How Does Dialectical Behavior Therapy Work for BPD?

Dialectical Behavior Therapy (DBT) is a unique and highly structured form of therapy that was developed specifically to treat people with Borderline Personality Disorder (BPD).

Dialectical Behavior Therapy is based on a synthesis of acceptance and change. It incorporates techniques geared toward validating and accepting yourself.

DBT therapy is organized by a series of stages. Each stage targets goals that must be met before moving on to the next stage.

DBT Therapy

Dialectical Behavior Therapy incorporates four primary forms of Borderline Personality Disorder treatment: individual DBT therapy, group DBT skills training, telephone contact with a DBT therapist, and a DBT consultation group.

Individual DBT therapy

During individual DBT therapy, you will meet with a DBT therapist typically once a week for 45 to 60 minutes. The therapist may use diary cards to help you review your behaviors during the past week and will follow a prioritized (hierarchical) list of behavioral targets.

Individual DBT therapy targets include the following: 

1. Reducing suicidal and self-harming behaviors
2. Reducing behavior that impacts effective therapy
3. Reducing behavior that interferes with your quality of life
4. Reducing behavior related to Post Traumatic Stress Disorder (PTSD) and trauma
5. Improving behavioral skills
6. Improving self-esteem
7. Addressing your individual goals

Group DBT Skills Training

Group DBT therapy usually meets weekly for up to two hours. DBT skills groups focus on four core skills:

1. Emotional regulation: These skills offer you ways to work through distressing emotional states.
2. Distress tolerance skills: These skills offer techniques for dealing with distressing emotional states if there is no way to change them for the time being.
3. Mindfulness: Derived from Buddhist meditation techniques, this skill area helps you focus on experiences and develop the ability to stay in the present moment.
4. Interpersonal effectiveness skills: These skills help you focus on what you hope to achieve from your interactions with others, to learn to ask for what you want, to say no effectively, to maintain relationships with others, and to maintain your self-esteem when you interact with others. 

DBT Phone Coaching Sessions

Dialectical Behavior Therapy phone coaching allows you to have phone contact with your DBT therapist between your individual sessions. Phone sessions are typically reserved for crisis situations, when your DBT therapist can help you while using skills learned from the DBT skills group sessions.

DBT Consultation Group

Dialectical Behavior Therapy consultation is a team treatment approach that involves the DBT therapists, not the actual patient. It allows individual and group DBT therapists to meet and review their patient treatment plans.

Stages of DBT Therapy

Dialectical Behavior Therapy is organized into a series of stages, with certain targets designed to be met at each stage:

• The Pre-Treatment Stage focuses on your assessment, commitment to therapy, and gaining an understanding of the structure of DBT therapy.
• Stage 1 addresses suicidal and problematic behaviors, specifically those that interfere with therapy or that could interfere with your quality of life.
• Stage 2 addresses problems related to trauma and Post Traumatic Stress Disorder (PTSD). This may involve addressing memories of the trauma.
• Stage 3 targets self-esteem issues, happiness, individual therapy goals, and problems.
• Stage 4, which is not always used, aims to overcome a sense of incompleteness and develop the ability to experience joy.

You must address the behaviors targeted in each stage before moving on to the next one. Problems related to PTSD must be dealt with before you successfully complete the first stage.

Overall, Dialectical Behavior Therapy is a demanding treatment, and you must be committed to it in order for it to be successful in your Borderline Personality Disorder treatment.