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".
- 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.
- 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)
- 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"