The evolution of traditional cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) emphasizes the balance between acceptance and change and is a type of treatment distinguished by a dialectical approach. DBT advocates use “Devil’s advocate” frequently throughout psychotherapy. Examples of this include asking the patient, “It takes a lot to learn to use the skills, why do you want to participate in this therapy,” presenting a strong attitude by saying, “I can’t continue treating you if you die,” and confronting the consequences of negative behaviors by directly asking about suicidal thoughts and plans. This is the planning phase of dialectical behavior therapy, not the therapist’s own style. They attempt to push the patient into an alternative way of thinking in this way, the therapist in the video says. This therapy places a focus on a balance of acceptance and transformation (and is thus dialectical). Its overall objective is to help the individual not only survive but also live a life worth mentioning
There are typically four parts to this treatment:
It begins with a focus on life-threatening issues such as self-harm. Following a structure of treatment objectives, the patient and the therapist (individual) talk about the problems that have come up over the week and are written on a diary card. Life-threatening behaviors, such as self-harming and suicidal tendencies, are given top priority. This is because, although the fact not being directly damaging to oneself or others, unpracticed behaviors can interfere with the therapeutic process.
During the second phase, the group usually meets twice a week for two to two and a half hours. They come up in four skill modules: core positive thinking, interpersonal effectiveness, emotional regulation, and distress tolerance. Positive thinking of the group skills training is an attempt to “meet specific behavioral deficits associated with borderline personality disorder and replace them with positive beliefs and behaviors that will help patients learn to solve their problems (Kevin Dawkins & Linehan, M. M., 1995 29:53). Additionally, improving interpersonal abilities might help lower emotions like relationship uncertainty and abandonment anxiety. Patients should be encouraged to feel the negative emotions they have been avoiding all the time.
The third portion, which discusses telephone strategies, is designed to assist patients in learning how to ask for assistance and generalize abilities into their everyday lives. It seeks to gradually educate patients on how to replace the negative emotions, attitudes, and behaviors that are linked with borderline personality disorder with good ones. By learning how to control their emotions, patients can diminish their feelings of rage, fear, guilt, and grief while also empowering them to face their issues head-on.
Finally, all therapists who provide DBT must attend supervision by the therapist’s counseling team. This weekly meeting is designed to assist the therapists in delivering treatment. This session is important because the therapist needs to maintain consistent, professional treatment strategies throughout the whole process. Team supervision helps ensure this.
Dr. Linehan believes that “people who meet criteria for borderline have skills deficits or capability deficiency, and that they can’t gage in the behaviors that they need to dissolve their problems” (Kevin Dawkins & Linehan, M. M., 1995 05:35). This is why positive thinking is one of the core ideas behind all the elements of DBT. Because it enables people to accept and tolerate the strong emotions they can experience when they challenge their patterns or put themselves in a state of frustration. One of the goals of DBT is “to figure out a way to get your behavior, and what you do less hooked up with how you feel. ” (Kevin Dawkins and M. M. Linehan, 1995, 11:15)
I believe the largest limitation of this specific, specialized DBT therapy may be the ethical concerns and the need to take into account if there is survivorship bias in the general treatment outcomes of DBT. For instance, if a patient asks for extra time and more attention from the therapist and the therapist only agrees to talk to the patient if the patient is suicidal, it may be falsely implied that “suicide tendency is the way to exchange a talk,” which might lead the patient to believe that suicidal thoughts are the only option. This raises the concern of whether the patient will develop an unhealthy dependency that could possibly become a reinforcer of suicidal thoughts. Or, whether the patient will depend on the link that has been established by these accessible phone calls during the period of the phone strategy’s transition to the upcoming phases. As a result, it is crucial to assist the patient in learning effective telephone support strategies during the therapy process. However, the therapist’s increased interaction with the patient may cause him or her to worry about the patient excessively. The telephone is, after all, a close contact between the two parties, even though the counselor has support staff to assist them to remain on track. The potential success of treatment using DBT may also be affected by the therapist’s unpredictable professional identity and self-attack. We also don’t know if patients who stop receiving DBT treatment can experience negative influences including an increase in aggression toward themselves and a lack of trust in their upcoming therapy. After all, we are more likely to focus on the great effectiveness of this therapeutic strategy while missing the situation of those “unsurvivors of DBT.”
It places a stronger focus on the patient’s present life circumstances and encourages the patient to approach problems with a positive attitude, so I believe DBT gives substantial specificity. The telephone technique differs from the traditional counseling approach in that it promotes a distinct form of immediateness. Based on this, alternative communication channel tools like texting or email may be an option. These methods have the benefit of creating a clearer limit to be established than a phone conversation. While offering immediate help and guidance when the patient needs it, these limits maintain the benefits of distance in traditional therapy. The text or email can also be kept and reviewed later, with the permission of the patient and the therapist, which might bring some new insights.
References
Kevin Dawkins (Producer), & Linehan, M. M. (Director). (1995). Treating Borderline Personality Disorder. [Video/DVD] Guilford Publications. Retrieved from https://video.alexanderstreet.com/watch/treating-borderline-personality-disorder
Gruman, J. A., Schneider, F. W., & Coutts, L. M. (Eds.). (2016). Applied social psychology: Understanding and addressing social and practical problems. SAGE Publications, Incorporated.
Hello, I really enjoyed reading your blog. Your insights into Dialectical Behavior Therapy (DBT) are quite enlightening, especially considering my own personal interest in potentially working with clients diagnosed with borderline personality disorder in the future. The phased structure of DBT—from addressing critical behaviors to enhancing emotional and interpersonal skills—demonstrates a comprehensive approach tailored to the complexities of this condition. I find the balance DBT strives for between accepting limitations and promoting change particularly compelling. It encourages self-accountability in patients, an aspect crucial for long-term management and personal growth. The ethical considerations and innovative use of communication technologies like phone calls and emails to bridge traditional therapy gaps are also notable. This approach seems well-poised to support individuals in not just coping, but truly thriving. Again, great job.