What Is Dialectical Behavior Therapy, And Would You Benefit?

Fifty-five year-old Lisa (not her real name, and details of this story have been changed to protect her identity) was more than a slight challenge for her neighbors. She had a peculiar, and disturbing, habit of adopting their cats. When a neighbor's cat would go outside at night, Lisa, lurking behind a tree or a large vehicle in the parking lot, would trap it and take it to her apartment. There she would feed the hapless cat fresh sashimi-grade tuna and tie satin ribbons around its neck. She would invite it to play in her cat gymnasium, and feed it the finest of cat food day and night.

Lisa also made a habit of introducing herself to new people in the building, telling them they were wonderful supporters of her ideas (whether or not they had discussed her ideas), inviting them to a coffee shop, and then, more often than not, slapping the cup of coffee out of their hands when they said something she did not like. Long retired on disability for post-traumatic stress, Lisa mostly slept in every day, but sometimes she would find the energy to spend long hours demanding to speak at city council meetings and political conventions, probably convincing far more people to vote against her proposals and her party than for them. At one city council meeting, Lisa excoriated elected officials for not making traffic lights "gay friendly". At another, she claimed that the city's failure to ban aspartame and require agave sweeteners in all coffee shops was evidence of residual racism from its history with the Confederacy.

Lisa refused to believe that she suffers a psychiatric condition, so she asked her priest for help. “You are so kind to cats,” the priest told her, “that the problem couldn't be sin.” When the apartment complex sent her a bill for removing 500 pounds (over 200 kilos) of used kitty litter a month after her eviction, Lisa became so angry she called them over 250 times threatening to kill them.

Lisa, it appears, suffers a condition called borderline personality disorder. Borderline personality disorder is notoriously difficult to treat, and extremely difficult for family members, neighbors, and the people willing to call someone who has a borderline personality disorder a friend.

What Is Borderline Personality Disorder?

Fortunately, most people who have borderline personality disorders do not suffer symptoms as severe as Lisa's. Borderline personality disorder is a condition of pervasive instability in interpersonal relationships. People who have this psychiatric condition have to deal with real or imagined fears of abandonment. They may, for instance, wonder if a friend who is five minutes late for a lunch appointment has decided to end the relationship. They may have lost their temper on the job so many times they are in real danger of becoming unemployed.

See Also: Borderline Personality Disorder (BPD): Emotional Dysregulation

People who have borderline personality disorder also tend to act on impulse. They may buy items on impulse, steal, gamble, make inappropriate sexual advances, and drive dangerously. They have a fragile sense of self, and may invent life stories that help them feel better, at least temporarily, about personal setbacks, or increase their attractiveness to others.

What Causes Borderline Personality Disorder?

Many people who develop borderline personality disorder were abandoned as infants or children. They may have suffered sexual or physical abuse. However, some people who have borderline personality disorder invent stories of abuse to justify their choices later in life. There seem to be some genes that increase the risk of developing the condition, but life experiences have to activate their expression.

A Therapy For People Who Have Borderline Personality Disorder

There is no medication specifically for borderline personality disorder. People who have this condition are usually sane, and do not, usually, require custodial care. People who have the condition often know something is wrong but do not know what. They may become so afraid of abandonment that they become suicidal, but if they have constant access to social interaction — often by taking care of other people who are also in desperate need — they usually manage to plod through life, staying housed, clothed, and fed, but never really successful.

In the late 1980's, psychologist Marsha M Linehan developed a method of counseling called dialectical behavior therapy as a kind of talk therapy for people who have borderline personality disorder. In this method, it is necessary for the patient to have enough insight to realize some kind of psychological help is necessary, but the therapist can help the patient develop the skills for coping with mood swings and impulses to avoid destroying work, family, and social relationships.

Dialectical behavior therapy is:

• Supportive. It helps people recognize their inner strengths, talents, and value, to accept themselves, making it easier to believe that others will accept them, too.
• Cognitive. It helps people think through the events that cause them distress and put them into distress. People who have borderline personality disorder often are upset about becoming upset. The therapist helps patients understand that extremes of emotion are simply part of their basic makeup, and that they can make choices that over the long run make their lives easier.
• Collaborative. Patients work out their problems in relationships with their therapists, and therapists do the same with them. Patients are also recommended to groups for discussion of their problems in relating to others.

Dialectical behavior therapy may be used with or without prescription medications. It is often recommended for people who have a tendency to self-harm, whether cutting, overeating, anorexia, extreme exercise, penitential punishments, suicidal ideas, or suicide attempts.

Therapists have also begun using dialectical behavior therapy as a treatment for binge eating. Binge eating is the consumptive of a large amount of food over a short period of time, impulsively, with a felling of being out of control. In treating binge eating, dialectical behavior therapy is a kind of guided self-help, with opportunities to meet in groups to understand motivations and methods for avoiding future binge eating episodes.

See Also: Individualized Anxiety-Management: Finding Out What Works For You

Is dialectical behavior therapy something that could help you? You don't necessarily have to have borderline personality disorder or a binge eating disorder to benefit from meeting with a therapist and joining a group. Dialectical behavior therapy, however, is oriented toward solving problems. It is not a technique for getting over childhood trauma, or for gaining insight into your personality.

If you were “crazy,” your therapist would not offer you dialectical behavior therapy. It is not a method of treating people who suffer a psychosis. However, if you are suffering from lifetime patterns that do not work for you, dialectical behavior therapy is the method you may be able to use to overcome them.