Dialectical Behavioral Therapy
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 (see summaries of sample worksheets). Group therapists are not available over the phone between sessions; they refer patients in crisis to the individual therapist.