Dialectical behavior therapy (DBT)

Dialectical behavior therapy (DBT)

Dialectical Behaviour Therapy (DBT) is a type of therapy which was designed for those with borderline personality disorder.  It is aimed at changing the typical behaviour patterns of borderlines such as the suicidal tendencies which are fairly common to those with BPD. 

Dialectical Behavioral Therapy (DBT) is a form of cognitive-behavioral therapy, which was developed by Dr. Marsha Linehan, a professor in the Department of Psychology at the University of Washington and is becoming more popular now and more therapists are being trained to use this style of therapy with their borderline clients.

Patient learn problem-solving techniques for dealing with stressful events, including ways of improving social skills and od controlling anger and other emotions. Treatment is intensive with individual and group sessions and access by telephone to the therapist between sessions and lasts for up to a year.

DBT also has a number of distinctive defining characteristics. As its name suggests, its overriding characteristic is an emphasis on "dialectics" - that is, the reconciliation of opposites in a continual process of synthesis. The most fundamental dialectic is the necessity of accepting patients just as they are within a context of trying to teach them to change. This emphasis on acceptance as a balance to change flows directly from the integration of a prespective drawn from Eastern (Zen) practice with Western psychological practice.

The treatment itself is based largely in behaviorist theory with a sprinkling of cognitive therapy thrown in for good measure. There are two essential parts of the treatment, and without either of these parts the therapy is not considered "DBT adherent."

1. An individual component in which the therapist and client discuss issues that come up during the week following a treatment target hierarchy. Self-injurious and suicidal behaviors take first priority, followed by therapy interfering behaviors. Then there are quality of life issues and finally working towards improving one's life generally. During the individual therapy, the therapist and client work towards improving skill use. Often, skills group is discussed and obstacles to acting skillfully are addressed.
2. The group, which ordinarily meets once weekly for about two hours, in which clients learn to use specific skills that are broken down into 4 modules: core mindfulness skills, emotion regulation skills, interpersonal effectiveness skills and distress tolerance skills.

What are the Modes and modules of Treatment in DBT - Dialectical Behaviour Therap?

There are four modules focusing in turn on four groups of skills:

1. Mindfulness -The mindfulness skills are derived from certain techniques of Buddhist meditation, although they are essentially psychological techniques and no religious allegiance is involved in their application. Essentially they are techniques to enable one to become more clearly aware of the contents of experience and to develop the ability to stay with that experience in the present moment.
2. Interpersonal Effectiveness - Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.
3. Distress Tolerance - Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus willfulness.
4. Emotion Regulation - Emotion modulation skills are ways of changing distressing emotional states and 'distress tolerance skills' include techniques for putting up with these emotional states if they can not be changed for the time being.

There are four primary modes of treatment in DBT :

1. Individual therapy
2. Group skills training
3. Telephone contact
4. Therapist consultation

Guidelines for Therapists -Dialectical Behaviour Therapy (DBT)

In order to deal with these demanding, narcissistic patients, therapists are required to be in either group or individual supervision. Supervision accepts that each therapist sets rules and limits that are appropriate for that therapist, without interpreting therapists' limits as neurotically reflecting either a fear of intimacy or a need to be nurturant.

Therapists are expected to make mistakes and to be accepting of their own mistakes. Therapists are vulnerable to the pattern of appeasing these demanding patients, then becoming angry and punitive, then guilty and appeasing again.

Therapists must modify the treatment to suit each patient without undermining the principles of DBT. Therapists must maintain a balance between giving nurturance and demanding change, giving patients needed help and guidance, without doing for patients what patients can do for themselves. Therapists must maintain and communicate optimism that the therapy will cure each patient.

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