Dialectical Behavior Therapy In Borderline Personality Disorder
Dialectical Behavior Therapy in Borderline Personality Disorder
People with borderline personality disorder can be challenging to treat, because of the nature of the disorder. Borderline Personality Disorder (BPD) can be defined as a mental health condition in which a person has long-term patterns of unstable or turbulent emotions (US National Library of Medicine, 2013). They are often difficult to keep in therapy, frequently fail to respond to therapeutic efforts and make considerable demands on the emotional resources of the therapist, particular when suicidal behaviors are prominent.
Dialectical Behavior Therapy is an innovative method of treatment that has been developed specifically to treat this difficult group of patients in a way …show more content…
which is optimistic and which preserves the integrity of the therapist. The technique was devised by Marsha Linehan, a psychology researcher at the University of Washington in Seattle and its effectiveness has been demonstrated in a wealth of research in the past decade (Wikipedia, 2013).
The success of treatment is dependent on the quality of the relationship between the patient and therapist. The emphasis is on this being a real human relationship in which both members matter and in which the needs of both have to be considered. The therapist must avoid at all times viewing the patient, or talking about her, in terms that could be considered antagonistic so that they can proceed to a successful therapeutic intervention and being mindful to not feed into the problems that have led to the development of BPD in the first place. The approach is a team approach (Linehan, 2001).
Linehan has a particular dislike for the word “manipulative” as commonly applied to these patients. She points out that this implies that they are skilled at managing other people when it is precisely the opposite that is true. Also the fact that the therapist may feel manipulated does not necessarily imply that this was the intention of the patient. It is more probable that the patient did not have the skills to deal with the situation more effectively (Linehan, 2001).
The therapist relates to the patient in two dialectically opposed styles. The primary style of relationship and communication is referred to as ‘reciprocal communication’, a style involving responsiveness, warmth and genuineness on the part of the therapist. Appropriate self-disclosure is encouraged but always with the interests of the patient in mind. The alternative style is referred to as ‘irreverent communication’. This is a more confrontational and challenging style aimed at bringing the patient up with a jolt in order to deal with situations where therapy seems to be stuck or moving in an unhelpful direction. It will be observed that these two communication styles form the opposite ends of another dialectic and should be used in a balanced way as therapy proceeds (Psychcentral, 2013).
The therapist should try to interact with the patient in a way that is:
Accepting of the patient as she is but which encourages change.
Centered and firm yet flexible when the circumstances require it.
Nurturing but benevolently demanding.
There is a clear and open emphasis on the limits of behavior acceptable to the therapist and these are dealt with in a very direct way.
The therapist should be clear about his or her personal limits in relations to a particular patient and should as far as possible make these clear to her from the start. It is openly acknowledged that an unconditional relationship between therapist and patient is not humanly possible and it is always possible for the patient to cause the therapist to reject her if she tries hard enough. It is in the patient’s interests therefore to learn to treat her therapist in a way that encourages the therapist to want to continue helping her. It is not in her interests to burn him or her out. This issue is confronted directly and openly in therapy. The therapist helps therapy to survive by consistently bringing it to the patient’s attention when limits have been overstepped and then teaching her the skills to deal with the situation more effectively and …show more content…
acceptably.
It is made quite clear that the issue is immediately concerned with the legitimate needs of the therapist and only indirectly with the needs of the patient who clearly stands to lose if she manages to burn out the therapist.
The therapist is asked to adopt a non-defensive posture towards the patient, to accept that therapists are fallible and that mistakes will at times inevitably be made. Perfect therapy is simply not possible.
This form of therapy must be entirely voluntary and depends for its success on having the co-operation of the patient. From the start, therefore, attention is given to orienting the patient to the nature of DBT and obtaining a commitment to undertake the work. Before a patient will be taken on for DBT she will be required to give a number of undertakings (Elliott, 2009)
To work in therapy for a specified period of time and, within reason, to attend all scheduled therapy sessions.
If suicidal behaviors or gestures are present, she must agree to work on reducing these.
To work on any behaviors that interfere with the course of
therapy
To attend skills training.
The strength of these agreements may be variable and a “take what you can get approach” is advocated. Nevertheless a definite commitment at some level is required since reminding the patient about her commitment and re-establishing such commitment throughout the course of therapy are important strategies in Dialectical Behavior Therapy .
The therapist agrees to make every reasonable effort to help the patient and to treat her with respect, as well as to keep to the usual expectations of reliability and professional ethics. The therapist does not however give any undertaking to stop the patient from harming herself. On the contrary, it should be make quite clear that the therapist is simply not able to prevent her from doing so. The therapist will try rather to help her find ways of making her life more worth living. DBT is offered as a life-enhancement treatment and not as a suicide prevention treatment, although it is hoped that it may indeed achieve the latter.
References
Elliott, C. (2009). Increasing Hope for Treatment of Borderline Personality Disorder. Psych Central: Retrieved on April 22,2013 from http://blogs.psychocental.com
Grohol, J. (2007). An Overview of Dialectical Behavior Therapy. PsychCentral, Retrieved on April 22, 2013 from http://psychcentral.com/lib/2007
Linehan, (2001). Dialectical Behavior Therapy in a nutshell. California Psychologist Vol. 34 pp 10-18 National Library of Medicine. Retrieved on April 19, 2013 from http://www.nlm.nih.gov/medlineplus/ency/article/000935.htm
Wikipedia, 2013
People with borderline personality disorder can be challenging to treat, because of the nature of the disorder. Borderline Personality Disorder (BPD) can be defined as a mental health condition in which a person has long-term patterns of unstable or turbulent emotions (US National Library of Medicine, 2013). They are often difficult to keep in therapy, frequently fail to respond to therapeutic efforts and make considerable demands on the emotional resources of the therapist, particular when suicidal behaviors are prominent.
Dialectical Behavior Therapy is an innovative method of treatment that has been developed specifically to treat this difficult group of patients in a way …show more content…
which is optimistic and which preserves the integrity of the therapist. The technique was devised by Marsha Linehan, a psychology researcher at the University of Washington in Seattle and its effectiveness has been demonstrated in a wealth of research in the past decade (Wikipedia, 2013).
The success of treatment is dependent on the quality of the relationship between the patient and therapist. The emphasis is on this being a real human relationship in which both members matter and in which the needs of both have to be considered. The therapist must avoid at all times viewing the patient, or talking about her, in terms that could be considered antagonistic so that they can proceed to a successful therapeutic intervention and being mindful to not feed into the problems that have led to the development of BPD in the first place. The approach is a team approach (Linehan, 2001).
Linehan has a particular dislike for the word “manipulative” as commonly applied to these patients. She points out that this implies that they are skilled at managing other people when it is precisely the opposite that is true. Also the fact that the therapist may feel manipulated does not necessarily imply that this was the intention of the patient. It is more probable that the patient did not have the skills to deal with the situation more effectively (Linehan, 2001).
The therapist relates to the patient in two dialectically opposed styles. The primary style of relationship and communication is referred to as ‘reciprocal communication’, a style involving responsiveness, warmth and genuineness on the part of the therapist. Appropriate self-disclosure is encouraged but always with the interests of the patient in mind. The alternative style is referred to as ‘irreverent communication’. This is a more confrontational and challenging style aimed at bringing the patient up with a jolt in order to deal with situations where therapy seems to be stuck or moving in an unhelpful direction. It will be observed that these two communication styles form the opposite ends of another dialectic and should be used in a balanced way as therapy proceeds (Psychcentral, 2013).
The therapist should try to interact with the patient in a way that is:
Accepting of the patient as she is but which encourages change.
Centered and firm yet flexible when the circumstances require it.
Nurturing but benevolently demanding.
There is a clear and open emphasis on the limits of behavior acceptable to the therapist and these are dealt with in a very direct way.
The therapist should be clear about his or her personal limits in relations to a particular patient and should as far as possible make these clear to her from the start. It is openly acknowledged that an unconditional relationship between therapist and patient is not humanly possible and it is always possible for the patient to cause the therapist to reject her if she tries hard enough. It is in the patient’s interests therefore to learn to treat her therapist in a way that encourages the therapist to want to continue helping her. It is not in her interests to burn him or her out. This issue is confronted directly and openly in therapy. The therapist helps therapy to survive by consistently bringing it to the patient’s attention when limits have been overstepped and then teaching her the skills to deal with the situation more effectively and …show more content…
acceptably.
It is made quite clear that the issue is immediately concerned with the legitimate needs of the therapist and only indirectly with the needs of the patient who clearly stands to lose if she manages to burn out the therapist.
The therapist is asked to adopt a non-defensive posture towards the patient, to accept that therapists are fallible and that mistakes will at times inevitably be made. Perfect therapy is simply not possible.
This form of therapy must be entirely voluntary and depends for its success on having the co-operation of the patient. From the start, therefore, attention is given to orienting the patient to the nature of DBT and obtaining a commitment to undertake the work. Before a patient will be taken on for DBT she will be required to give a number of undertakings (Elliott, 2009)
To work in therapy for a specified period of time and, within reason, to attend all scheduled therapy sessions.
If suicidal behaviors or gestures are present, she must agree to work on reducing these.
To work on any behaviors that interfere with the course of
therapy
To attend skills training.
The strength of these agreements may be variable and a “take what you can get approach” is advocated. Nevertheless a definite commitment at some level is required since reminding the patient about her commitment and re-establishing such commitment throughout the course of therapy are important strategies in Dialectical Behavior Therapy .
The therapist agrees to make every reasonable effort to help the patient and to treat her with respect, as well as to keep to the usual expectations of reliability and professional ethics. The therapist does not however give any undertaking to stop the patient from harming herself. On the contrary, it should be make quite clear that the therapist is simply not able to prevent her from doing so. The therapist will try rather to help her find ways of making her life more worth living. DBT is offered as a life-enhancement treatment and not as a suicide prevention treatment, although it is hoped that it may indeed achieve the latter.
References
Elliott, C. (2009). Increasing Hope for Treatment of Borderline Personality Disorder. Psych Central: Retrieved on April 22,2013 from http://blogs.psychocental.com
Grohol, J. (2007). An Overview of Dialectical Behavior Therapy. PsychCentral, Retrieved on April 22, 2013 from http://psychcentral.com/lib/2007
Linehan, (2001). Dialectical Behavior Therapy in a nutshell. California Psychologist Vol. 34 pp 10-18 National Library of Medicine. Retrieved on April 19, 2013 from http://www.nlm.nih.gov/medlineplus/ency/article/000935.htm
Wikipedia, 2013