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Dialectical Behavior Therapy: Treatment Strategies

In Dialectical Behavior Therapy, there are several treatment strategies taken with patients who have Borderline Personality Disorder. One particular approach that is taken when dealing with the network of people with whom the patient with Borderline Personality Disorder is involved, both personally and professionally, is referred to as “case management strategies.”

The basic idea in “case management strategies” is that the patient should be encouraged, with the appropriate help and support, to deal with his/her own problems in the environment in which they occur. Therefore, as much as possible, the therapist does not do things for the patient; but, instead, encourages the patient to do things for herself.

The core strategies in Dialectical Behavior Therapy are “validation” and “problem solving.” Attempts to encourage change in the patient with Borderline Personality Disorder are surrounded by interventions, which validate the patient's responses and behavior as understandable in relation to his/her current life situation, and that also show an understanding of his/her suffering and difficulties.

“Problem solving” focuses on the establishment of necessary skills for the patient of Dialectical Behavior Therapy. If the patient is not dealing with his/her problems effectively, then it is assumed that either he/she does not have the necessary skills to do so, or that he/she does have the skills, but may be prevented from using them. If he/she does not have the skills, then he/she will need to learn them. This is the purpose of the skills training part of Dialectical Behavior Therapy.

Having the skills, he/she could be prevented from using them in specific situations either because of emotional or cognitive (thought) problems, or of environmental factors, getting in the way. To deal with these difficulties, the following techniques may be applied in the course of Dialectical Behavior Therapy, and used in a relatively informal way: Contingency Management; Cognitive Therapy; Exposure-Based Therapies; and Pharmacotherapy (medication).

In the session-by-session course of therapy, care is taken to systematically reinforce targeted adaptive (positive) behaviors, and to avoid reinforcing targeted maladaptive (negative) behaviors. This process is made obvious to the patient, explaining to them that behavior which is reinforced can be expected to increase.

The contingency management approach is taken in dealing with behaviors that overstep the therapist's personal limits, in which case they are referred to as “observing limits procedures.”

Change strategies and problem solving are again balanced by the use of “validation strategies.” At every stage, it is important to convey to the patient that his/her behavior, including thoughts, feelings and actions, are understandable, although they may be negative or unhelpful. This is especially significant regarding parasuicidal behavior.

Frequently, patients with Borderline Personality Disorder will attempt to avoid behavioral analysis, since they may resent the therapist’s looking at their behavior in such detail. However, behavioral analysis can be seen as part of the contingency management strategy. This process can also be seen as an “exposure technique” which helps to desensitize the patient to his/her painful feelings and behavior. Then, having completed the behavioral analysis, the patient can be rewarded with a “heart-to-heart” conversation about the things he/she likes to discuss.

Behavioral analysis may be seen as a way of responding to maladaptive (negative) behavior – in particular, to parasuicide – in a way that shows interest and concern, but that avoids reinforcing the behavior. Although there are several different treatment strategies involved in Dialectical Behavior Therapy, they combine to give the patient with Borderline Personality Disorder the best therapeutic approach possible to gain the most success.

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.

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