-By Timothy Lyons
I first encountered Dialectical Behavior Therapy several years ago when I read Kelly Koerners’ book Doing Dialectical Behavior Therapy. Dialectic Behavior Therapy (DBT) is a therapeutic modality which was first designed to treat persons with Borderline Personality Disorder. It now has uses in many other psychological conditions. It primarily came about to deal with persons who held suicidal ideation and were harmful to themselves.
Marsha M. Linehan founded Dialectic Behavior Therapy in the late 1970’s. It was designed in response to her own mental illness and what she saw as the failure of cognitive behavior therapy (CBT) in dealing with Borderline Personality Disorder. DBT is a type of CBT that is often included in what is considered to be third wave behavioral therapies. It is a psychotherapy that uses behavioral science combined with Zen concepts like acceptance and mindfulness.
Borderline personality disorder (BPD) is characterized by unstable self-image, turbulent interpersonal relationships, unstable affect or emotions, impulsive actions and risk taking activity. In many cases the BPD sufferer with show signs of rigid perfectionism, inflexible emotions, and the inability to regulate emotions. The person with BPD may show signs of being antagonistic as well as disinhibition. These personality traits are stable with persons with BPD.
Borderline Personality Disorder
This modality was Linehan’s response to the highly treatment resistant borderline personality disorder especially in regard to pervasive emotion dysregulation (the inability to control emotions). The design of Dialectic Behavior Therapy encompasses a core biosocial theory which holds that this inability to control emotions comes from both a vulnerable biology as well as an invalidating social environment.
The idea behind DBT is that there is total acceptance of the world as it is, which is essentially learned both by the client and the therapist. It comes from the understanding that for every stance or thought that a person takes there is an opposite. As the client begins to understand that there is another opposite thought in their rigid thinking, they become more objective. They then gain a perspective that is a synthesis of the two ideas. In this way, the client can begin to understand the relationship between their problems and their thinking.
Treatment
Initially the therapy starts our just as many others. The client and therapist take time to establish a therapeutic relationship. During this period the client and therapist come to an understanding about treatment goals. This includes treatment times, duration of treatment and general agreements about working through the stages of treatment. The primary focus for the person who engages in maladaptive or self-harming behaviors is the cessation of such. It is like when the crisis worker begins to reduce the crisis situation that enable the patient to receive more advance treatment.
Dialectic Behavior Therapy
The first two steps are more geared toward addressing the primary behaviors that are pathological and normally therapeutic resistant. These are behaviors such as suicidal ideation
The first step in treatment is the cessation and reduction of self-injurious behavior. This allows the person to continue on with higher order treatment stages in Dialectic Behavior Therapy.
The next step in treatment is to introduce a number of cognitive behavioral techniques combined with Buddhist methods to target problematic behavior. As the therapy continues to succeed, the treatment deals with other pathological behaviors until the person can move to the next higher order of the treatment protocol.
At the next stage, the treatment begins to focus on behaviors that are not injurious but do cause problems with normal life endeavors. This is more in line with what typical psychological treatments would address.
The last stage is dealing with higher order self-realization. This stage encompasses the wholeness of the person. It involves the integration of higher order processes such as spiritual and psychological.
References:
Chapman, A. L. (2006). Dialectical Behavior Therapy: Current Indications and Unique Elements. Psychiatry (Edgmont), 3(9), 62–68.
Koerner, Kelly. (2012) Doing dialectical behavior therapy :a practical guide New York : Guilford Press,
Moglia, Paul. (2009). Dialectical behavioral therapy. In N. Piotrowski (Ed.), Psychology and Mental Health. Hackensack: Salem. Retrieved from http://online.salempress.com