Dialectical Behaviour Therapy is a specialized type of talking therapy under the general category of Cognitive Behavioural Therapy (CBT). This kind of CBT was developed by psychologist, Marsha M. Linehan, in the 1980’s to especially focus on treating Borderline Personality Disorder (BPD) and has since proven to be a valuable treatment for this particular mental illness.
What does “Dialectic” in DBT mean?
The word dialectic in the term Dialectical Behaviour Therapy refers to the unification or synthesis of two opposing positions, concepts, or realities. DBT seeks to meld two key concepts that naturally oppose each other: acceptance and change.
Acceptance refers to coming to terms with who you are—your emotions, experiences, and natural responses. Change means altering your responses and thoughts toward more positive behaviour and coping strategies in order to reach personal and social goals in becoming a more integrated individual.
People with Borderline Personality Disorder have very heightened negative emotions. As a result, they are often acutely emotionally unstable and have a tendency toward inflicting self harm and attempting suicide. DBT seeks to help BPD patients accept their personal liabilities and to help them acquire new behavioural skills to replace their ineffective and damaging responses for achieving emotional stability and personal goals.
Four Stages of Treatment with Dialectic Behaviour Therapy
The end goal of all four stages is to mould the patient toward making their own paradigm shift from feelings of worthlessness to: I am worth as much as everyone else; life is worth living.
Stage 1: Achieving Behavioural Control
At the start of therapy, the patient’s condition may be dangerously low—in psychological misery, out of control, and therefore may be self-destructive with drug and alcohol use, sexual promiscuity, or binge eating. They may also be suicidal with a history of attempts or still at the contemplation stage. The objective of Stage 1 therapy is to assist the patient into gaining command of his spiralling out-of-control thoughts and behaviour.
Stage 1 is all about setting and achieving three main goals:
- Stop suicidal or self-harming behaviour
- Rid the patient of obstacles or behaviour that prevent or interfere with therapy — the patient may justify to himself why he does not need to go on with therapy or his family may be embarrassed about his condition and prevent him from getting needed treatment.
- Addressing issues that lower patient’s quality of life — Problems like depression, unstable relationships, or being expelled from school may be issues distressing the patient to a volatile degree.
At this stage, the therapist tries to equip the patient with emotion-managing skills so that the patient can disengage from dangerous behaviour and gain some mastery over his negative thought patterns.
Stage 2: Emotional Experiencing
Although Stage 1 behaviour control has been achieved, the patient continues to suffer quietly. Their emotional turmoil is usually due to past trauma and invalidated feelings. For those with Post Traumatic Stress Disorder (PTSD), past trauma is explored and analysed and its accompanying negative beliefs and behaviours, verified. PTSD is treated at this stage.
The goal of stage 2 is to move the patient past suffering with inhibited emotions and on to a level where they experience their emotions in full. At this second stage, the therapy involves the following:
- The patient is encouraged to remember and accept the traumatic event.
- Reduction of stigmatization
- Reduction of self-blame
- Lowering incidences of negative intrusive and denial syndromes
Stage 2 goals can only be achieved once negative behaviour is under control.
Stage 3: Learning to Live
Stage 3 focuses on building self-esteem, owning one’s behaviour, creating trust and value for one’s self, and goal setting. The patient is gradually led toward coming to terms with happy and unhappy events in life, thus enabling him to live life normally.
Stage 4: Building Capacity for Joy
Some people stop at stage 3 but for others, stage 4 is an important part of recovery. Stage 4 is all about spiritual fulfilment which helps the patient feel connected to humanity as a whole. The goal at this stage is to help the patient go beyond just living day to day and be able to incorporate the ability to experience joy and freedom.
Scientific evidence has proven Dialectical Behaviour Therapy to be effective in lowering rates of suicides, self-harm, dropouts in treatment, depression, hospitalization, and substance abuse. DBT has indeed helped many patients to improve functioning and relationships in their personal and social lives.