Borderline Personality Disorder

Dialectical Behavior Therapy (DBT) developed by Marsha Linehan (1991) specifically targets the suicidal and self-harm behaviors commonly associated with Borderline Personality Disorder (BPD).  BPD is thought to most often affect younger women, and is characterized by “identity problems and unstable relations, lacking impulse control, emotional instability, and feelings of emptiness often in combination with anxiety, depression, and substance abuse” (Perseius, Ojehagen, Ekdahl, Asberg, & Samuelsson, 2003, p. 218). A high percentage of patients with a diagnosis of BPD attempt or successfully commit suicide; additionally, treatment drop rates are often exceedingly high (Perseius et al., 2003). 

Treatment Goals

As such, the treatment of BPD can be taxing on both clients and their therapists. In Linehan’s (1991) DBT treatment model, clients participate in weekly individual therapy sessions, weekly group skills-based sessions, and treatment calls with their individual therapists as needed. To best troubleshoot issues that arise during treatment, clinicians are also required to have weekly team meetings to discuss each case and adjust treatment to meet clients’ needs most effectively. DBT combines treatment strategies from cognitive-behavioral therapy (CBT) and supportive psychotherapy and focuses on three phases of treatment goals:

1.      Stability and security: This stage focuses on decreasing suicidal and non-suicidal self-harm behaviors, as well as behaviors that decrease patients’ quality of life.

2.      Reduction of posttraumatic stress by focusing on traumatic life events: Often patients with a diagnosis of BPD have suffered trauma during childhood or adolescence.

3.      Increase of self-respect and achievement of individual life goals (Perseius, Ojehagen, Ekdahl, Asberg, & Samuelsson, 2003, p. 219).

Examining Perceptions of DBT

Determining patient and clinician perspectives on the effectiveness of DBT in the treatment of BPD was of interest to the researchers (Perseius et al., 2003). Therefore, they conducted a study among patients who had been in DBT treatment for a year under the diagnosis of BPD and several other co-morbid disorders, such as anxiety and depression. Participants were interviewed concerning their experiences of symptoms pre and post treatment, the impact of therapy on their current functioning, the particular components of treatment that were most effective, and their perceptions of the effectiveness of DBT in comparison to other modalities of therapy. The participating therapists, all of whom had been trained in DBT and had been practicing for 12 to 23 years, were asked similar questions about their experiences facilitating treatment.

Similar Perceptions of DBT Effectiveness

The results indicate a “strikingly concordant” similarity between patients’ and therapists’ experiences of DBT and its effectiveness. All patients indicated DBT was a “life-saving” experience that taught the coping skills necessary to deal with life stressors (Perseius et al., 2003, p. 225). Similarly, patients report profound effects from the perception of understanding, respect, and empowerment achieved through therapy. The therapists describe a similar progression in treatment where patients become more independent and responsible for emotional and behavioral states. Both therapists and patients agree that DBT is specifically tailored to all intricate and challenging components of BPD treatment and hold patients to a higher degree of responsibility for wellness.

Reference

Perseius, K., Ojehagen, A., Ekdahl, S., Asberg, M., & Samuelsson, M. (2003). Treatment of suicidal and deliberate self-harming patients with borderline personality disorder using Dialectical Behavioral Therapy: The patients’ and the therapists’ perceptions. Archives of Psychiatric Nursing, XVII(5), 218-227.