A short reminder: if you have been diagnosed with Borderline Personality Disorder, please do not read further. It is important you work with your medical team to ensure you the best possible outcome. This information is provided for the general population and writers in particular, to provide a base of knowledge and understanding.
As discussed in an earlier post, Borderline Personality Disorder (BPD) is confusing, hard to treat and hard to live with – for both its victims and their families. BPD is an illness of ‘extremes’, all or nothing and/or black and white thinking, and because it is a personality disorder, that is, it affects how a person sees the world, it is hard to treat. Many forms of therapy can help this client, but the single greatest predictor of success in the therapist/client relationship is trust. That is hard to build with a BPD patient and it’s hard to sustain over time. But a stalwart therapist can go a long way in helping these clients.
Many psychiatrists prescribe drugs to alleviate the symptoms of this disorder. For example, anti-depressant drugs (Cylexa and Zoloft), mood stabilizers (Depakote), and/or anti-psychotics (Zyprexa and Resperidol) are samples of the many drugs that may be prescribed. Each one usually has some success (many would say limited success), but on their own, none of them work to give the BPD patient a rich and rewarding life. At best they decrease symptoms so that the patient has time for psychotherapy to work.
Several models of talk therapy have been used in treating BPD, each with varying degrees of success. The two most well known models are:
- Cognitive Behavior Therapy, which helps people to identify and change their core beliefs and behaviors that are at the root of their inaccurate self-perceptions and their problems interacting with others. Because CBT is known to reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors, it is a great aid in treating Borderline Personality Disorder.
- Dialectic Behavior Therapy grew out of CBT and was developed by Marsha Lineham who ‘came out’ as a survivor of mental illness in 2011. Her story can be read here. http://www.nytimes.com/2011/06/23/health/23lives.html?pagewanted=all
This treatment model is an evolving growing method of helping BPD patients and is a beacon of hope for so many.
According to GoodTherapy, Dialectic Behavior Therapy (DBT) is founded on the belief that undetermined causes (likely environmental and biological) cause some people to respond to emotional states more quickly, and they remain in this aroused emotional state for extended periods of time before returning to normal. This is logical since BPD includes symptoms of lives peppered with crises and drama – both highs and lows. DBT teaches these people coping techniques that they did not receive in their invalidated childhoods.
According to Lineham, therapy must accomplish five goals:
1) Expand and sustain the motivation the client possess to facilitate transformation
2) Provide opportunity for skill-development in the client
3) Assimilate the client’s new skill set so that it can be applied across a broad cross-section of situations and circumstances
4) Develop the therapist’s own abilities and desire to effectively and willingly treat people
5) Provide a nonjudgmental and secure environment in which healing can occur
DBT is always provided in a team environment and includes individual and group therapy, coaching and ‘homework’. Because of the difficulty and long timelines of this work, it is imperative a team approach is adopted, ensuring the therapist receives the support, encouragement and direction needed to effectively continue providing psychotherapy.
In the 1993 training manual, Lineham says that DBT is taught as a series of skills in four modules: mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. The first of these modules makes this treatment very different from any other for mindfulness is based in Eastern Zen philosophy, and it includes Western contemplative practices. Mindfulness is an awareness of thoughts, feelings, behaviors, and behavioral urges. By learning mindfulness, we are empowered to be in charge of ourselves in a different way. It has been proven that awareness assists in emotional regulation. As we understand ourselves, we accept ourselves and change ourselves. It is a practice of attention and intention.
In DBT, core mindfulness begins with the concept of states of mind. According to the theory, there are three states of mind that everyone is in at varying times: wise mind, logical mind, and emotional mind. Wise mind is the ideal state of mind that we strive to reach to make good decisions. The other two states of mind combine to form wise mind. Logical mind is used when doing math, reading a map, and a wide variety of concrete tasks. Last is emotional mind. which is the state in which we feel emotions and then act from that emotional state. For example, we’re in this state of mind when we react out of anger without regard to consequences. This is considered the “hot” state of mind.
For people who live life out of the ever-changing kaleidoscope of emotions, living in mindfulness is the first step in overcoming BPD. By accomplishing this goal, the other three develop and evolve and result in a rich and productive life.
Dialectic Behavior Therapy is not simple to explain, but it works. It is interesting to me that it combines successful, disciplined therapy with meditation to achieve results.