Dr. Marsha Linehan developed a structured Dialectical behavior therapy (DBT) to treat outpatient patients with borderline personality disorder (BPD). DBT is the only evidence-based treatment supported for the treatment of BPD. The approach combines aspects of CBT (cognitive-behavioral therapy) with mindfulness approaches and incorporates skills training groups and individual therapy (Linehan, 2021). Some of the crucial components of dialectical behavior therapy include individual therapy. In this component, patients can have face-face interactions with trained therapists. These sessions aim to tackle specific treatment goals, manage lifestyle challenges, and increase motivation (Linehan, 2021). The therapist helps patients develop problem-solving strategies, apply new skills, and navigate therapeutic relationships using acceptance and validation.
The second component is skills training groups. DBT focuses on teaching patients specific skills to enhance their abilities to tolerate distress, regulate emotions, develop mindfulness, and improve interpersonal effectiveness. In other words, skills training groups primarily focus on four modules: distress tolerance, interpersonal effectiveness, mindfulness, and emotion regulation (May et al., 2016). The third component involves phone coaching. Patients can access coaching sessions via their phones for guidance and support, especially when they are implementing new skills or experiencing real-life challenges or crises. This component aims to improve skills generalization and promote continuity of care. Finally, the fourth component involves consulting a team. DBT therapists often receive ongoing support and supervision through consultation teams. This practice aims to help therapists maintain well-being, manage countertransference, and stay effective.
Besides DBT being effective for treating BPD, it has its own strengths and limitations. Some of the strengths include empirical support. DBT is based on empirical evidence, and substantial literature supports its effectiveness in limiting suicide attempts, reducing self-harm, and improving and supporting the overall functioning of BPD individuals (Wolbert, 2017). Secondly, DBT uses a comprehensive approach to address the various issues surrounding the nature of BPD. It combines skills training, individual therapy, consultations teams, and phone coaching. Finally, DBT applies a skills-based focus to provide patients with practical skills that help them manage interpersonal conflicts, intense emotions, and distressing situations. Empowering skills acquisition aims to increase an individual’s coping abilities and self-efficacy, thus empowering individuals to live fulfilling lives.
The limitations of DBT include the potential for therapist burnout. DBT therapist handles many patients, especially high-risk patients. The intensity of caring for and managing DBT patients can cause therapist burnout. Besides, the well-being and self-care of a therapist are crucial to ensure patients receive high-quality treatment. DBT is also resource and time-intensive (Wolbert, 2017). The treatment and management of DBT require significant commitments from both the patient and the therapist regarding time and demands. Besides, the resources required to treat and manage DBT may be limited in personnel and expertise, thus making it difficult to effectively manage health issues and denying DBT clients access to therapy services. In addition, DBT has limited generalizability (May et al., 2016). Although DBT is highly effective in treating and managing individuals with BPD, its application in other conditions or personality disorders remains uncertain. Moreover, there is limited research on DBT generalizability to a wider range of populations.
In conclusion, based on DBT’s strengths and limitations, it is obvious that there is no superior method for treating BPD. In such a case, other alternatives become very necessary. Some therapeutic approaches have shown significant promises, such as TFP (transference-focused therapy), MBT (mentalization-based treatment), and schema therapy. Making decisions collaboratively with clients seeking treatment help, availability of trained personnel, and cross-examinations of specific needs and preferences is recommended.
Linehan, M. M. (2021, September 21). Introduction to Dialectical Behavior Therapy (DBT) [Video]. Retrieved from https://www.youtube.com/watch?v=Q8coci6KNpo
May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as a treatment for borderline personality disorder. Mental Health Clinician, 6(2), 62–67. doi:10.9740/mhc.2016.03.62
Wolbert, R. (2017). Modifying behavior therapy to meet the challenge of treating borderline personality disorder. The Oxford Handbook of Dialectical Behaviour Therapy, pp. 90–106. doi:10.1093/oxfordhb/9780198758723.013.5