The Challenges of doing DBT

Marsha Linehan, PhD first started offering DBT when the approach at the time, CBT, wasn't working. The focus on change was too much for people who had yet to be validated or soothed. It was the "toughest" people that Dr. Linehan served - the people for whom other therapies had failed.

The most common diagnosis for people seeking DBT is borderline personality disorder. This doesn't mean that everyone who benefits from DBT has this disorder. There are common personality traits of those who benefit - they tend to react emotionally very quickly, very intensely and have a difficult time coming out of their reaction. They tend to experience interactions with others with a higher sensitivity and assumption of being hurt, dismissed, or ignored. They tend to ruminate and obsesses over thoughts about these interactions and create myths about how they were treated. It's often difficult for others to soothe them even when that's the very thing they want. Avoidance of pain from feeling unheard is usually what prompts people into ineffective behaviors.

For all these reasons, the success of DBT relies on consistency of behavioral changes and acceptance of people as they are. There is a line of continuously validating and holding to commitments. 

For those coming to DBT, these can be the challenges:

* Attending skills group weekly and on-time
* Doing the homework according to curriculum
* Not sharing personal stories or experiences in group but rather saving them for individual sessions
* Paying for sessions
* Being in a group with others who are also struggling
* Confronting habits and patterns that are no longer serving them
* Using the skills to change

As a therapist these can be the challenges:

* Asking for commitment from clients who are fearful
* Holding clients to their commitments, including finances and homework
* Asking for support from DBT trained colleagues
* Maintaining awareness when moving away from the curriculum
* Sticking to the curriculum even when clients want something else
* Seeing people in suffering and not being able to help

Overall, I want to help people change a life of suffering to a life of change and feeling fulfilled. That requires acceptance and change on my part as much as the client's part. Many therapists do not want to work with clients with personality disorders because of these challenges. It can leave the therapist feeling like they failed. This gives me insight to how the patients feel everyday and reminds me that my feeling of failure is more reason to keep helping, doing the best I can just as the client is doing.


Nina Perales