All Kinds of News for May 04, 2016
“Anxious”, “Exhausted”, “Feeling ineffective” – These are words used by many therapists who have served clients suffering from Borderline Personality Disorder (BPD). Marsha Linehan, the founder of Dialectical Behavioral Therapy (DBT), contends this is a typical and unfortunate result of attempting to manage a client with BPD using traditional methods. Interestingly, according to Dr. Linehan, traditional therapies, especially Cognitive-Behavioral Therapies, may actually exacerbate the client’s issues because the client experiences the techniques as invalidating. DBT, conversely, seeks to establish a validating environment.
What is Invalidation?
Invalidation is easily explained. A well-meaning therapist may confront and suggest reasonable and helpful behavioral changes and associated strategies. The client, however, experiences this as harsh criticism, because clients with this disorder tend to lack appropriate defenses. They experience themselves as unfinished, shameful, rotten, etc. Given this, BPD clients see suggestions as the therapist pointing out flaws, which is incredibly painful for them - Invalidating.
An effective DBT always focuses on validation strategy (Linehan says 85% of DBT is validation). Validation builds strong rapport, which allows the therapist to suggest behavioral change in a way the client can accept.
Effective therapists must balance validation and acceptance with behavioral change. In DBT the therapist must practice mindfulness, acceptance, and effectiveness. A therapist, using this technique, validates the client’s behavior regardless of how self-defeating or destructive the behaviors may be. Validation does not equate to condoning behaviors. Rather, the therapist may say, “This self-injuring behavior makes sense given your history, anxiety, etc. It is what you always have done. I know you have experienced this as soothing in the past. At some level you think this works for you.” Never do they say, “This is OK.”
Behavior Change Strategies
When the validating environment is established with acceptance and unconditional regard, the therapist can begin to help the client create behavior-change strategies. The therapist will draw from the skills the client is learning in the DBT skills classes.
The client will learn more effective skills to replace the behaviors that are disrupting their life and keeping them from attaining a life worth living. Moreover, DBT skills development helps alleviate therapy-interfering behavior.
The client learns four categories of skills: Core Mindfulness; Distress Tolerance; Interpersonal Effectiveness; and Emotion Regulation. Within each of these categories are multiple specific skills. An example of a Core Mindfulness skill is the Wise Mind skill. This skill teaches the client to attend ultimately simultaneously to their emotional and logical mind. As a client is making a life decision or reacting to a situation they access the messages from both parts of their mind. Synthesizing the opposing messages allows the client to make a decision from their wise mind.
For many skills Dr. Linehan has developed clever acronyms to help clients (and therapists) remember them. For instance, an Interpersonal Effectiveness skill, aimed at helping navigate relationships, is the G.I.V.E. skill. G-be Gentle in your approach, I – act Interested in the other person, V- Validate the other’s feelings, and E- use and Easy manner.
Notably, DBT requires that therapists be practicing these skills in their own lives and practices.
Remaining Effective as a Therapist
The components of DBT are designed not only to help the client, but to help the therapist remain effective and mindful. DBT buffers against the feelings expressed by therapists in the opening sentence. The components include Individual Therapy, Skills Training, and Consultation Team. The Consultation Team is designed to help the therapist stay true to the model, practice effective therapy, experience support, and remain mindful. Thus, providing a network on non-judgmental teammates to help the therapist feel invigorated and effective.
In summation DBT is proven to be more effective at treating BPD than treatment as usual. Moreover, it helps practitioners remain mindful and effective.
DBT in New Roads’ Outpatient:
New Roads’ therapists are all intensively trained in DBT. The effective and evidence-based therapy described above is offered to clients on an outpatient basis with or without supported housing. In this program, clients attend skills groups, therapy groups, and individual therapy. Telephone consultation is available to them. Further, clients in this program can access on-site psychiatric care.
New Roads Behavioral Health’s family of treatment programs are based upon a holistic, community-focused treatment approach, with a foundation in research and results. New Roads has residential treatment, transitional living, and outpatient options for their clients. There are three distinct and completely separate programs within the residential and transitional living; Pathways to Healing (PATH), Women’s Road to Healing (Worth), and New Roads to Healing (NoRTH). PATH is a dual-diagnosis treatment program for young men between the ages of 18-28 struggling with substance abuse and mental health concerns. WoRTH is a program designed specifically for young women that focuses on both substance abuse and mental health disorders (including borderline personality disorder) with a strong emphasis on Dialectical Behavioral Therapy (DBT). NoRTH is designed to assist clients with severe mental health disorders in achieving independence by teaching them how to successfully live a life with their diagnoses.
For more information, visit www.newroadstreatment.org