Linehan's Dialectical-Behavioral Therapy

Borderline personality disorder constitutes a general pattern of instability in emotions, interpersonal relationships, and identity, as well as a notable impulsiveness that begins in early adulthood and occurs in various contexts (APA, 2000: 760). Between 1% and 2% of the general population suffers from this disorder. Self-injurious behaviors and suicide attempts are frequent and suicide rates reach 9%.

In this PsychologyOnline article, we will discuss Linehan's Dialectical-Behavioral Therapy.

Despite the seriousness of this disorder, the development and testing of effective intervention strategies for it is still scarce; therapeutic achievements are slow and dropouts and relapses occur very frequently. One of the treatment programs that has received the most empirical support is the Dialectical-Behavioral Therapy developed by Dr. Marsha Linehan and her research group at the University of Washington in the United States (Linehan, 1993).

This intervention constitutes a treatment program that is part of cognitive-behavioral therapy, whose main objective is for the patient to learn to regulate the extreme emotionality, reducing mood-dependent maladaptive behaviors and learning to trust and validate their own experiences, emotions, thoughts and behaviors.

We would like to highlight the aspects that constitute important innovations of this therapy. First, unlike other cognitive-behavioral programs, therapy dialectical-behavioral is an intervention based on therapeutic principles and not an intervention based on a treatment manual. This program is based on a hierarchy of therapeutic goals that are addressed according to their importance. The hierarchy established in individual therapy is as follows:

1. Suicidal and parasuicidal behaviors.
2. Behaviors that interfere with the course of therapy.
3. Behaviors that affect the quality of life.
4. Increase behavioral skills.

This structure allows a flexible approach depending on the needs of each patient.

Another important contribution refers to the change in the focus of the intervention. Traditional cognitive-behavioral therapy focuses on achieving the resolution of emotional problems through behavioral and cognitive change. Linehan puts the emphasis on acceptance and validation, to achieve change from there.

Another relevant aspect to highlight of dialectical-behavioral therapy is that it establishes that the intervention is carried out by a team of therapists, not by isolated therapists. Therapists receive feedback and supervision from the other therapists in the follow-up of each case.

The treatment program is structured in a pre-treatment phase and in three treatment phases. Pretreatment is aimed at guiding the patient towards therapy, that is, establishing the therapeutic relationship, goals and commitments. This phase is essential because it determines the limits of the therapy, flexible but constant limits that will guide the therapy. One of the most beneficial effects of these pretreatment strategies and that makes dialectical-behavioral therapy a very attractive intervention is that it promotes adherence to treatment.

• The first phase The treatment lasts for one year and there the main goals of the treatment are carried out using individual therapy, group therapy and telephone consultations: reduce suicidal behaviors, behaviors that interfere with both therapy and quality of life in general, and increase awareness skills, emotional regulation, tolerance to discomfort and social skills. One individual session and one group session per week are established and telephone consultations are used between sessions primarily to help the patient generalize the skills and strategies learned in therapy to life everyday.
• The second phase of the treatment is dedicated to the treatment of post-traumatic stress that is usually frequent in these patients. This second moment of treatment does not have a specific duration.
• Finally, in the third phase, which does not have a specific duration either, an important objective is for the patient to build respect for himself and to learn to validate his own experiences. In addition, another therapeutic goal is for the patient to begin to set and pursue realistic life goals in different areas such as work, family, etc.

In short, dialectical behavioral therapy constitutes a treatment program that, while maintaining a cognitive-behavioral therapy perspective, has incorporated new technical and relative elements the therapeutic approach and process to effectively address specific aspects of borderline disorder personality such as inflexible and dysfunctional patterns of functioning in the emotional and behavioral.

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.