Dialectical Behaviour Therapy (DBT) is the National Institute for Health and Care Excellence (NICE) recommended treatment for Borderline Personality Disorder (BPD). We asked RSCPP therapists to explain what DBT is and how it works to treat BPD.
Dialectical Behaviour Therapy (DBT) is a treatment that was initially developed especially for women who self-harm. It is now being used in more and more settings to help both men and women with a much wider range of difficulties. DBT assumes that you are doing the best you can with the existing skills you have, facing the problems you experience. It believes that by helping you to become more aware of yourself, and then teaching you new skills to cope with the difficulties you encounter, you will learn to function more effectively in the world. It also recognises that some problems in life can't be fixed and therefore it supports you in learning to accept and tolerate the areas you can't change, as well as teaching you skills to change the areas you can.
A key part of DBT is a balance between acceptance (of yourself, your circumstances, your feelings) and making proactive changes in your life.
DBT has different stages. The first stage is aimed at helping you to learn new skills to get in control of difficult emotions, thoughts and behaviours. The second stage goes on to help you with past traumas, and the third to improve your quality of life. This may take the form of group or individual therapy, and you may also be offered telephone sessions so that you can receive support between appointments. The focus of groups is to teach new awareness of and skills in managing difficult emotions, thoughts and behaviours. The individual and telephone sessions focus on helping you put these skills into practice.
DBT as a psychotherapeutic approach has an evidence-based reputation in the treatment of Borderline Personality Disorder. The approach was developed specifically for BPD, especially for clients with Post Traumatic Stress Disorder (PTSD) following sexual abuse.
DBT explains that people with BPD are biologically predisposed to feel things more strongly than other people, which makes their lives more difficult to cope with. It also explains that you may have not been taught the appropriate skills for managing these strong emotions over the years. It therefore understands the behaviours that are commonly seen in BPD to be your best attempts at trying to manage your strong emotions. The treatment therefore focuses on helping you to become more aware of your strong emotions, so that you can spot them earlier and deal with them before they become overwhelming, and then teaching you new and more effective skills in managing these emotions. It recognises that many people with BPD feel lost and talk of feeling a chronic sense of emptiness inside, which they constantly try to fill.
DBT is suitable for people who have problems with managing difficult emotions, and can help people replace unhelpful coping strategies such as self-harm, substance abuse, binge-eating and similar.
Through learning to be more accepting of yourself, being able to interact with the world more successfully, and being less at the whim of your emotions. People who complete DBT often talk of feeling more stable and having a strong sense of who they are as a person.
Taking the example of sexual abuse and BPD, the outcomes you could expect from DBT are to be assisted against your unhelpful appraisals or perceptions, including suspiciousness of others, core beliefs - such as that you are to blame for what took place in your life, fear of perceived threats and danger, avoidant behaviours towards others, who you may think of as ‘potential perpetrators' or ‘sneaking accomplices', and fear that the traumatic event of sexual abuse could happen again.
To offer DBT, a therapist needs to be trained and work in a DBT team. DBT is a whole team approach, where people receiving DBT attend individual and group sessions, can access telephone support between sessions, and the therapists have group sessions to help them work more effectively. Very few therapists are able to offer this intensity of treatment in private practice. However, many therapists draw on DBT principles within other therapies. In my work, I find it helpful to incorporate DBT skills training in individual sessions at the start of therapy to help people develop skills to cope with difficult emotions before moving on to addressing more difficult issues such as childhood abuse or trauma.
All therapists on rscpp.co.uk are accredited, registered or chartered by a UK professional body. Therapists who offer Dialectical Behaviour Therapy will in addition have completed a course in DBT practice.