Dialectical Behavior Therapy: Patient and Therapist Relationship

The success of Dialectical Behavior Therapy in treating patients with Borderline Personality Disorder is dependent upon the quality of the relationship between the patient and his/her therapist. This differs from tradition therapy in that the emphasis here is on this being a real human relationship in which both members matter, and in which the needs of both patient and therapist have to be considered.

Marsha Linehan, who is responsible for the research and development of Dialectical Behavior Therapy, is particularly alert to the risks of burnout to therapists treating patients who have Borderline Personality Disorder, believes that therapist support and consultation is an integral and essential part of the treatment. The approach is a team approach.

The therapist is asked to accept a number of working assumptions about the patient that will then establish the required attitude for therapy:

1. The patient wants to change and, in spite of appearances, is trying his/her best at any particular time.
2. His/her behavior pattern is understandable given his/her background and present circumstances. His/her life may currently not be worth living (however, the therapist will never agree that suicide is the appropriate solution but always stays on the side of life. The solution is rather to try and make life more worth living).
3. In spite of this, he/she needs to try harder if things are ever to improve. He/she may not be entirely to blame for the way things are, but it is his/her personal responsibility to make them different.
4. Patients can not fail in DBT. If things are not improving, it is the treatment that is failing.

In particular, the therapist must avoid at all times viewing the patient, or talking about him/her, in negative terms, since such an attitude will be antagonistic to successful therapeutic intervention, and will be likely to feed into the problems that have led to the development of Borderline Personality Disorder in the first place.

The primary style in which the therapist relates to the patient in relationship and communication is referred to as “reciprocal communication,” which is a style involving warmth, responsiveness, and genuineness on the part of the therapist. Appropriate self-disclosure is encouraged on the part of the therapist, but always with the interests of the patient in mind.

The therapist should try to interact with the patient in a way that is:
1. Accepting of the patient as he/she is, but which encourages change.
2. Centered and firm, yet flexible when the circumstances require it.
3. Nurturing, yet benevolently demanding.
(The dialectical approach is here again apparent.)

The limits of behavior that are acceptable to the therapist are made clear to the patient from the start, and these are dealt with in a very direct way. It is openly acknowledged that an unconditional relationship between therapist and patient may not be humanly possible, yet it is in the patient's best interests to try to learn to treat his/her therapist in a way that encourages the therapist to want to continue helping her, and not in his/her best interests to burn the therapist out. This issue is confronted openly and directly in the beginning of therapy.

The therapist helps therapy to survive by consistently bringing it to the patient's attention when limits have been overstepped, and then teaching the patient the skills necessary to deal with the situation more acceptably and effectively.

Before a patient will be taken on for Dialectical Behavior Therapy, he/she will be required to agree to certain things:

1. To work in therapy for a specified period of time (Linehan initially contracts for one year) and, within reason, to attend all scheduled therapy sessions.
2. If suicidal or parasuicidal behaviors are present, he/she must agree to work on reducing these.
3. To work on any behaviors which interfere with the course of therapy.
4. To attend Skills Training.

The strength of these agreements may be variable, according to the patient. Nevertheless, a definite commitment at some level is required, since reminding the patient about his/her commitment, and re-establishing such commitment throughout the course of therapy, are important strategies in Dialectical Behavior Therapy.

The DBT therapist agrees to make every reasonable effort to help the patient, and to treat him/her with respect. The therapist does not agree, however, to stop the patient from harming herself. On the contrary, it should be make quite clear that the therapist is simply not able to prevent the patient from doing so. Dialectical Behavior Therapy is offered as a life-enhancement treatment, and not as a suicide prevention treatment, although it is hoped that it may, indeed, achieve the latter.

The better the patient-therapist relationship, the greater the chances for a successful turn-out from the Dialectical Behavior Therapy experience.

About the Author

David Oliver is the founder of BorderlineCentral.com a one stop source of information on how to cope and deal with borderline personality disorder.

FREE Borderline News,
Tips, Tricks and Secrets

Name:

E-mail:

Other:

This Week's Borderline Personality Disorder News

The Cutting Truth of Borderline Personality Disorder
FYI Living
Cutting and other forms of self-mutilation may be hard for many people to understand. People who self-harm are more likely to have an underlying emotional problems, such as Borderline Personality Disorder (BPD). According to a study by German researchers, people with BPD may engage in self-injury because they get a sense of emotional relief from physical pain. BPD is a complex set of... Read More

Click here for all Borderline News.

BorderlineCentral
Your One Stop Source For Information On
Borderline Personality Disorder