Dialectical Behavior Therapy – A Detailed Overview

Teenage girl with personality disorder touching broken mirror

Though Dialectical Behavior Therapy  (DBT) also helps people who suffer from depression, eating disorders or Post-Traumatic Stress Disorder, and substance abuse, this article focuses on how Dialectical Behavior Therapy helps people with Borderline Personality Disorder (BPD), particularly if they are suicidal.

Let’s break down that mind-boggling mouthful with definitions for those words and initials.

 


Table of Contents:

A Logical Discussion about Very Different Points of View
What is Borderline Personality Disorder, Exactly?
DBT Skills: Hope for People with Borderline Personality Disorder
Writing things Down to Promote Future Success
What about Everyone Else?
How do People with BPD See Themselves?
Employment Options


A Logical Discussion about Very Different Points of View

A dialectic is a logical question-answer format for probing and better understanding specific statements. The goal of a dialectic is to determine if the statements within a given conversation are valid, that they make sense. Dialectics are a logical form of argument for examining and/or discussing ideas and opinions. Humans behave according to the thoughts they process. A DBT counselor speaking with a client who has BPD will thus point out logical fallacies in the client’s comments, and even the differing points of view that might have been expressed in the same breath. The points of view that precede the client’s comments either focus on demonstrable realities or imagined assumptions. It is those assumptions which need to be broken down into demonstrably true or demonstrably false, and diametrically opposed to each other as the case may be.

Ideas and opinions tend to change rapidly and unpredictably among people with Borderline Personality Disorder. DBT is thus about helping someone with BPD to perceive neutral realities without assigning them negative or positive meanings. Being able to agree on what “is” instead of what’s been unjustifiably imagined is the only hope that a person with BPD has for preserving relationships and self-confidence. Putting relationships into a mutually agreed-upon context allows the relationships to continue. Without the mutual agreement, BPDers and everyone in their lives remain strangers to each other.

Without a method for mediating opposing or different points of view with the people in their life, people with BPD face a future of feeling alienated from loved ones, of being incapable of sustaining friendships and of feeling self-contempt. The people who are part of a BPD person’s life are often bewildered by their predicament in being misunderstood despite the clearly stated facts they’ve presented to the person with BPD.

What is Borderline Personality Disorder, Exactly?

In the mental health world, behavioral problems are categorized as mood, thought or personality disorders. Borderline Personality Disorder lends itself to some confusion, though, because of overlapping characteristics with other psychological disorders. There’s more clarification about that in the Distinguishing Between Mood and Personality Disorders paragraph at the What’s the Difference Between a Personality Disorder and a Mood Disorder? site.

BPD is a personality disorder, as its name implies. It affects how the affected person interprets the world and their interactions with people. The standard form of therapy for the problem is indicated in the link Overview of Dialectical Behavior TherapyDialectical behavior therapy(DBT).

Destructive and a source of enduring misery for everyone involved, BPD is a matter of inappropriate, obsessive thoughts and people who are emotionally other otherwise hurt when the BPD person acts against them.

On the border of neurosis (building imaginary castles of alleged problems in the air, so to speak) and psychosis (living in those fictitious castles, unable to perceive reality), Borderline Personality Disorder is a lifelong problem. The cause of the problem seems to be a mixture of factors.  As this BPD OVERVIEW – Borderline Personality Disorder explanation indicates “… however, scientists generally agree that genetic and environmental influences are likely to be involved. Certain events during childhood may also play a role in the development of the disorder, such as those involving emotional, physical and sexual abuse. Loss, neglect and bullying may also contribute. The current theory is that some people are more likely to develop BPD due to their biology or genetics and harmful childhood experiences can further increase the risk…”

What it comes down to is this: Borderline Personality Disorder is about unstable thought processes that influence personality traits. The affected person is unable to establish well-reasoned motives or behavior and thus does not develop reliable habits. Ever-changing moods and conclusions tend to result in impulsivity and unpredictable behavior let alone unpredictable opinions. This results in “You never know what to expect” confusion for anyone interacting with the BPD person.

DBT Skills: Hope for People with Borderline Personality Disorder

Efforts to cope with a person who has BPD can be emotionally and physically exhausting. The adoption of Dialectical Behavior Therapy (DBT) skills is a BPD sufferer’s essential hope for being able to interact with a measure of any, and continued, success with psychologically normal people. DBT is a specific type of cognitive-behavioral psychotherapy developed in the late 1980s by psychologist Marsha M. Linehan to improve upon the treatment of borderline personality disorder.

DBT skills enable a person with BPD to regulate their moods and other responses to the wider world. DBT skills enable BPDers to use distress tolerance techniques so that they can more calmly and consistently deal with life and with their interactions among other people.

Interpersonal Effectiveness is the result of using DBT skills for reaching and  for maintaining balance between demands and priorities, desires and obligations. The balance leads to self-control and self-respect. All of that lets the person with BPD to build and to sustain relationships. The behavior promotes what DBT teachers call a Wise Mind; the overlapping and integration of a reasonable and emotional mind, a wise mind lets truth be recognized for what it is.

Distress tolerance techniques are another BPD coping mechanism. A set of mindfulness skills for being aware of the situation, one’s breath and one’s very the self, distress tolerance skills help an unhappy BPDer to get through and to get past an emotional or physical crisis. Able to identify and label their own emotions thanks to acquired DBT skills, BPDers can recognize the obstacles that they’ve caused or might cause while striving to reach their own goals, and instead choose to use self-control to prevent those obstacles. By mastering their ability to initiate positive emotional events and to alter their own emotions from negative to positive, people with BPD can alter their behavior, minimizing the chaotic misery that’s usually part of their lives.

Check  out https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/

and  https://www.elementsbehavioralhealth.com/mental-health/difference-between-personality-disorder-and-mood-disorder/

for further information about distress tolerance techniques.

Writing things Down to Promote Future Success

Some people with BPD use a journal, perhaps a set of diary cards, to record successes, failures, moods, impulses and whatever else seems important to remember. Notes about the person’s use of specific DBT skills, or their failure to use them, and which ones, go into the journal, too. The overall record is tool for success in managing life better than the person did in the past.

There is ample proof that DBT works. It is sometimes called a “gold standard” for BPD care. This DBT therapy is a bit different for teens video demonstrates that that the therapeutic model for younger BPD clients is different from DBT therapy for adults. Personalized sensitivities must be accommodated for successful therapy to happen.

 

What about Everyone Else?

People can’t rely on someone with out-of-control BPD. No one in the relationship can predict if they’ll get along or be at odds with each other from one hour to the next, and whom the BPD person will blame for a deteriorating situation.

Relationships with BPD people are pretty much a “Starting all over – again – at square one” situation.

Boundaries will be reiterated by the person with BPD.

The person with BPD will demand that those rules be redefined or repeatedly defined, and followed by anyone in their midst.

Without those boundaries and proscribed behaviors, BPDers tend to accuse the people in their life of betrayal, abandonment, and trickery.

People with someone who has BPD might witness – with considerable discomfort – temper tantrums in public and in private locations.

How do People with BPD See Themselves?

BPDers often loathe themselves and feel rejected by others. This informative link Borderline personality disorder Symptoms – Mayo Clinic presents the problems in a clear, simple manner. It is clear that supportive therapy is a necessity in a BPD person’s life. Occasional visits to a relevant therapist can be made once the client has acquired the skills to live life productively and to maintain the practice of those skills.

Employment Options

People with Borderline Personality Disorder can and do hold jobs. Specific career tracks lend themselves to success. Several online sites, including social media outlets that allow interactive discussions, indicate the possibilities, as seen below:

Jobs for Someone With Borderline Personality Disorder – Verywell

Jun 13, 2017 – Some Symptoms of Borderline Personality Disorder May Change Your Path. … If you have been diagnosed with borderline personality disorder (BPD), it’s common to be frightened and worried about how this disorder may impact your life, especially in terms of your career.

Best jobs for someone with BPD? – Forums at Psych Central

Jun 27, 2013 – 10 posts – ‎8 authors

I have a LOT of trouble keeping jobs. I’m intelligent and a hard worker, but for some reason, I just can’t seem to make it out there in job land. … Is having difficulty holding down a job normal for those withBPD?

The best career/life track for someone with borderline personality …

Everyone with BPD is different and it manifests uniquely in each person so there is no set occupationpeople with BPD uniquely find themselves in, with a caveat …

“safe” careers for someone with BPD : BPD – Reddit

Apr 20, 2015 – 11 posts – ‎9 authors

Hi, Not looking for the one correct answer, just some suggestions. I currently have no job and a desperate need to find one and was just hoping.

Career/work options for people with BPD : Borderline Personality …

Mar 4, 2015 – 10 posts – ‎7 authors

That also helps come up with career options that fit your personality. … The BPD people that I have come into contact with all seem to be very …

Butcher, Baker, Candlestick Maker: Career Issues … – Healing From BPD

Someone made an interesting observation about me the other day, and I have to admit, it’s true. Over the years, I’ve had a very difficult time sticking with any one …

Employment in Borderline Personality Disorder – NCBI – NIH

by RA Sansone – ‎

A number of studies in the literature have explored employment outcomes in patients with borderline personality disorder. However, after imposing our exclusion …

Having borderline personality disorder helps me in my NHS job …

Oct 26, 2015 – Some people have said it’s a career death sentence but my lived experience of mental health problems makes me a more compassionate …

How to Help Your Loved One with BPD Start Their Career

Namely, career choice, which translates somewhat loosely to, “What do I want to do for the … For someone with Borderline Personality Disorder (BPD), however, …

Employment for Persons With Borderline Personality Disorder …

by B Elliott – ‎2010 – ‎

Apr 1, 2010 – Employment for Persons With Borderline Personality Disorder.

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Eric Silver

Eric Silver

Eric Silver has been helping a close family member learn to cope with depression for nearly twenty years. Over the years, he's developed a passion for mental health awareness. Mr. Silver has researched and written extensively within the mental health area, specifically in regard to bi-polar, depression, stress, and anxiety issues.