Dialectical Behavior Therapy: "In a Nutshell"

  • Dr. Martha Linehan pioneered the research and treatment methodology.
  • The only data-supported treatment for BPD thus the treatment has been designated "Best Practice" for BPD in many parts of USA and Canada.
  • Reframes suicidal and other dysfunctional behaviors as part of the persons "learned problem-solving repertoire".
  • Focuses therapy on "active problem solving balanced by a corresponding emphasis on validating the persons’ current emotional, cognitive, and behavioral responses just as they are".

DBT 101

  • Establishes a Clear Diagnosis (on all Axis).
  • Target Behaviors are clearly defined and prioritized.
  • Co-occurring disorders are identified, prioritized and treated.
  • Expects a verbal commitment to treatment. Preferably, a one-year minimum commitment is considered the norm.
  • Treatment is renewable after one year, only if there has been improvement in target behaviors / goals.
  • Treatment is transferred to someone/somewhere else if there has been no improvement. The client is not expected to find the resources that are more appropriate on their own.

Treatment involves:

  • A designated Primary Therapist who coordinates all treatment with the client.
  • Weekly one hour psychotherapy and behavioral therapy with the primary therapist.
  • Collaboration with multidiscipline therapists.
  • Use of other appropriate resources (ancillary treatments) for specifically targeted problems, as long as there is only one primary therapist.
  • Working with the client on 'how to deal with other systems/persons' vs. telling the system/person how to work with the client.
  • Skills training sessions during Stage 1 work.

Core DBT strategies

  • Validation and Problem Solving

Core DBT Skills

  • Distress tolerance skills
  • Emotion regulation skills
  • Mindfulness skills
  • Interpersonal skills
  • Life Management skills

DBT Comparisons with Conventional Psychotherapies

  • Behaviorally focused (even when the client moves to higher levels of functioning)
  • Directive
  • Seeks to motivate the patient
  • Fast paced
  • Present focused
  • Encompasses numerous problem-solving strategies
  • Uses a "consultation-to-the-patient" philosophy
  • Coaches the client to become his or her own "case manager"
  • Explicit in a commitment to treatment and time frame

Characteristics of DBT Therapists and persons who work best with Borderline Clients

  • Comfortable with the ambiguity and paradox inherent in the DBT strategies
  • Holds a stance of acceptance (validation) and expectation for change
  • Finds the 'inherent wisdom' and 'goodness' in the moment and the person
  • Unwavering centeredness
  • Compassionate flexibility
  • Observes limits, while flexibly changing, adapting and 'giving in', as the situation requires
  • Nurtures with "benevolent demandingness"
  • Stays certain on select principles while "stepping into the storm"
  • Able to be appropriately transparent, yet not becoming a 'friend or sole provider'
  • Aware of their vulnerable times and uses support
  • 'Joins' with another yet remains centered in themselves
  • Tolerates dependency yet expects 'the client will do what they want to do'
  • Tolerates anger, whining, etc.
  • Acts as the clients "backbone" while making them use their own
  • Has a "Teflon skin"
  • Holds unbelievable faith in the clients 'worth' and capacity to change, despite the high odds against
  • Believes that the future will be better and there is "HOPE IN HELL"

More Information