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Dialectical Behavior Therapy
Achieving New Architecture in the Borderline Personality Structure

Clinical Update
By Zur Institute

View a complete list of Clinical Updates.

 

For decades, clinicians who have worked with clients diagnosed with Borderline Personality Disorder (BPD) felt helpless and overwhelmed. No matter what degree or credential clinicians held, or what clinical methods were employed, the diagnosis seemed to present a largely incurable and frustrating condition.

Following Dr. Marsha Linehan's development of Dialectical Behavior Therapy (DBT), many clinicians breathed a collective sigh of relief. Finally, an effective approach to the treatment of this complex Personality Disorder was in hand.

Following Dr. Marsha Linehan's development of Dialectical Behavior Therapy (DBT), many clinicians breathed a collective sigh of relief. Finally, an effective approach to the treatment of this complex Personality Disorder was in hand.

DBT outlines specific strategies to facilitate the empowerment and eventual independence of the client.

There are four modes of treatment for DBT

  • Individual therapy
  • Group skills training
    • Group skills training is used to enhance core mindfulness skills, interpersonal effectiveness skills, emotion modulation skills, and distress tolerance skills.
  • Telephone contact
  • Therapist consultation

Linehan outlines specific stages of treatment and strategies to be used as well as goals to be met within each stage of treatment. Issues or "targets" are prioritized in each stage of therapy and are addressed this way in the treatment setting.

  • The Pre-Treatment Stage focuses on assessment, commitment and orientation to therapy.
  • The First Stage of treatment focuses on limiting, resolving and avoiding crisis situations. The therapy also addresses suicidal behaviors, therapy interfering behaviors and behaviors that interfere with the quality of life. Techniques for better managing these behaviors are identified during this first stage of treatment.
  • The Second Stage addresses issues associated with Post-Traumatic Stress.
  • The Third Stage focuses on the development of self-esteem and the identification of individual treatment goals.

The core strategies in DBT are "validation" and "problem solving". Circumstantial and/or emotional obstacles may inhibit effective problem-solving, even when the individual has learned the required skills. In those instances, additional strategies for management may be required. These may include:

  • Contingency management
  • Cognitive therapy
  • Exposure based therapies
  • Pharmacotherapy

The spontaneous provision of telephonic support between sessions is a unique feature of DBT.
 

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