Dialectical Behaviour Therapy (DBT) is a therapeutic methodology developed by Linehan, a psychology researcher at the University of Washington to treat people with Borderline Personality Disorder (BPD). DBT combines Cognitive Behavioural Therapy with concepts of methodologies from various practices including Eastern mindfulness techniques. Research has shown that DBT is the first therapy that has been effective for treating BPD. Further research has been carried out and appears to show that it is also effective in treating people with spectrum mood disorders including self harming behaviour. Linehan created DBT after realising that other therapies were ineffectual when used for BPD. She recognised that the chronically suicidal people that she worked with had been brought up in invalidating environments and required unconditional acceptance in order for them to develop a successful therapeutic relationship. She also maintained that people need to recognise and accept their low level of emotional functioning and be ready to make a change in their lives.
Helping the person with Borderline Personality Disorder to make therapeutic changes in their lives is extraordinarily difficult for at least two reasons. Firstly, focusing on patient change, either of motivation or by teaching new behavioural skill, is often experienced as invalidating by traumatised individuals and can precipitate withdrawal, non compliance, and drop out from treatment on the one hand, or anger, aggression, and attack, on the other. Secondly, ignoring the need for the patient to change (and thereby, not promoting much needed change) is also experienced as invalidating. Such a stance does not take the very real problems and negative consequences of patient behaviour seriously and can, in turn, precipitate panic, hopelessness and suicidal ideation Email Extractor Software.
DBT involves two components:
1. An individual component in which the therapist and patient discuss issues that come up during the week, recorded on diary cards, and follow a treatment target hierarchy. These sessions typically last for 45-60 minutes and are held weekly. Self Harming and Suicidal behaviours take first priority, followed by therapy interfering behaviours. After this there are issues surrounding quality of life and working towards improving one’s life in general. During the individual therapy, both the therapist and the patient work towards improving skill use to survive and manage difficult feelings. The whole session should be working towards a setting that is validating for the patient. A lot of attention should be paid to the immediate problems, feelings and actions. Often, a skills group is discussed and obstacles to acting skillfully are addressed.
2. The group, which usually will meet once a week for two to two-and-a-half hours, once a week, learns to use specific skills which can be broken down into four modules: Core Mindfulness Skills, Interpersonal Effectiveness Skills, Emotion Regulation Skills, and Distress Tolerance Skills. The room should be arranged like a classroom with the trainers (usually two) placed at the front. Issues and emotions are discussed and dealt with if they are life threatening or interfering with the group therapy. For example if someone is behaving badly this would only be addressed if it was causing a problem with the running of the group. Otherwise, it would be ignored. Skills Training is run around a manual that gives details of the programme that has to be followed. This gives guidance and advice about how it should be taught. It also contains handouts for individuals. Group work can include role-play and, as in CBT, homework is encouraged.
Commitment Before DBT can begin, the patients have to make a commitment to participate in the therapy. This is an exercise in itself and may take several meetings. Both the patient and the therapist make explicit commitments. In practice, the therapist may initially ‘play hard to get’ and lead the patient, to persuade him or her that the programme is indeed justified.
People with BPD have often experienced treatments that have been at best unrewarding. Consequent wariness needs to be validated and the new therapeutic endeavour presented in a realistic way as promising but also demanding. Time spent on commitment before therapy is a good investment. Likewise, if the therapeutic relationship becomes wobbly or threatens to break down, then time needs to be spent on maintaining this commitment. It is usual for there to be an agreement that if three consecutive sessions of one kind are missed for any reason then the patient is out of the DBT programme.