14). 
 
 

 

The research undertaken for this inquiry applies 
activity theory to structure relevant aspects of a 
micro-climate that facilitates virtuous listening 
on the part of the researcher. In this activity 
system, DBT skills training group participants 
are organized around a shared objective of 
representing the impact of DBT skill use in a 
collaborative art piece. Participants (subjects) work 
as part of a DBT skills training group (community) 
organized around producing an artwork (object). 
This process is mediated by art supplies and the 
concepts shared through DBT skills training (tools 
and symbols). The DBT Skills Training Manual 
provides the rules within the social environment 
that are further defined by an emergent division of 
labor.  
 
Arts-Based Research 
Arts-based research (ABR) is a constructive process 
in which knowledge is created and physicalized 
through the collaborative construction of work and 
the roles that participants embody (Greenwood, 
2019). By providing a medium for participants 
to intentionally self-construct and self-edit 
(Greenwood, 2019), ABR democratizes research 
participation and reporting (Bartlett, 2015; 
Boydell, 2011). ABR expands opportunities for 
participants and audiences to engage with research 
by presenting findings in mediums beyond 
academic discourse (Bartlett, 2015; Boydell, 2011; 
Nilssen & Klemp,2020).

Participatory research demonstrates the promising 
potential to interrupt epistemic injustice (Boni 
& Walker, 2020). The research undertaken for 
this publication is structured in accordance 
with Mitchell and colleagues’ participatory 
visual research methodologies (PVRM, 2011). 
PVRM promotes community engagement in 
arts-based research by creating a structure 
of relationship-building between researcher 
and participants alongside interpretation that 

Figure 1. Activity System Schematic, developed by  
Engreström, 1987 p. 14



41 VO L .  4 ,  I S S U E  1

B A I L E Y  &  T R A C E Y  |  U N D E R M I N I N G 
E P I S T E M I C  I N J U S T I C E

engages all stakeholders. PVRM recommends five 
characteristics of research design: a reassuring 
invitation to draw, choice of drawing tools, leisurely 
pace, shared analysis, and civic dissemination. 

 

collaborative investigation 
with the dbt skills training 
community 
Guiding Questions 
This inquiry applies the theoretical framework 
of activity theory (Leont’ev, 1978) while using 
best practices for arts-based research (Mitchell 
et al., 2011). The guiding questions focus on 
exploring the ways in which DBT skills training 
participants organize themselves around creating a 
collaborative art piece:

Q1: How are tools and symbols used by 
participants to mediate shared expression of 
knowledge constructed in DBT skills training?

Q2: How do participants negotiate shared 
expression of public knowledge constructed in DBT 
skills training? 

Q3: How does a division of labor emerge to 
organize participant actions around creating a 
shared expression of knowledge construction in 
DBT skills training?

Q4: In what ways are the expectations provided 
by the DBT Skills Training Manual applied by 
participants in creating a shared expression of 
knowledge constructed in DBT skills training?

Each guiding question is designed around a unique 
triad of activity system nodes that includes the 
subject node, the object node, and one additional 
node. These triads are: Q1 subject, object, tools; Q2 
subject, object, rules; Q3 subject, object, division 
of labor; Q4 subject, object, community. While 
these questions are not explicitly answered by this 
publication, they serve as a basis for the approach 

to inquiry and interpretation of outcomes.

Participants and Context 
The participants in this inquiry were active in an 
outpatient DBT skills training program that is 
offered through the counseling center at an urban 
research university in the midwestern region of the 
United States. This treatment program is offered 
at a sliding scale cost to students and community 
members. Two DBT skills training program 
participants agreed to be part of the research. The 
identities of the participants have been anonymized 
for confidentiality reasons. 
 
Approach to Collaborative Inquiry 
Participant introductions occurred virtually 
following a regularly scheduled skills training 
session. Individuals who expressed interest in 
participating were provided an informed consent 
form, and individuals who completed the form 
were sent an electronic survey that asked about art 
supplies that were familiar and of interest to them. 
This survey offered a “choice of drawing tools” 
(Mitchell et al., 2011), which were then purchased 
and provided to the participants at no cost. These 
supplies included a mounted canvas measuring 
three feet by four feet; acrylic paints, brushes, 
and pallets; and collaging materials including 
magazines, construction paper, and adhesive. 

Next, participants attended a virtual planning 
meeting that lasted approximately 30 minutes. 
This meeting provided a "reassuring invitation to 
draw" where participants were assured that "the 
focus is on the content of their drawing, and not 
on the quality of it as a drawing" (Mitchell et al., 
2011 p. 23). Participants were shown the materials 
available and discussed their approach to the 
project.

At the end of the first meeting, participants 
determined the need for a second discussion. The 
second virtual meeting lasted approximately 20 



ENGAGE!  |  c r e at i v e  a rts 42

B A I L E Y  &  T R A C E Y  |  U N D E R M I N I N G 
E P I S T E M I C  I N J U S T I C E

minutes and allowed participants to set a leisurely 
pace (Mitchell et al., 2011) that fostered creative 
engagement with the project. Both meetings 
were audio-recorded to produce a conversation 
transcript which was reviewed using conversation 
analysis (Charmaz, 2014). 

After receiving the partially completed piece 
from Participant 1, Participant 2 experienced 
several life-interrupting events that derailed piece 
completion. As a result of these disruptions, the 
final stage of the project had not yet been reached 
at time of publication; the piece had not been 
completed, participants had not created a shared 
description of the final piece, and the piece had not 
been put on display. 
 

findings 
Participant quotations from the two planning 
meetings are employed in reporting the results of 
this collaborative project. Italicized words indicate 
descriptive choices employed by the participants 
throughout the meetings. By including participant 
quotations in their entirety, using participant 
utterances as the primary organizational 
structure, and by using descriptive choices made 
by participants, this work uplifts participant 
experiences as the primary source of knowledge in 
this inquiry.  
 
Program, Project, and Constraints: The 
idea of balance 
“And just the idea of balance. Because balance 
was something that definitely came to me really 
fast, just in terms of how we’re associating it 
to the skills and everything that we talk about” 
(Participant 1, meeting 1). 
 
Participants constructed knowledge when they 
discussed structures for the project alongside 
logistical constraints, a process that determined 
the structure of the piece. Participants considered 

two possibilities for structure. They explored the 
possibility of having the first participant create a 
rough version of the piece that covered the entire 
canvas and then having the second participant 
overlay their work onto the existing piece. The 
second possibility the participants explored was 
to split the canvas into a half-half structure with a 
side-to-side horizontal orientation of the canvas, 
and each participant would create their portion 
of the piece on half of the canvas. Participants 
found the half-half structure was more clearly 
defined while the overlay structure was less clear, 
and participants recognized there would be more 
negotiation involved in the overlay approach.

As participants engaged with their proposed 
half-half structure, they explored the ways in 
which DBT engages with duality. The participants 
reflected on the idea of existing along dialectics – 
the idea that two apparently opposing things can 
be true simultaneously – which is foundational to 
DBT. Participants also discussed balance and the 
ways in which messages surrounding balance are 
threaded throughout DBT skills training.  
 
“Emotions that you’re dealing with can be put 
in as far as how distress tolerance and emotion 
regulation help balance these emotions. But the 
emotions can be present via color or words” 
(Participant 2, meeting 1). 
 
Aesthetic Choices: Brightness and darkness 
“That brightness and darkness. And its correlation 
to how we identify with these things, especially 
with our own feelings and emotions” (Participant 
1, meeting 1). 
 
The consideration of the dualities explored by DBT 
supported the participants’ decision to engage with 
the half-half structure. This decision led to further 
discussion on aesthetic choices. Participants agreed 
that Participant 1 would make aesthetic choices 



43 VO L .  4 ,  I S S U E  1

 B A I L E Y  &  T R A C E Y  |  U N D E R M I N I N G 
E P I S T E M I C  I N J U S T I C E

that could be easily continued by Participant 
2, referring to a color spectrum that could be 
terminated in a line that would fade into a solid 
color allowing the participants to merge from color 
to color providing a unified look to the piece.

Participants also discussed the ways in which 
emotion regulation and distress tolerance allowed 
them to manage emotions characterized by 
brightness and darkness, and ways the artwork 
could externally express this internal experience. 
As the project developed, participants began to 
discuss more concrete options for the visual and 
aesthetic representation of the temporal aspect of 
DBT skills training. They considered the ways that 
skills practice may translate into a mindset over a 
span of time. 
 
“I was thinking about things going from in focus 
to out of focus or vice versa. Words are kind of 
smudgy and it’s become more bold” (Participant 1, 
meeting 2). 
 
Communication of Knowledge Constructed: 
A glimpse of artistically what it means 
“People who might not even know what DBT is 
could at least get a glimpse of artistically what it 
means” (Participant 2, meeting 2). 
 
Participants constructed connections between the 
content of their program, the ideas that underly 
their program, and the impact of DBT skills on 
their lives outside of the program. The participants 
then considered the ways in which these different 
aspects can be expressed visually. This process 
included considerations of project content that 
segued into discussing metaphoric options for 
visual expression.

As the structure, content, and aesthetic choices 
became more concrete for the participants, they 
began to consider their intended audience’s 

perceptions of the piece. Participants began to view 
their piece as a negotiation of meaning between 
themselves alongside their audience as they 
worked to navigate the tension of trying to visually 
translate the impact of a large program on a finite 
canvas in a way that would provide a meaningful 
experience to the audience. 
 
“What has stood out to me and what parts of each 
module stick out to me. And it’s kind of a challenge 
to do that. To put that in display” (Participant 2, 
meeting 2). 
 

implications 
Epistemic justice requires virtuous hearing 
(Fricker, 2013), and virtuous hearing requires 
a micro-ecosystem and time (Bourgault, 2020). 
This publication presents a discussion of the arts-
based activity system as a micro-ecosystem that 
can contribute to epistemic justice in DBT skills 
training research, with further exploration of the 
role of time in future research.

The micro-ecosystem empowered participants 
to determine their own expression priorities 
– a structure that stands in stark contrast to 
researcher/practitioner-driven case studies and 
trials. By minimizing researcher/practitioner 
voices, this research created space for DBT skills 
training participants to serve as active agents 
of knowledge construction and experts in their 
own experience. Within this space, participants 
demonstrated profound insight and creativity as 
they planned and executed their shared project.

While practitioners have deep knowledge of 
the therapeutic and training processes, only 
participants can truly be experts on the impact that 
skills have on them. Participant voices can – and 
should – provide insights that guide the future of 
DBT skills training research. While the findings 
revealed in this study are likely already present in 



ENGAGE!  |  c r e at i v e  a rts 44

B A I L E Y  &  T R A C E Y  |  U N D E R M I N I N G 
E P I S T E M I C  I N J U S T I C E

practice for many DBT practitioners, they are left 
unexamined in literature, preventing these lessons 
from being broadcast across the wider community 
of DBT skills trainers and therapists.

The data collected for this study demonstrate the 
types of insights and knowledge that can be gained 
when participants’ voices are centered. The data 
not collected for this study contain equally valuable 
implications for working alongside vulnerated  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

communities. Individuals completing DBT skills 
training are part of a community that experiences 
an increased likelihood of encountering life- 
interrupting events. To collaboratively create 
knowledge surrounding their experiences, that 
community’s relationship to – and experience of 
– time must drive project timelines and pacing. 
Centering participant voices requires intentional 
effort to elevate the participants’ experience 
with time over the researcher’s preferences for 
expediency, or any sponsoring institution’s time-
bound requirements for results. Researchers/
practitioners should work with participants to 
create and communicate fluid expectations for 
completion that fit the changing circumstances of 
participants’ lives.

While practitioners have 
deep knowledge of the thera-

peutic and training processes, only 
participants can truly be experts on the 

impact that skills have on them.



45 VO L .  4 ,  I S S U E  1

B A I L E Y  &  T R A C E Y  |  U N D E R M I N I N G 
E P I S T E M I C  I N J U S T I C E

References

References marked with an asterisk 
indicate studies included in the me-
ta-analysis.

* Banks, B. P., & Gibbons, M. M. 
(2016). Dialectical behavior therapy 
techniques for counseling incar-
cerated female adolescents: A case 
illustration. Journal of Addictions & 
Offender Counseling, 37(1), 49–62. 
https://doi.org/10.1002/jaoc.12015

Barab, S. A., Evans, M. A., & Baek, E.-
O. (2004). Activity theory as a lens 
for characterizing the participatory 
unit. In D. H. Jonassen (Ed.), Hand-
book of research on educational 
communications and technology (pp. 
199–214). Lawrence Erlbaum Associ-
ates Publishers.

* Barrett, J. J., Tolle, K. A., & Sals-
man, N. L. (2017a). Dialectical 
behavior therapy skills training for 
persistent complex bereavement 
disorder. Clinical Case Studies, 
16(5), 388–400. https://doi.
org/10.1177/1534650117699700

Bartlett, R. (2015). Visualising 
dementia activism: Using the 
arts to communicate research 
findings. Qualitative Research, 
15(6), 755–768. https://doi.
org/10.1177/1468794114567493

Boni, A., & Walker, M. (2020). Poten-
tial of participatory action research 
processes to overcome epistemic 
injustice in non-ideal university set-
tings. In M. Walker & A. Boni (eds.), 
Participatory research, capabilities 
and epistemic justice: A transfor-
mative agenda for higher education. 
Palgrave Macmillan. https://doi.
org/10.1007/978-3-030-56197-0_10 

Bourgault, S. (2020). Epistemic 
injustice, face-to-face encounters, 
and caring institutions. International 
Journal of Care and Caring 4(1), 91-
107. https://doi.org/10.1332/239788
219X15682725266696 

Boydell, K. (2011). Using performa-
tive art to communicate research: 
Dancing experiences of psychosis. 
Canadian Theatre Review, 146, 12-17. 
https://doi.org/10.3138/ctr.146.12

* Braden, A., Ferrell, E., Redondo, 
R., & Watford, T. (2020). Dialectical 
behavior therapy skills and behavior-
al weight loss for emotional eating 
and obesity: A case study. Journal of 
Contemporary Psychotherapy, 50(3), 
177-186. https://doi.org/10.1007/
s10879-020-09451-x

* Burckell, L. A., & McMain, S. (2011). 
Contrasting clients in dialectical 
behavior therapy for borderline per-
sonality disorder: “Marie” and “Dean,” 
two cases with different alliance 
trajectories & outcomes. Pragmatic 
Case Studies in Psychotherapy, 7(2), 
246–267. https://doi.org/10.14713/
pcsp.v7i2.1090

* Cannon, J. L., & Umstead, L. K. 
(2018). Applying dialectical behavior 
therapy to self-harm in college-age 
men: A case study. Journal of College 
Counseling, 21(1), 87–96. https://doi.
org/10.1002/jocc.12089

* Chan, C. C., Bach, P. A., & Bedwell, 
J. S. (2015). An integrative approach 
using third-generation cognitive-be-
havioral therapies for avoidant 
personality disorder. Clinical Case 
Studies, 14(6), 466–481. https://doi.
org/10.1177/1534650115575788

Charmaz, K. (2014). Constructing 
grounded theory. SAGE. 

* Cheng, P.H., & Merrick, E. (2017). 
Cultural adaptation of dialectical 
behavior therapy for a Chinese in-
ternational student with eating dis-
order and depression. Clinical Case 
Studies, 16(1), 42–57. https://doi.
org/10.1177/1534650116668269

*Chu, B. C., Rizvi, S. L., Zendegui, E. 
A., & Bonavitacola, L. (2015). Dia-
lectical behavior therapy for school 
refusal: Treatment development 
and incorporation of web-based 
coaching. Cognitive and Behavioral 
Practice, 22(3), 317–330. https://doi.
org/10.1016/j.cbpra.2014.08.002

* Crossland, T., Hewitt, O., & Walden, 
S. (2017). Outcomes and experiences 
of an adapted dialectic behaviour 
therapy skills training group for 
people with intellectual disabilities. 

British Journal of Learning Disabil-
ities, 45(3), 208–216. https://doi.
org/10.1111/bld.12194

*Dimeff, L. A., & Linehan, M. M. 
(2008). Dialectical behavior therapy 
for substance abusers. Addiction Sci-
ence & Clinical Practice, 4(2), 39-47.

*Dimeff, L., Rizvi, S. L., Brown, M., & 
Linehan, M. M. (2000). Dialectical 
behavior therapy for substance 
abuse: A pilot application to meth-
amphetamine-dependent women 
with borderline personality disorder. 
Cognitive and Behavioral Prac-
tice, 7(4), 457–468. https://doi.
org/10.1016/S1077-7229(00)80057-
7

Duffy, T. M., & Cunningham, D. J. 
(1996). Constructivism: implications 
for the design and delivery of instruc-
tion. In D. H. Jonassen & Association 
for Educational Communications and 
Technology (Ed), Handbook of re-
search for educational communica-
tions and technology. (pp. 171-201). 
Macmillan.

Engeström, Y. (1987). Learning by 
expanding: An activity-theoretical 
approach to developmental research. 
Orienta-Konutit.

*Erb, S., Farmer, A., & Mehlenbeck, R. 
(2013). A condensed dialectical be-
havior therapy skills group for binge 
eating disorder: Overcoming winter 
challenges. Journal of Cognitive Psy-
chotherapy, 27(4), 338–358. https://
doi.org/10.1891/0889-8391.27.4.338

*Fassbinder, E., Schweiger, U., Marti-
us, D., Brand-de Wilde, O., & Arntz, A. 
(2016). Emotion regulation in sche-
ma therapy and dialectical behavior 
therapy. Frontiers in Psychology, 
7, 1373. https://doi.org/10.3389/
fpsyg.2016.01373

*Finney, N., & Tadros, E. (2019). Inte-
gration of structural family therapy 
and dialectical behavior therapy with 
high-conflict couples. The Family 
Journal, 27(1), 31–36. https://doi.
org/10.1177/1066480718803344

*Florez, I. A., & Bethay, J. S. (2017). 

Using adapted dialectical behav-
ioral therapy to treat challenging 
behaviors, emotional dysregulation, 
and generalized anxiety disorder 
in an individual with mild intellec-
tual disability. Clinical Case Stud-
ies, 16(3), 200–215. https://doi.
org/10.1177/1534650116687073

Fricker, M. (2007). Epistemic 
injustice: Power and the ethics 
of knowing. Oxford University 
Press.  DOI:10.1093/acprof:o-
so/9780198237907.001.0001 

Fricker, M. (2013). Epistemic justice 
as a condition of political freedom? 
Synthese 190(7), 1317-1332. https://
doi.org/10.1007/s11229-012-0227-3

Granato, H. F., Wilks, C. R., Miga, E. 
M., Korslund, K. E., & Linehan, M. M. 
(2015). The use of dialectical behav-
ior therapy and prolonged exposure 
to treat comorbid dissociation and 
self-harm: The case of a client with 
borderline personality disorder 
and posttraumatic stress disorder: 
Integrating DBT and PE. Journal of 
Clinical Psychology, 71(8), 805–815. 
https://doi.org/10.1002/jclp.22207

Greenwood, J. (2019). Arts-based 
research. In J. Greenwood, Oxford 
research encyclopedia of edu-
cation. Oxford University Press. 
https://doi.org/10.1093/acre-
fore/9780190264093.013.29

Gunawardena, C. N., Lowe, C. M. A., 
& Anderson, T. (1998). Transcript 
analysis of computer-mediated 
conferences as a tool for testing 
constructivist and social-construc-
tivist learning theories [conference 
session]. Distance Learning ‘98, 
Madison WI, United States.

*Gupta, A., Kashyap, A., & Sidana, A. 
(2019). Dialectical behavior therapy 
in emotion dysregulation—Report 
of two cases. Indian Journal of Psy-
chological Medicine, 41(6), 578-581. 
https://doi.org/10.4103/ijpsym.
ijpsym_352_19 

*Hewitt, O., Atkinson‐Jones, K., 
Gregory, H., & Hollyman, J. (2019). 
What happens next? A 2‐year fol-



ENGAGE!  |  c r e at i v e  a rts 46

B A I L E Y  &  T R A C E Y  |  U N D E R M I N I N G 
E P I S T E M I C  I N J U S T I C E

References cont..

low‐up study into the outcomes 
and experiences of an adapted 
dialectical behaviour therapy skills 
training group for people with intel-
lectual disabilities. British Journal of 
Learning Disabilities, 47(2), 126–133. 
https://doi.org/10.1111/bld.12267

*Huss, D. B., & Baer, R. A. (2007). 
Acceptance and change: The in-
tegration of mindfulness-based 
cognitive therapy into ongoing 
dialectical behavior therapy in a 
case of borderline personality dis-
order with depression. Clinical Case 
Studies, 6(1), 17–33. https://doi.
org/10.1177/1534650106290374

*Johnson, L. (2013). Adapting and 
combining constructivist grounded 
theory and discourse analysis: A 
practical guide for research. Interna-
tional Journal of Multiple Research 
Approaches, 4120–4141. https://doi.
org/10.5172/mra.2013.4120

*Johnson, P., & Thomson, M. (2016). 
Journeys into dialectical behaviour 
therapy (DBT): Capturing the 
staff and service-user experience. 
Journal of Intellectual Disabilities 
and Offending Behaviour, 7(2), 
84–93. https://doi.org/10.1108/
JIDOB-09-2015-0027

*Katz, L. Y., & Cox, B. J. (2002). 
Dialectical behavior therapy for 
suicidal adolescent inpatients: A 
case study. Clinical Case Stud-
ies, 1(1), 81–92.  https://doi.
org/10.1177/1534650102001001007

*Keuthen, N. J., & Sprich, S. E. 
(2012). Utilizing DBT skills to aug-
ment traditional CBT for trichotillo-
mania: An adult case study. Cogni-
tive and Behavioral Practice, 19(2), 
372–380. https://doi.org/10.1016/j.
cbpra.2011.02.004

*Koerner, K., Dimeff, L. A., Swenson, 
C., & Rizvi, S. L. (2021). Adopt or 
adapt? Fidelity matters. In L. A. Di-
meff, L. Shireen, & K. Koerner (eds.), 
Dialectical behavior therapy in clin-
ical practice (2nd ed., pp. 21–36). 
Guilford Press.

*Kohrt, B. K., Lincoln, T. M., & 
Brambila, A. D. (2017). Embedding 

DBT skills training within a trans-
actional-ecological framework 
to reduce suicidality in a Navajo 
adolescent female. Clinical Case 
Studies, 16(1), 76–92. https://doi.
org/10.1177/1534650116668271

*Koons, C. R. (2011). The role of 
the team in managing telephone 
consultation in dialectical behavior 
therapy: Three case examples. Cog-
nitive and Behavioral Practice, 18(2), 
168–177. https://doi.org/10.1016/j.
cbpra.2009.10.008

Leont’ev, A.N. (1978). Activity, con-
sciousness, and personality. Pren-
tice-Hall.

Linehan, M. M. (2015). DBT skills 
training manual. Guilford Press.

*Low, G., Jones, D., Duggan, C., 
MacLeod, A., & Power, M. (2001). 
Dialectical behaviour therapy as a 
treatment for deliberate self-harm: 
Case studies from a high security 
psychiatric hospital population. 
Clinical Psychology & Psychother-
apy, 8(4), 288–300. https://doi.
org/10.1002/cpp.287

* Lustig, S., Smrz, A., Sladen, P., 
Sellers, T. D., & Hellman, S. (2000). It 
takes a village: Caring for a trauma-
tized art student. Harvard Review of 
Psychiatry, 7(5), 290–298. https://
doi.org/10.3109/hrp.7.5.290

* Martin, C. G., Roos, L. E., Zalewski, 
M., & Cummins, N. (2017). A dialec-
tical behavior therapy skills group 
case study on mothers with severe 
emotion dysregulation. Cognitive 
and Behavioral Practice, 24(4), 
405–415. https://doi.org/10.1016/j.
cbpra.2016.08.002

* McNair, L., Woodrow, C., & Hare, D. 
(2016). Using repertory grid tech-
niques to measure change following 
dialectical behaviour therapy with 
adults with learning disabilities: 
Two case studies. British Journal 
of Learning Disabilities, 44(3), 
247–256. https://doi.org/10.1111/
bld.12142

* Mercado, A., & Hinojosa, Y. (2017). 
Culturally adapted dialectical be-

havior therapy in an underserved 
community mental health setting: 
A Latina adult case study. Practice 
Innovations, 2(2), 80–93. https://
doi.org/10.1037/pri0000045

Mitchell, C., Theron, L., Stuart, 
J., Smith, A., & Stuart. J. (2011). 
Drawings as research method. In L. 
Theron, A. Smith, & J. Stuart (Eds.) 
Picturing research: Drawing a visual 
methodology (pp. 19–36). SenseP-
ublishers.

*Nararro-Haro, M. V., Hoffman, H. 
G., Garcia-Palacios, A., Sampaio, M., 
Alhalabi, W., Hall, K., & Linehan, M. 
(2016). The use of virtual reality to 
facilitate mindfulness skills training 
in dialectical behavioral therapy for 
borderline personality disorder: A 
case study. Frontiers in Psychol-
ogy, 7, Article 1573. https://doi.
org/10.3389/fpsyg.2016.01573

*Neacsiu, A. D., Eberle, J. W., Kramer, 
R., Wiesmann, T., & Linehan, M. M. 
(2014). Dialectical behavior therapy 
skills for transdiagnostic emotion 
dysregulation: A pilot randomized 
controlled trial. Behaviour Research 
and Therapy, 59, 40-51. https://doi.
org/10.1016/j.brat.2014.05.005 

*Nee, C., & Farman, S. (2007). 
Dialectical behaviour therapy as 
a treatment for borderline per-
sonality disorder in prisons: Three 
illustrative case studies. Journal 
of Forensic Psychiatry & Psychol-
ogy, 18(2), 160–180. https://doi.
org/10.1080/14789940601104792

Nilssen, V., & Klemp, T. (2020). 
Encouraging working and commu-
nicating like mathematicians: An 
illustrative case on dialogic teaching. 
In M. B. Postholm & K. F. Vennebo 
(eds.), Applying Cultural Historical 
Activity Theory in Educational Set-
tings Learning, development, and 
research, (pp. 73-90). Routledge.

*Owens, M. D., Nason, E., & Yeater, E. 
(2018). Dialectical behavior therapy 
for multiple treatment targets: A 
case study of a male with comor-
bid personality and substance use 
disorders. International Journal of 

Mental Health and Addiction, 16(2), 
436–450. https://doi.org/10.1007/
s11469-017-9798-z

*Pluhar, E., Jhe, G., Tsappis, M., Bick-
ham, D., & Rich, M. (2020). Adapting 
dialectical behavior therapy for 
treating problematic interactive 
media use. Journal of Psychiatric 
Practice, 26(1), 63-70. https://doi.
org/10.1037/e515212008-001 

*Potter, A. E., Davidson, M. M., & 
Wesselmann, D. (2015). Utilizing 
dialectical behavior therapy and 
eye movement desensitization and 
reprocessing as phase-based trau-
ma treatment: A case study series. 
International Journal of Medical and 
Biological Frontiers, 21(2), 189.

*Rizvi, S. L. (2011). Treatment failure 
in dialectical behavior therapy. Cog-
nitive and Behavioral Practice, 18(3), 
403–412. https://doi.org/10.1016/j.
cbpra.2010.05.003

*Rizvi, S. L., Yu, J., Geisser, S., & 
Finnegan, D. (2016). The use of 
“bug-in-the-eye” live supervision 
for training in dialectical behavior 
therapy: A case study. Clinical Case 
Studies, 15(3), 243–258. https://doi.
org/10.1177/1534650116635272

*Safer, D. L., Couturier, J. L., & Lock, 
J. (2007). Dialectical behavior ther-
apy modified for adolescent binge 
eating disorder: A case report. Cog-
nitive and Behavioral Practice, 14(2), 
157–167. https://doi.org/10.1016/j.
cbpra.2006.06.001

*Safer, D. L., Telch, C. F., & Agras, W. 
S. (2001). Dialectical behavior thera-
py adapted for bulimia: A case re-
port. International Journal of Eating 
Disorders, 30(1), 101–106. https://
doi.org/10.1002/eat.1059

*Sakdalan, J. A., Shaw, J., & Collier, V. 
(2010). Staying in the here-and-now: 
A pilot study on the use of dialectical 
behaviour therapy group skills train-
ing for forensic clients with intel-
lectual disability: DBT with Forensic 
ID clients. Journal of Intellectual 
Disability Research, 54(6), 568–572. 
https://doi.org/10.1111/j.1365-
2788.2010.01274.x



47 VO L .  4 ,  I S S U E  1

B A I L E Y  &  T R A C E Y  |  U N D E R M I N I N G 
E P I S T E M I C  I N J U S T I C E

*Scheiderer, E., Carlile, J. A., Aosved, 
A. C., & Barlow, A. (2017). Concurrent 
dialectical behavior therapy and 
prolonged exposure reduces symp-
toms and improves overall quality 
of life for a veteran with posttrau-
matic stress disorder and borderline 
personality disorder. Clinical Case 
Studies, 16(3), 216–233. https://doi.
org/10.1177/1534650116688557

*Telch, C. F. (1997). Skills training 
treatment for adaptive affect regu-
lation in a woman with binge‐eating 
disorder. International Journal 
of Eating Disorders, 22(1), 77-81. 
https://doi.org/10.1002/(sici)1098-
108x(199707)22:1<77::aid-
eat10>3.0.co;2-f 

*Thomson, M., & Johnson, P. (2017). 
Experiences of women with learning 
disabilities undergoing dialectical 
behaviour therapy in a secure ser-
vice. British Journal of Learning Dis-
abilities, 45(2), 106–113. https://doi.
org/10.1111/bld.12180

Voswinkel, M. M., Rijkers, C., van 
Delden, J. J. M., & van Elburg, A. A. 
(2021). Externalizing your eating 
disorder: a qualitative interview 
study. Journal of Eating Disorders, 
9(128), 1-12. DOI:10.1186/s40337-
021-00486-6

Vygotsky, L. (1978). Mind in society: 
The development of higher psycho-
logical processes. Harvard University 
Press.

*Welch, S. S., & Kim, J. (2012). 
DBT-enhanced cognitive behavioral 
therapy for adolescent trichotilloma-
nia: An adolescent case study. Cog-
nitive and Behavioral Practice, 19(3), 
483–493. https://doi.org/10.1016/j.
cbpra.2011.11.002

Wooffitt, R. (2001). Researching 
psychic practitioners: Conversation 
analysis. In M. Wetherell, S. Taylor, & 
S. J. Yates (Eds.) Discourse as data: A 
guide for analysis (pp. 49–92). SAGE 
Publications, Inc.


