| |
Marsha Linehan (1991) pioneered this treatment, based on
the idea that psychosocial treatment of those with
Borderline Personality Disorder was as important in
controlling the condition as traditional psycho- and
pharmacotherapy were. Concomitant with this belief was a
hierarchical structure of treatment goals. Paramount among
these was reducing parasuicidal (self-injuring) and
life-threatening behaviors. Next came reducing behaviors
that interfered the the therapy/treatment process, and
finally reducing behaviors that reduced the client's quality
of life. In 1991, Linehan published results of a study that
seems to do remarkably well at achieving these goals. |
| |
|
| |
The Theory |
| |
Basically, DBT maintains that some people, due to
invalidating environments during upbringing and due to
biological factors as yet unknown, react abnormally to
emotional stimulation. Their level of arousal goes up much
more quickly, peaks at a higher level, and takes more time
to return to baseline. This explains why borderlines are
known for crisis-strewn lives and extreme emotional lability
(emotions that shift rapidly). Because of their past
invalidation, they don't have any methods for coping with
these sudden, intense surges of emotion. DBT is a method for
teaching skills that will help in this task. |
| |
|
| |
How it works |
| |
Dialectical Behavioral Therapy (DBT) consists of two
parts:
- Once-weekly psychotherapy sessions in which a
particular problematic behavior or event from the past
week is explored in detail, beginning with the chain of
events leading up to it, going through alternative
solutions that might have been used, and examining what
kept the client from using more adaptive solutions to
the problem:
Both between and during sessions, the therapist
actively teaches and reinforces adaptive behaviors,
especially as they occur within the therapeutic
relationship. . . the emphasis is on teaching
patients how to manage emotional trauma rather than
reducing or taking them out of crises. . . .
Telephone contact with the individual therapist
between sessions is part of DBT procedures.
(Linehan, 1991)
DBT targets behaviors in a descending hierarchy:
- decreasing high-risk suicidal behaviors
- decreasing responses or behaviors (by either
therapist or patient) that interfere with therapy
- decreasing behaviors that interfere with/reduce
quality of life
- decreasing and dealing with post-traumatic
stress responses
- enhancing respect for self
- acquisition of the behavioral skills taught in
group
- additional goals set by patient
- Weekly 2.5-hour group therapy sessions in which
interpersonal effectiveness, distress tolerance/reality
acceptance skills, emotion regulation, and mindfulness
skills are taught . Group therapists are not available
over the phone between sessions; they refer patients in
crisis to the individual therapist.
|
|
