Dialectical behavior therapy to help ‘borderline’ patients
I would like to clarify several points in our article on using dialectical behavior therapy to treat patients with borderline personality disorder (Current Psychiatry, April 2005).
The reader is given the impression that a training program involving 2 weeks of didactic training plus some months of consultation is sufficient to practice the treatment competently. Although 2 weeks of intensive training may be a useful first step, providing competent treatment requires using that knowledge and continuing to develop skill as a therapist over time.
Table 2 (problem-solving strategies) includes structural strategies, which are neither acceptance nor problem-solving strategies, but rather serve to organize treatment.
Irreverence was misidentified as an acceptance strategy in Table 3 (acceptance strategies). Irreverence is used primarily to present novel stimuli to which the patient must respond; in this way, it is primarily a change strategy. Also in Table 3:
- Dialectical strategies defy being clearly acceptance or problem-solving tools. To the degree that these strategies highlight tensions, they serve to push the patient toward change.
- Case management can be both an acceptance and problem-solving strategy. It is acceptance when the therapist accepts that patients’ situations are such that they cannot effectively act on their own behalf and that the therapist must intervene. It is problem-solving when the therapist coaches patients to intervene on their own behalf.
Anthony P. DuBose, PsyD
President & CEO, DBT Center of Seattle, PLLC