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.
My first reaction to this piece was positive. I have often thought that a complete state of empathy such as that which we see in humanistic psychology is insufficient. I stigmatize the humanistic therapist as one who continually exudes toxic positivity whilst validating everything the client says, even if they do not really agree or if the client is wrong. Often, the positivity I see in humanism appears counter to the authenticity that humanistic therapy claims it has. DBT seems very different from this; it takes CBT and turns it up a notch to deal with clients who are extremely unreasonable and who may take advantage of a humanistic therapist. 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.
I have not had experiences with a therapist like this personally. However, some female role models of mine I have had in the past embody these techniques, including one manager whom I had whom I admired very much. It is a dangerous balance, though, because I have also had another manager who tried to embody this strict tough-love approach, and she came across as cruel, so striking the right balance seems critically important to me. Because DBT is so prescriptive, both stylistically and in its methods, I feel it limits the approach to a particular kind of person. The same way many psychoanalysts copy Frued. DBT can probably only be done correctly by a certain kind of practitioner who naturally has the same demeanor as Linehan, and it can probably only be received by a particular kind of client, one that needs a disciplinarian mother figure.
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. Will it forever be relegated to a small market with a small number of practitioners and a small number of clients? Due to the rigidity of its approach, its specific style and prominent intensity? I also wonder, is DBT a personality cult style of therapy? I am beginning to notice a pattern that personality cults are big in psychology, starting with Freud for psychoanalysis, Skinner for behaviorism, and then Rogers for humanism, Beck for CBT, and now Linehan for DBT. How can we unify therapy to be more of a combined body of knowledge instead of disparate odes to individual legacies?
As a counselor, I am interested in using a kind of therapy that makes the therapy space the instrument instead of the individual. I gravitate towards group therapy situations. Other group members could best give this stern and challenging feedback instead of a therapist adopting a parental role. The environment, such as the physical or digital space, can be leveraged as a therapeutic intervention. New technologies like secure recording devices could listen to conversations and objectively provide feedback. A device can then support feedback to the client with data and evidence in real-time, eliminating the need for the therapist to take on a challenger role. About DBT, I wonder if developers could program a little robot or a piece of software on a phone that could run during therapy sessions and do everything Linehan had hoped via the software instead of the intensive training and emotional battering required for the individual therapist to undergo before delivering DBT.
