Atlanta DBT Center

Why haven't I heard about DBT?

Comprehensive training is intense, expensive, and time-consuming. Given the inherent difficulties in treating this population, there are few therapists willing to make the commitments necessary to become experts in this field. That said, for several years now, the data continues to build, supporting the unique efficacy in the dialectical model and treatment program.

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What makes the DBT Center unique?

Our team is led by an intensively trained DBT therapist, taught by Marsha Linehan PhD., who herself has a comprehensive women's program, men's program, adolescent program, as well as day treatment options. We also have a DBT therapist trained in adolescent DBT, taught by Alec Miller PhD. and Charles Swenson MD.

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Do you accept any insurance?

Unfortunately, we are a private pay practice, and we do not currently work directly with any insurance. However, we will provide invoices and receipts with the necessary information for you to seek reimbursement from your insurance company for our services. Many of our patients are successfully reimbursed for the costs of our program, and we do everything in our power to make obtaining reimbursement as simple as possible. 

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What can I receive treatment for at Atlanta DBT?

We offer a wide variety of services and modalities to address: 

• Borderline Personality Disorder
• Bipolar Disorder
• Mood Disorders
• Life Transitions and Aging
• Medication Management
• Behavioral Disorders
• Eating Disorders
• Substance Abuse and Addiction
• Multi-Disordered Patients
• General Concerns
• Vocational-Rehabilitation Counseling
• General Psychological and Psychiatric Services for Adults, Adolescents, and Seniors

What does DBT treat primarily?

Dialectical Behavior Therapy was primarily founded as a treatment for Borderline Personality Disorder (BPD), which is one of the most controversial diagnoses in psychology today. Since it was first introduced in the DSM, psychologists and psychiatrists have been trying to give the somewhat amorphous concepts behind BPD a concrete form. Kernberg's explication of what he calls Borderline Personality Organization is the most general, while Gunderson, though a psychoanalyst, is considered by many to have taken the most scientific approach to defining BPD. The Diagnostic Interview for Borderlines and the DIB-Revised were developed from research done by Gunderson, Kolb, and Zanarini. Finally, there is the "official" DSM-IV definition. 

Dialectical Behavior Therapy can be helpful in many cases. Some researchers, like Judith Herman, believe that BPD is simply a name given to a particular manifestation of post-traumatic stress disorder: in Trauma and Recovery, she theorizes that when PTSD takes a form that emphasizes heavily its elements of identity and relationship disturbance, it gets called BPD; when the somatic (body) elements are emphasized, it gets called hysteria, and when the dissociative/deformation of consciousness elements are the focus, it gets called DID/MPD (Dissociative Identity Disorder/Multiple Personality Disorder). Others believe that the term "borderline personality" has been so misunderstood and misused that trying to refine it is pointless and suggest instead simply scrapping the term.

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What does a typical DBT Program consist of?

DBT Programs include the following:

• DBT Skills Training Modules
  • Core Mindfulness: present-oriented living
  • Distress Tolerance: non-impulsive decision making
  • Emotion Regulation: assigning emotions to promote goal-oriented change
  • Interpersonal Effectiveness: achieving goals, relationship needs, and self-respect in interactions
  • Walking the Middle Path: moving away from all-or-nothing thinking as you shape your behavior through the understanding of dialectics, the biosocial theory of severe emotional dysregulation, and de-escalation techniques  
• Individual Psychotherapy and Coaching Sessions
• Email and Phone Consultation Between Sessions
• Team-Centered Approach

Do you offer any training for professionals interested in learning about DBT?

We do not currently offer any professional DBT training. For a comprehensive list of the programs we do offer, please see below.

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What programs does Atlanta DBT offer?

• DBT Adult Skills Classes: a protocol program for emotionally deregulated people needing the original research-substantiated format skills training and DBT psychotherapy 
  
• DBT-S Skills Training for Chemical Dependency: individual instruction geared to addressing chemical and substance abuse
• DBT Skills Training for Eating Disorders: skills classes addressing coping skills involving eating patterns, body image, and weight concerns
• DBT Graduate Classes: a program that addresses stage 3 and 4 goals of self-exploration, continuing goal-directed growth, developing and maintaining self-sufficiency while balancing social, professional, and familial arenas
• DBT Couples' Program: therapeutic intervention targeting interaction-effectiveness and emotional regulation during marital interactions
• DBT for Adolescents and Families: a 16-week curriculum for families facing stress, chaos, painful situations, and ineffective interactions
• DBT for Families: for adult members-spouses, parents, siblings, grandparents, etc. of people in a DBT class

What causes BPD?

It would be remiss to discuss BPD without including a comment about Linehan's work. In contrast to the symptom list approaches detailed below, Linehan has developed a comprehensive sociobiological theory which appears to be borne out by the successes found in controlled studies of her Dialectical Behavioral Therapy.

Linehan theorizes that borderlines are born with an innate biological tendency to react more intensely to lower levels of stress than others and to take longer to recover. They peak "higher" emotionally on less provocation and take longer coming down. In addition, they were raised in environments in which their beliefs about themselves and their environment were continually devalued and invalidated. These factors combine to create adults who are uncertain of the truth of their own feelings and who are confronted by three basic dialectics they have failed to master (and thus rush frantically from pole to pole of):

• vulnerability vs invalidation
• active passivity (tendency to be passive when confronted with a problem and actively seek a rescuer) vs apparent competence (appearing to be capable when in reality internally things are falling apart)
• unremitting crises vs inhibited grief.

DBT tries to teach clients to balance these by giving them training in skills of mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation.

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What characteristics does a Borderline person have?

Gunderson's conception of BPD

John Gunderson, MD., a psychoanalyst, is respected by researchers in many diverse areas of psychology and psychiatry. His focus tends to be on the differential diagnosis of Borderline Personality Disorder, and Cauwels gives Gunderson's criteria in order of their importance:

• Intense unstable relationships in which the borderline always ends up getting hurt. Gunderson admits that this symptom is somewhat general, but considers it so central to BPD that he says he would hesitate to diagnose a patient as BPD without its presence.
• Repetitive self-destructive behavior, often designed to prompt rescue.
• Chronic fear of abandonment and panic when forced to be alone.
• Distorted thoughts/perceptions, particularly in terms of relationships and interactions with others.
• Hypersensitivity, meaning an unusual sensitivity to nonverbal communication. Gunderson notes that this can be confused with distortion if practitioners are not careful.
• Impulsive behaviors that often embarrass the borderline later.
• Poor social adaptation. In a way, borderlines tend not to know or understand the rules regarding performance in job and academic settings.

Kernberg's BPD Organization

According to Otto Kernberg, MD, diagnoses of BPD are based on three categories of criteria. The first, and most important, category, comprises two signs:

• the absence of psychosis (i.e., the ability to perceive reality accurately)
• impaired ego integration - a diffuse and internally contradictory concept of self. Kernberg is quoted as saying, "Borderlines can describe themselves for five hours without your getting a realistic picture of what they're like."

The second category is termed "nonspecific signs" and includes such things as low anxiety tolerance, poor impulse control, and an undeveloped or poor ability to enjoy work or hobbies in a meaningful way.

Kernberg believes that borderlines are distinguished from neurotics by the presence of "primitive defenses." Chief among these is splitting, in which a person or thing is seen as all good or all bad. Note that something which is all good one day can be all bad the next, which is related to another symptom: borderlines have problems with object constancy in people -- they read each action of people in their lives as if there were no prior context; they don't have a sense of continuity and consistency about people and things in their lives. They have a hard time experiencing an absent loved one as a loving presence in their minds. They also have difficulty seeing all of the actions taken by a person over a period of time as part of an integrated whole, and tend instead to analyze individual actions in an attempt to divine their individual meanings. People are defined by how they last interacted with the borderline.

Other primitive defenses cited include magical thinking (beliefs that thoughts can cause events), omnipotence, projection of unpleasant characteristics in the self onto others, and projective identification, a process where the borderline tries to elicit in others the feelings s/he is having. Kernberg also includes as signs of BPD chaotic, extreme relationships with others; an inability to retain the soothing memory of a loved one; transient psychotic episodes; denial; and emotional amnesia. About the last, Linehan says, "Borderline individuals are so completely in each mood, they have great difficulty conceptualizing, remembering what it's like to be in another mood."

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