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Specialized Treatment for Borderline Personality Disorder: What is Dialectical Behavior Therapy?

Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression ...Read More

One of the therapies for Borderline Personality Disorders that have been researched in clinical trials is Dialectical Behavior Therapy (DBT), developed by the Psychologist Marsha Linehan. The goal in developing DBT was to specifically help people who injured themselves, mutilated themselves, felt chronically suicidal, or made frequent suicide attempts.

The theory behind DBT says that some people are very vulnerable to intense emotions. This may be because of temperament, biology, a history of trauma, or some other reason. DBT assumes that self-injurious and self-destructive behaviors or impulses are ways of coping with these intense feelings.  The person does not have other skills readily available. There’s a saying in DBT that people are “doing the best they can with the skills they have”. The idea is to learn new skills for dealing with intense feelings and to build a life worth living.

So, where is the dialectic? Very simplified, the term dialectic refers to contradictory ideas and resolving the conflict between them. DBT is based on Cognitive Behavior Therapy and is therefore a treatment that focuses on changing behaviors and learning new skills. However, Marsha Linehan realized that clients found a constant focus on change to be frustrating and invalidating of their struggles. She introduced the idea of acceptance – trying to acknowledge and validate where a person is at and how they feel, and looking at how some of these harmful behaviors and intense feelings make sense. So, working on changing behaviors while accepting where one is at constitutes a dialectic, a balance between seeming contradictions.

Over the past several years, DBT has been adapted and modified for different treatment settings, such as inpatient, residential or outpatient facilities, and for different populations, for instance for people who deal with substance abuse and eating disorders. In standard DBT, a person will see an individual DBT therapist once a week and attend a skills training group once a week. The individual therapist coordinates between different treatment providers a person is consulting, and is also available for skills coaching on the phone.

DBT skills are organized into four modules. The Mindfulness Skills have to do with awareness and are similar to Eastern and Western meditation practices. They are the core skills used for all the other modules. Interpersonal Effectiveness Skills have to do with effectively asking for things, saying no to requests, or voicing an opinion and standing up for oneself. Emotion Regulation Skills deal with ways of understanding and coping with emotions, and Distress Tolerance Skills have to do with effectively getting through crisis situations and accepting reality.

For more information on DBT, go to or have a look at Marsha Linehan’s books Skills Training Manual for Treating Borderline Personality Disorders (New York: Gilford Press, 1993) and Cognitive Behavioral Therapy for Borderline Personality Disorder (New York: Guilford Press, 1993).



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