Dialectical Behaviour Therapy (DBT) is a therapeutic methodology developed by Linehan, a psychology researcher at the University of Washington to treat people with Borderline Personality Disorder (BPD). DBT combines Cognitive Behavioural Therapy with concepts of methodologies from various practices including Eastern mindfulness techniques. Research has shown that DBT is the first therapy that has been effective for treating BPD. Further research has been carried out and appears to show that it is also effective in treating people with spectrum mood disorders including self harming behaviour. Linehan created DBT after realising that other therapies were ineffectual when used for BPD. She recognised that the chronically suicidal people that she worked with had been brought up in invalidating environments and required unconditional acceptance in order for them to develop a successful therapeutic relationship. She also maintained that people need to recognise and accept their low level of emotional functioning and be ready to make a change in their lives.

Helping the person with Borderline Personality Disorder to make therapeutic changes in their lives is extraordinarily difficult for at least two reasons. Firstly, focusing on patient change, either of motivation or by teaching new behavioural skill, is often experienced as invalidating by traumatised individuals and can precipitate withdrawal, non compliance, and drop out from treatment on the one hand, or anger, aggression, and attack, on the other. Secondly, ignoring the need for the patient to change (and thereby, not promoting much needed change) is also experienced as invalidating. Such a stance does not take the very real problems and negative consequences of patient behaviour seriously and ?can, in turn, precipitate panic, hopelessness and suicidal ideation.

DBT involves two components:

1. An individual component in which the therapist and patient discuss issues that come up during the week, recorded on diary cards, and follow a treatment target hierarchy. These sessions typically last for 45-60 minutes and are held weekly. Self Harming and Suicidal behaviours take first priority, followed by therapy interfering behaviours. After this there are issues surrounding quality of life and working towards improving one’s life in general. During the individual therapy, both the therapist and the patient work towards improving skill use to survive and manage difficult feelings. The whole session should be working towards a setting that is validating for the patient. A lot of attention should be paid to the immediate problems, feelings and actions. Often, a skills group is discussed and obstacles to acting skillfully are addressed. Read the rest of this entry »