Marsha Linehan and Dialectical Behavior Therapy Leading Models of Personality Disorder Treatment

Developed by Marsha M. Linehan, Dialectical Behavior Therapy (DBT; 1993) is a therapeutic approach specifically designed for the treatment of Borderline Personality Disorder and suicidal behaviors and is currently the field's leading model in treating one of the most difficult of personality disorders. It uses both cognitive and behavioral techniques, such as problem solving, exposure techniques, skills training, contingency management, and cognitive modification, to effect a hierarchy of treatment goals. Potential outcomes of DBT intervention may include successfully teaching skills that will allow borderlines to regulate emotions, tolerate distress, and effectively interact with others. However, for such coveted abilities to be attained, the distinguishing aspects of DBT must be adhered to: accept and validate current behaviors, acknowledge and treat the behaviors that pose disruption to the therapeutic process, perceive the therapeutic relationship as indispensable to treatment, and accentuate the dialectical processes. The most notable and fundamental dialectical strategy is the process of accepting the individual's behavior while simultaneously guiding them to change. Concurrent are the underlying challenges inherent in maintaining dialectical thinking while targeting a patient's cognitive inflexibility. While the therapist is challenged with reframing the patient's view of past suicidal behaviors, for example, from self-destructive dysfunction to learning and problem-solving experiences, he or she must also validate the individual's emotions and feelings. Such paradox is not only the core component of the dialectical model but also essential to its efficacy.

of concern, together with a strong alliance that helps anchor borderlines to realistic interpretations of their stormy relationships, often forestalls increasing feelings of emptiness and depression. Subjects in crisis should be evaluated tactfully for the possibility of suicide and hospitalized when necessary.

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