Borderline personality disorder can be a very difficult condition to treat due to the nature of the symptoms. Patients tend to be resistant to therapy and can place huge emotional demands on the therapist trying to treat them. As a result of such issues, an innovative new technique known as Dialectical Behavior Therapy borderline personality disorder treatment has been developed to help those suffering from the disorder.
What is Dialectical Behavior Therapy borderline personality disorder?
Marsha Linehan at the University of Seattle in Seattle, USA, developed the Dialectical Behavior Therapy borderline personality disorder treatment plan, and over the past decade, several clinical studies have repeatedly demonstrated the effectiveness of the treatment.
What is borderline personality disorder?
Borderline personality disorder patients are very emotionally unstable. Their personal relationships are chaotic and they are at risk of impulsive behaviour, fears of abandonment, self-harming and suicide. Although the exact cause of the condition is not really understood, there are certain risk factors including a dysfunctional childhood, sexual abuse, and abandonment in early life.
Dialectical Behaviour Therapy (DBT) is based upon a bio-social theory of borderline personality disorder. Linehan hypothesises that the patient is an emotionally vulnerable person and the disorder is as a result of growing up in a dysfunctional home (referred to as the Invalidating Environment).
“Dialectical” derives from classical philosophy whereby an assertion is made, the opposing position is formulated, and then a position is taken somewhere in the middle. Over time, this dialectical approach allows the truth to be divined as the middle ground between the two extremes.
How does the dialectical approach help borderline personality disorder patients?
The DBT approach works through a process of acceptance and change and DBT therapy focuses on current behavior and the factors controlling those behavioral patterns. Techniques of acceptance help the patient to counter their self-invalidation, and combined with problem solving techniques, the patient can learn new skills to help them deal with their problems.
However, the treatment will only work if the patient is able to enjoy a good relationship with his or her therapist, and because of the demanding nature of the treatment, the therapist also receives DBT from colleagues as part of a team approach.
Borderline personality disorder patients are often considered to be highly manipulative, but the DBT approach requires that the therapist resists the urge to think of the patient in such a negative light and always treats the patient with warmth, genuineness and responsiveness. He or she should be nurturing but demanding, centred but flexible when required.
Boundaries of what behavior is acceptable should be set at the outset of DBT and if limits are overstepped, the patient will be informed. Before DBT begins, the patient will be asked to commit to a certain period of treatment, usually at least one year, plus other undertakings, including working on “therapy interfering behaviors”, reducing suicidal behaviors, and attending skills training.
The core strategies in DBT are problem solving and validation and the four modes of treatment are: individual therapy, group skills training, telephone contact and therapist consultation. Therapy is organized into different stages, from a pre-treatment assessment stage, to dealing with individual treatment goals, and behaviors from each stage are dealt with before the patient moves on to the next stage.