Dialectical Behavior Therapy
I wrote this reflection for my problem identification class at the University of Rochester. The professor asked us to reflect on a particular reading, the reading for this reflection was Linehan's Dialectical Behaviour Therapy (DBT) for Borderline Personality Disorder: Overview and Adaptation by Swales, Heard, and Williams (2000). I have included my reflection below.
Dialectical Behavior Therapy
This week, I chose to reflect on Linehan's Dialectical Behaviour Therapy (DBT) for Borderline Personality Disorder: Overview and Adaptation by Swales, Heard, and Williams (2000). Swales et al. provide a historical background of DBT. Originally designed as a form of CBT for suicidal women with Borderline Personality Disorder (BPD), DBT addresses the interrelated dysregulation this condition presents. DBT focuses on interrelatedness within the client and between the client and others and the world, with a special focus on the interrelationship between client and therapist. DBT wants to see the world as sets of dialectical ideas or feelings constantly in flux. In this dialectic, DBT refers to one pole as the thesis and the other as the antithesis; tension exists between each pole. DBT uses this tension to create change in the client. DBT is said to be one of the few empirically verified methods of psychotherapy that have evidence to work with BPD.
Swales et al. offer more details on how DBT is delivered, including its method of intentionally targeting problems one at a time and the different modalities through which practitioners deliver DBT to clients. Swales et al. list the primary tasks of DBT as enhancing a client's abilities, motivating the client, helping them expand their abilities to broader contexts, helping the client use structure, and caring for the well-being of the therapist. DBT offers a structured set of stages, starting with the creation of a safe environment, then processing past trauma, building self-respect, and finding joy. DBT cites that individuals with BPD often are too emotionally sensitive, passive within their environment, and feel like they are in constant crisis. DBT attempts to remedy these BPD traits by challenging the client to problem solve, offering accurate and genuine validation, and using a deadpan stylistic manner that unwaveringly faces the emotionality of the client within moments of tension, among other skills.
I have often wondered humanistic empathy alone is enough to treat clients with severe mental illness. DBT seems to take CBT and turn it up a notch to deal with clients who are more complicated. I felt that DBT’s approach embodies a ‘tough love’ style. When I researched Marsha Linehan, I was struck by how her persona resembled that of a stern headmistress, like Minerva McGonagall from Harry Potter, or even a strict educator from a British (Lockean) boarding school. This demeanor reflects the structured and disciplined nature of DBT.
Because DBT is so prescriptive, both stylistically and in its methods, I wonder if it limits the approach to a particular kind of person. The same way many psychoanalysts copy Freud. I wonder if DBT can only be done correctly by a certain kind of practitioner who naturally has the same demeanor as Linehan.
Questions I have include how this technique fared in modern times? I can see how it originated in the early 1990s, and the paper itself was written in 2000 and has a sentiment appropriate to that milieu. However, things have changed a lot since then, and I wonder if DBT stands the test of time?
