1. Dialectical Behavior Therapy
Borderline Personality Disorder

2. General Overview Marsha Linehan (1993).
Recommended readings.
Orientation combines systemic/transactional approach, CBT, Buddhism, and principles of Dialectics.
Developed for use with persons with BPD, but has also been applied to suicidal behavior in adolescents and bulimia.

3. “Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.” --Marsha Linehan

4. Linehan’s Theory of the Development of BPD
Emotionally Vulnerable Person
An invalidating Environment
Problems w/
1. Ability to Understand & label feelings.
2. Coping skills.
3. Emotion modulation.
Based on a bio-social theory of BPD.

5. The Dialectical Dilemma of Person’s with BPD
Inappropriate blame of other vs. In appropriate blame of self.
Inhibited grieving vs. Unrelenting crisis.
Active passivity vs. Apparent competence.

6. Therapists’ Working Assumptions about the Client
The client wants to change, and despite appearances, is trying his/her best as a particular time.
His/Her behavior pattern is understandable given his/her background and present circumstances.
In spite of this, he/she needs to try harder if things are to improve.
Clients can not fail at DBT.

7. Therapists’ Dialectical Style
Reciprocal communication vs. Irreverent communication.
Accepting of the client as he/she is, but encouraging change.
Centered and firm, yet flexible when the circumstances require it.
Nurturing, but benevolently demanding.

8. Clients’ and Therapists’ Agreements
To work in therapy for a specified period of time, and to attend the majority of therapy session.
If suicidal or para-suicidal behaviors are present, he/she must agree to work on reducing these.
To work on therapy interfering behaviors.
To attend skills training.

9. Modes of Treatment Individual therapy. Group skills training.
Telephone contact.
Therapist consultation.

10. Skills Training Core mindfulness skills. Interpersonal effectiveness.
Emotion modulation skills.
Distress tolerance skills.

11. Individual Therapy Stages of therapy. Hierarchy of therapy targets.
Treatment strategies.

12. Stages of Therapy Pre-treatment.
Stage 1: focus on suicidal behaviors and therapy interfering behaviors.
Stage 2: focus on PTSD related problems.
Stage 3: focus on self-esteem and individual treatment goals.

13. Hierarchy of Therapy Targets
Decreasing suicidal behaviors.
Decreasing therapy interfering behaviors.
Decreasing behaviors that interfere with quality of life.
Increasing behavioral skills.
Decreasing behaviors related to post-traumatic stress.
Improving self-esteem.
Individual targets negotiated with the client.

14. Treatment Strategies Contingency management. Cognitive therapy.
Exposure based therapies.
Pharmacotherapy.

15. Recommended Readings
Dimeff et al. (2007). Dialectical Behavior Therapy in Clinical Practice: Applications across Disorders and Settings.
Linehan (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder.
McKay et al. (2007). Dialectical Behavior Therapy Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance .
Moonshine (2008). Dialectical Behavior Therapy Volume 2 - Companion Worksheets.