Dialectical behavior therapy is a special type of cognitive behavior therapy. Cognitive behavior therapy is a psychotherapy that uses active collaboration of patient and therapist to achieve therapeutic goals. Linehan developed dialectical behavior therapy and it is effective in treatment of Borderline personality disorder. In borderline personality disorder, the patient has a continuous urge for self-injury and suicidal intend. Dialectical Behavior Therapy has a primary effect on such behavior. However, today use of Dialectical Behavior Therapy has extended for many other forms of mental illness. Dialectical Behavior Therapy also apply for patients who have not been responsive to traditional types of treatment, who have therapy-interfering behaviors such as non-attendance, non-compliance, crossing therapist limits and who have quality of life interfering behaviors. The list also extent to homelessness, severe work- or relationship-related behavioral deficits and who share the common feature of emotion regulation deficits, substance abuse, eating disorders and posttraumatic stress disorder. Dropouts in Dialectical Behavior Therapy are less reported and success rate of Dialectical Behavior Therapy is higher than traditional ones.
Who are eligible for Dialectical behavior therapy?
- Patients who are trying their best for cure of disease
- Patients who feel the need to Improve
- Patients who try harder and becomes more motivated to change on therapy
- Patients having a cause for problems and patients are not responsible for problems and the patient have to solve the problem anyway.
- The patients who feel it unbearable to live a live with suicidal intend.
- Patients who are willing to learn new behaviors in all relevant contexts
- Patients who proved that they will not fail in therapy
Strategies needed in Dialectical Behavior Therapy
- Assess the patient for eligibility
- Accept many of patient’s notions and change some of them
- Provide balanced nurturing for self-help
- Make a balance between capabilities and limitations and deficits of patient
- Move with speed so that the lacking of behavior cannot take over
- Make positions in patients mind whole-heartedly
- Respect patient’s own points of view
- Make patient aware of the changes taking place
- Question why the patient have made boundary to change some point of view
- Show necessity of interrelationships in identity
- Advice to take a middle path in case of inconclusive decisions
- Show patient’s own paradoxical contradictions in behavior, in the therapeutic process, and in life in general
- Speak in metaphors and tell parables and stories
- Borrow the seriousness or implications present in patient’s statements
- Give illustrations of emotional experience and give further knowledge for logical analysis
- Turn problems of the patient’s behavior into assets
- Allow changes to appear naturally in therapy
Method of Dialectical behavior therapy
In this therapy, at first we analyze the behavior deficits and then we take attempt to validate the right behavior. This method gathers many concepts from supportive, cognitive, and behavioral therapies. During analysis of behavior, we identify the important contextual factors, other relevant features of behavior that occur in chains, consequences of these behavior and behavioral links to maladaptive behavior. After gathering this information, the therapist starts formulating informed interventions. For example, patients with self-harm tendency due to fear needs exposure based interventions. We also communicate to the patient to validate responses, emotions, thoughts or behaviors of the patient that makes sense. We take the clients agenda seriously and search for the demon in the client’s response. This type of validation strengthens the therapeutic relationship with the therapist. It also helps the client develop a clear sense of normal responses. The therapist also enables the patient to deal with mixed feelings. The patient understands that if his/her behavior is normal everyone will give value and respect to his/her works and no one will ignore them. In this therapy, interviews are as frequent as once in a week. During the course, the patient is advised using metaphors, telling parables, stories and confrontation. These techniques are proved to improve interpersonal skills and decrease self-destructive behavior. This technique is also applicable for patients who cannot identify emotional experiences and cannot tolerate frustration or rejection.
Dialectical Behavior Therapy has four modes of treatment protocol.
- Group skills training
- Individual therapy
- Phone consultations
- Consultation team
All the protocols work in the same principles described above and may need ancillary drug support and hospitalization.
Group Skills Training
A group of patients achieves behavioral, emotional, cognitive, and interpersonal skills at a time. Each group makes improvement at different occasions. So comparison should be avoided. Specific exercises, taken from a skills training manual, when used in a group many of patients are geared to control emotional deficit and impulsive behavior.
Sessions in Dialectical Behavior Therapy generally extend for 50 to 60 minutes and held once in a week. Here, life events in each week and skills learned during group training are reviewed. Patients are told to keep record of their thoughts, feelings, and behavior so that we can analyze them during session. We give special notice to pathological behaviors and rectify them if the group therapy is unable to do so.
The therapist is available over phone anytime of the day for consultation. When the patient feels that he/she is in crisis and they can involve into self-destructive activity, they should call the therapist. Calls should be brief and should not last more than 10 minutes.
Therapists meet weekly with each other and consult with each other regarding their work with their patients. This type of meeting will motivate the therapist, they will be able to compare techniques and search for best technique for individual patient. The therapist may also tell a patient to consult other therapist for better management.
Functions served by Dialectical Behavior Therapy
According to the originator’s description Dialectical Behavior Therapy has five functions:
- Enhance and expand every aspect of patient’s skillful behavioral patterns
- Increase patient’s urge to change
- Ensure that new behavioral patterns gained by therapy become part of natural environment of patient
- Structure the environment of the patient in a way so that effective behavior reinforces and dysfunction behavior turns off
- Enhance the motivating power and capabilities of the therapist