Tuesday, November 2, 2010

Does DBT Work?

In the previous post, the question came up of whether DBT works.  I have not undergone this therapy, so I invite responses from anyone who has.  

In the meantime, here is a bit of unexpected skepticism towards DBT from an article in a British journal on psychiatric treatment:


Dialectical behaviour therapy (DBT; Linehan, 1993) is based on the principle that BPD is essentially the result of deficits in interpersonal and self-regulatory skills and that these skills can be taught in therapy.  Defective affect regulation is seen as particularly important.  Treatment consists of weekly individual and group therapy sessions based on a skills-training model, together with out-of-hours telephone contact with the therapist.


Dialectical behaviour therapy has been shown, in a single study, to be superior to 'treatment as usual' in reducing self-harm and time spent in hospital, but not subjective experiences such as depression and hopelessness (Linehan et al, 1991).  There were also significant improvements in social and global functioning and anger (Linehan et al, 1994).  However by one year after the end of treatment, rates of self-harm were no different in the DBT group and treatment-as-usual groups, although both had improved (Linehan et al, 1993).

Despite this essentially negative finding, DBT has attracted considerable interest; however, Linehan's study is open to a number of methodological criticisms.  Only 39 patients were studied, all of them female, and of these only 20 were fully assessed.  The level of self-harm required for entry into the study (two episodes in the last five years and one in the last eight weeks) may have led to the inclusion of patients who were less severely disturbed than those commonly seen in clinical practice.  Furthermore, DBT involves a high level of input from professionals and it is not yet clear whether it is the skills training itself or simply the high level of support which leads to the reduction in self-harm.

-Anthony P. Winston, "Recent Developments in Borderline Personality Disorder" (2000)


This assessment of DBT surprised me.  I had never heard negative remarks about this therapeutic approach before.  Reading Linehan's dense tome on CBT for borderlines helped me a lot in reconfiguring my attitudes.  The idea of radical acceptance was at first a big frustrating puzzle to me - another opaque window - but gradually it settled inside me as something useful that I can draw on, especially regarding family relationships.  

Anybody else have thoughts on DBT, CBT, Linehan, or this methodological critique from Winston?

33 comments:

  1. I am not against DBT--I would refer the right patients to it all the time. But the DBT community is very tight and doesn't much like a closer examination of some of the shortcomings of the program, or some reasons why they have more success.

    This is what I wrote in my book The Essential Family Guide to Borderline Personality Disorder (EFG):
    .......................

    LIMITATIONS OF DBT

    DBT offers great hope and a way to counter the oft-¬repeated (and demonstrably false) maxim that there is no treatment for BPD. Many patients say DBT has improved their lives tremendously. However, DBT is not a miracle cure. As you evaluate treatment alternatives, keep these limitations in mind:

    • DBT has been shown to lessen suicidal thoughts and reduce instances of self-¬harm. Studies have not shown that it relieves depression or makes clients happier (although many individuals say it does).

    • DBT is appropriate only for patients who acknowledge their illness, want to learn about it, and will work hard in therapy. Higher-¬functioning invisible BPs do not meet this criteria.

    • DBT is demanding. Each day, patients fill out diary forms, and most patients spend many hours each week in therapeutic activities. To benefit from the therapy, patients must be highly motivated.

    • DBT is not available in all locations. Also, it can be costly (we’ll take a closer look at insurance in the next chapter).
    ..............................................

    Now, add to that the difference between DBT and "treatment as usual" the following facts:

    * It's been proven again and again that the expectations of the teacher influence the outcome of the teaching. For example, grade school teachers who think they are teaching "gifted" students--even though they are average--expect more and their students excel. Not only are DBT therapists much better trained, but they expect more from clients.

    * Treatment as usual takes place once a week. DBT programs require participation two times a week plus homework--again for the HIGHLY MOTIVATED PATIENT.

    * In group skills training, patients get emotional group support (although that's not the purpose). Support groups provide validation and show patients that they are not their disorder. I know how much my online groups help family members; this is an important fact we should not overlook.

    In sum, while we know DBT is effective in some respects, I don't think we really know WHY.

    I think it's a good bet that if I took highly motivated family members, had them see a therapist once a week, and had them attend a support group once a week where they learn skills from EFG they would do very well. No research dollars need be spent.

    In fact, I think the family members would be less depressed and better able to cope with just a support meeting once a week where they all go out to dinner or do something fun together.

    To end this post, I am NOT anti-DBT. Whatever its merits, it has helped revolutionize the way we see treatment of BPD.

    I just think that if we know just what makes the program effective, we can use this in places where DBT does not exist, is not affordable, or the patients are not qualified.

    Randi Kreger
    www.BPDCentral.com

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    1. Hi Randi,

      Could you please elaborate on your qualifications, other than being a journalist? I can find no mention of any sort of therapeutic qualifications you have. I understand that you co-authored (with a clinician) a very popular book, but is it your assertion that you are a qualified expert in BPD?

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  2. I have done the first two modules of DBT because unfortunately Australia's Medicare system compensates half for only twelve DBT sessions. BPD is only a very 'new' mental illness in Australia. Anyway, I have to completely agree with Winston's second paragraph. DBT was very helpful for me when I was doing it and for some time afterwards. Four months on and I find myself more and more grappling with my almost insatiable compulsion to self-harm because fading from my mind, which they teach in DBT, are the reasons why I shouldn't do it. I'm not harming anyone else, and it helps me in the short-term so why shouldn't I?

    My 'rages' have decreased because now I am more introspective of why I want to lash out. However, I am still as irritable, angry and anxious. I am learning to self-soothe as I know now (after the DBT) that I need to do this, although it is difficult whilst working, studying and self-therapising (not a word but I like it). I need to keep myself as busy as possible though.

    DBT has taught me to be more introspective, to look into myself and realise why I do what I do, and in turn this acts as some form of cognitive therapy for me. However, DBT never really did help with the depression or the emptiness I often feel. There were external factors existing in my life at the time which could have impacted on this though. The therapist I adored left just as I started DBT and I was given someone I just couldn't connect with, and who focussed more on my eating disorder than my unhappiness. Apparently we were only allowed to talk about issues embedded in DBT, not my own personal issues. That is something I really didn't like about it.

    And one other thing before I finish, I think for the most part, DBT helped because I met others who experienced similar feelings and emotions to myself. I was actually quite depressed at the end when I was not allowed to stay in touch with any of the people I'd met.

    Thanks for reading,
    Joanna

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  4. Hey Lisa!

    While there may be some detractors, DBT is highly-effective in treating individuals with borderline personality disorder and those with traits of BPD such a self-injury.

    DBT has now been around for almost 20 years. Dozens of peer-reviewed studies have consistently revealed that DBT works for a lot of people and over a long period of time. Heck, DBT has now been successfully adapted to treat eating disorders and substance abuse.

    Does it mean that it's a perfect therapy? Nope. Does it mean that it's the "best" therapy for everyone with BPD? Not a chance. Does it mean that it's going to always work in helping someone create a "life worth living"? No one is promising that.

    But it is really effective and countless lives have been saved because of those sometimes-annoying diary cards.

    DBT naysayers are few and far between.

    Amanda

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  5. I don't have BPD, but just learning about DBT has helped me immensely in dealing with the people in my life who do. Its emphasis on affirmation, self-acceptance, paradox, and humor can be appealing and helpful to everyone. I agree with Ms. Kreger that its best application as treatment is for highly motivated patients.

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  6. DBT was very successful for myself.I'd give it 10 out of 10.

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  7. dbt and related workbooks as well as videos and other texts have been helpful to me. i still struggle, but also appreciate LMJ's points about alcohol intake control. i do not struggle with self-harm and suicide ideation so i am not sure about dbt in that regard, but the paradoxical concept of radical acceptance is helpful to me as is the notion of opposite action.

    i too have found (ok, do not sneer!) some elements of 12-step programs to be helpful esp. after a former professor who is trained as a psychiatrist invited me to an aa meeting. i am trying to be a bit more spiritually inclined even via yoga and/or meditation. lastly, i really like the about.com bpd therapist and she had a post about listening to music to alter your mood. i am a fan of drowning my own sorrows, etc. but also turn to lighter fare--comedy or upbeat music, film, art to help me gain perspective. also, walks with my dogs do wonders! bits and pieces and learning from others helps a great deal. also, not feeling so isolated in my craziness assists in making the madness more (self) manageable.

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  8. ps--could you recommend other books you find/found helpful? I like the Linehan workbook as well as a DBT workbook, which is cheaper--Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance (McKay et al. 2007). A 1997 book by Santoro entitled: The Angry Heart: Overcoming Borderline and Addictive Disorders : An Interactive Self-Help Guide also received positive reviews by those dealing with living w/ bpd and related traits, etc. Thanks!

    Have you tried to read the bigger book by LInehan for clinicians? I checked a book out from the library by Bateman and Fonagy: Mentalization-based treatment for bpd. I like this approach but would like an affordable therapist utilizing this technique. They also wrote another book, which I have not read, but this one by Bateman and Fonagy helps me see I have trouble mentalizing. With that being said, the concept of mindfulness that I have learned more about through LInehan and Kiera Van Gelder in relation to bpd AND the concept of mentalization seem fruitful. Mindfulness helps me work towards acceptance, tolerance, and validation of myself and others in terms of emotions whereas mentalization assists me understanding relational aspects of my thoughts, beliefs and actions involving others experiences, my experiences and my experiences of those other people and their experiences. hmmm, now if only that made any sense. hope to read further and thank you for any recs.

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  9. pss--i requested that the book, Girl in need of a tourniquet : memoir of a borderline personality, become a part of the NY public library collection and now it is available! Yay. I am so excited bc it makes the book so much more accessible to read in the library or take home for many folks. I purchased my own copy but I am psyched that it is now in the public library. I wish there were books like these (Buddha and the Borderline, Girl in need of a tourniquet) when I was younger and would look through the library and local bookstores. What is extra great imho is that although it may be cataloged in various ways these books are shelved with the other texts on bpd/mental health issues. I love how there is more diversity now and various perspectives represented. I also am happy to see the new book by Valerie Porr, in NYC, who really helped me out a great deal. I found out I am younger than her daughter but she is truly compassionate and knowledgable plus helpful to families and people living with bpd alike.

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  10. i was fortunate to be able to begin the process of dbt...it is working for me but perhaps i am older now and i am tired of the madness.

    i find dbt awesome and from one borderline to another, i highly recommend it.

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  11. Let me first say that I love your blog and will read your book too. I've thought about writing and seeing where it takes me.

    Now for DBT. I have symptoms of BPD, bipolar, ADD, and a diagnosis of temporal lobe epilepsy so life is interesting to say the least.

    DBT right now is being somewhat forced on me. I thought my therapist just wanted me to read this book on DBT for bipolar and then discuss it like he said. However, it is clear to me that we are doing more than that.

    My session last night was quite invalidating. I told him some difficult things about myself and what I head back was I live in the past and worry about the future and basically everyone has trauma, challenges, problems etc. The indirect message seemed to be suck it up.

    I've been with him a long time and he's helped me by the way we have been doing therapy. But, apparently, he doesn't think so.

    Now, I'm in hell and am coming apart at the seams. I do not see how this type of therapy helps me especially if it continues to be so invalidating. I get enough of that every day from certain people in my life.

    This type of therapy seems to protect therapists from burnout (Marsha's words not mine) so since that is a component, the rest is suspect as far as I'm concerned.

    I'm done with it, he will be told this and if that is not acceptable, we're done.

    Having said all this I am glad it works for some people and applaud them for their success.

    Therapy is an individualized process or it should be.

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  12. I have a behaviorist friend with BPD that absolutely swears by DBT. I don't know much about it, but as long as it helps more people than it hurts, it's a good option for people to at least try. I don't believe that any treatment is a "one size fits all" type of deal, so if it fits for the person in need of therapy, then it fits. If not, then don't force it and try something else.

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  13. Hi,
    I have borderline and I have, not so long ago, completed the DBT-program in Belgium for 7 months. I really must say it worked splendid for me!
    I have learned to accept myself for who I am and I even dare to say I love myself a litle bit. I used to have an appointement with my psychologist every week but now she has convinced me to come every other week, that's how good it is with me now.
    I am not that pathetic, scared girl no more who used to harm herself in every possible way (physically and mentally), who hated every single thing about herself, who didn't dare to say her opinion out loud when it was different from others, who always excused herself for everything, in fact including for living, who was even afraid to take care of her own sweet baby daughter. For heavens sake, I even was afraid to cook because I tought I couldn't do anything. I am now strong and self confident and the opposite from all the other things I descriped above. I dare to be myself, even if it means I am slightly different from other "normal" people, who give me the eye, before DBT i would have been ashamed of myself and would have looked down to my toes and would have avoided every eyecontact but now I hold my head up straight and look right back. In fact because of DBT and how well I am now I even dared to make my dream come true and now I am a member of a theater company and I act in plays on stage wich is my passion for many years. I am proud of myself now, because of all the things I am now and that's all thanks to DBT, it changed me but it changed my life too in every good way!
    Greetings,
    Noukie

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    1. Where in Belgium did you find a DBT program?

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  14. I will be starting DBT this week, after months of searching and defunct programs. I really want to change my life, not have the negative thoughts, to be able to accept love, to love myself, but I am frightened it won't work. Does it help at all with depression and substance abuse? I love my new therapist but I am so stuborn and mysery is my comfort zome. Will it really work for me?

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  15. Does it really matter if DBT is clinically found to be "effective" or not?
    Consider this: If it IS in fact "all in your head," and you believe suicide to be the only means of alleviation; then, upon completing DBT, you believe it has helped you and no longer consider suicide or self-harm THE means of coping...

    Is that not really the only thing matters?

    You have to practice and use the skills. DBT just introduces you to them.

    Many may feel as though they do not have a choice. And certainly I will agree you cannot choose how you FEEL.

    However, you can choose how you THINK and what you DO with those thoughts.

    -From the person standing next to you in the hospital, sitting beside you in the bathroom, or wherever you may be when you need an ear to listen or a hand to hold.

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  16. I have A friend with BPD, and a friend that had a friend that has it also. And we both agree that DBT doesn't work at all. And She lost her friendship, after 20 years. And now she is vary mad at the hole stupid DBT thing like am I! Now my best friend is happy for it. The only thing, why she think that it working for her is because, They what her too. To get more of her Money. And plus now she is in rehab, just because it works so well! Me and my other friend, really wish that all the DBT Clinics would shut down!

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  17. I'm a 26 year old male with BPD and I came across this post searching for criticism of DBT. I've never been in a proper DBT group but I have been in a CBT outpatient "day camp" of sorts for BPD at McLean hospital (the legendary McLean!). I found CBT frustrating philosophically. I never bought the central theory of mind as a neat little triangle of thoughts, feelings and behaviors, and I felt like I was being brainwashed. I recognize of course that feeling as if people are trying to brainwash you is a symptom of BPD, but damn it, the whole thing creeped me out. I got the sense, which I wouldn't be able to articulate for another few years, that the viewpoint of these therapeutic approaches ignores the personhood of the patient and looks at him or her simply as a brain that needs to be "re-wired". It all seems like subtle, sophisticated Pavlovian conditioning-- a little too dystopian for my tastes.

    Back in the late 60's, in his book "The Divided Self", R.D. Laing warned that psychiatry's ignorance of the view of the human being as person in favor of the view of the human being as biological mechanism could never truly heal patients, because it completely ignores one side of what it means to be human. Laing's own failure was perhaps to champion the personal side of things over the biological, swinging the pendulum back too far the other way.

    But his criticism still stands, and it is still ignored by psychiatry, which, despite its being immensely more compassionate now than it was in Laing's day, still treats people, psychologically, like very smart dogs who need to be taught new tricks. Questions of meaning in the events of our lives, of the significance of suffering, are simply not discussed. You are just told to re-frame your thoughts and conform your expectations to what is probable instead of what you fear. The implication is that life has no meaning, it's just a matter of how you see it. Well I don't know about anyone else, but I find that idea immensely disturbing, and, more importantly, immensely invalidating.

    Who cares what the underlying philosophy is as long as it helps people? You'll hear this a lot. It does help people, no doubt, and much more effectively than psychodynamic approaches, but God knows it didn't work for me. It made me a lot worse, actually.

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    1. Hi Alvin, I think that one adaptation of DBT from traditional CBT is the fact it DBT is supposed to be validating therapy, it teaches that your emotions are valid but you don't have to act on them. Where as CBT can be more, your thinking is disordered, lets try and replace this disordered thought with a rational thought. That is how I understand it anyway.

      I suspect my boyfriend has BPD, and I'm trying to work out how he can be best be helped. My research is saying mentalizing (which doesn't seem to be very available in the uk) or dbt are what should be done initialing, and one suggestion is after DBT a person may benefit more from counselling or psychotherapy which looks at their past or deep rooted issues. This makes sense to me, when my boyfriend had counselling earlier in the year, it actually seemed to make him worse - he'd always explode the day he had counselling - it seemed like he found it too painful to delve into his issues. However perhaps if he learnt some coping skills first, and managed to not get completely consumed by his emotions then he may finally be able to deal with past trauma.

      I almost things borderline traits can be contagious, I've been through hell and back in this relationship and got counselling myself for post-traumatic stress after a particularly bad incident before he started medication... unfortunately the nhs only offered 6 sessions. It did help, but a few months later I feel back to square one. I now often feel overwhelmed by emotion and just 'snap', acting before I think. When my boyfriend lashes out at me verbally, instead of refusing to engage sometimes I lash out back. I feel really annoyed with myself and a few months ago when he randomly broke up with me in the middle of the night when I had a migraine I felt like I was overwhelmed with pain and scratched my arm till it bled as I just wanted to feel something else. I haven't self harmed before or engaged in otherwise self destructive behaviours. I am also looking at DBT principles to apply to myself to stop snapping.

      I concur with the philosophy that DBT is also helpful in the way that it helps therapists manage sufferers better. I know people can get frustrated easily with my boyfriend as sometimes his thoughts are completely paranoid, he won't listen to to reason and anyone who disagrees with him is a complete idiot in his mind and he will tell them so. He lashes out at anyone who tries to help him and so yes therapy should aim at helping the person with BPD but it shouldn't damage a therapist in the process (or the people at home from a reaction to the therapy), and I don't think trying to protect other people as long as the therapy still helps is a bad thing.

      One of the most scary things about dealing with my boyfriend is when he has his worst 'turns' he has no memory of them after, is this usual with borderline personalities?

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    2. Anonymous. . . as a borderline sufferer myself I can tell you that it is not usual for people to forget their behaviours like this. Obviously we are all individuals and bpd is often co-morbid with other psychological difficulties so this may be a factor.
      I worry very much about my own partner and the effect that my illness has on him, and reading what you have written here makes me worry about you too.
      I imagine I speak for many of us when I say that I would never want to hurt my partner or damage them psychologically, but my behaviour seems so far out of my own control sometimes that I fear I may do.
      I have had years of therapy and only recently been referred to DBT. One thing I can promise you; yes, we need support, but no one can fix us but ourselves, with the aid of highly trained psychological professionals.
      Please remember you are his girlfriend and not his psychiatrist. I have a wonderful partner myself, he is calm and non-judgemental and he helps me no end, but I'd hate for that to be at the cost of his own health and happiness.
      It shouldn't be at the cost of yours. Find yourself some appropriate help and support and don't drain yourself dry. Its great that you're so supportive, you're obviously a wonderful and caring person, just be careful not to drown yourself trying to save someone else.

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  18. I did DBT therapy for a year and a half. It does not work. Alot of DBT is common sense and people do skills and they don't even realize it. After a year and a half I thought it was a bunch of nonsense. I cannot figure out who decided that it was a valid therapy. All it was it common sense that anybody can figure out themselves. It is just a set of skills to get you through situations. In my experience it didn't work for my situation. My situation is very difficult and DBT did not help me through it. DBT is not meant to save you from your circumstances. It is meant to get you to cope with your circumstances. Useless if you ask me.

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    1. I was considering undergoing dbt, it is expensive. So instead I got a book on it and you read my mind. Most of it is stuff that I already do. And its not about reducing bpd, but about coping with it. So basically you will still feel like shit sometimes but everyone around you wont see it bc ur "coping" better. It seems the goal of this therapy is simply to make you less of a nuisance to others.

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  19. I did DBT. I have to say it did not work, it just made things worse. It perpetuates a lot of self hate and involves shaming and gas lighting their clients. I felt better after I broke free from Dialectical Behavioral Therapy. I joined because I wanted to be better. I want to be among other people like a normal person again. I was told that because I had Borderline, I make irrational choices, that I manipulate people, that I see things in "black and white" I did not know I was doing all of these things!!! I felt so horrible, so I acknowledge my flaws, sympathized the people who dealt with my personality disorder, took all my medication as instructed and went to DBT.

    I was considered their "best" student towards the end but honestly I felt the most horrible than I ever had all of my life. There was so much self hate. I couldn't say anything that didn't totally oblige to the ideals of DBT and I couldn't question it because if I did, I would be immediately treated like I was insane. I got yelled at once by one of the people who worked there when I requested someone to talk about what I was going through. It was a one on one meeting. She kept interupting me and kept repeating the same things that were said in DBT. I told her even though I have been praticing DBT non stop I just... really needed someone to listen and broke down crying. She got angry and started yelling. I did not like that, I told her that it was innapropriate to yell and she just smiled at me and told me that I was looking in "black and white."

    It kept going like that. Whenever I tried to be optimistic they said I was thinking unrealistically, when I tried to be realistic by also acknowledging the negative aspects as well they said I was thinking too pessimisticly and when I made sure to make a well rounded balance approach to both the positive and negative, I was told again I was thinking too "black and white." I was scared to use words like bad or good or any other words that can be percieved to have the same meaning because I was scared they were going to say I was thinking "black and white" again then dismissing me immediately. I was scared to provide any feedback because one time I did, I was diagnosed with paranoia. I tried so hard to accept how irrational and flawed my thinking was but it eventually just made me felt like... a vegetable. And that was what I was by the end. That was when I was considered their best student. I was a vegetable, I didn't say anything, I followed what they told, spoke only when spoken to and I didn't react to anything. I didn't show happiness, sadness, anger or any other emotions anymore. I didn't speak my mind anymore. I was just.. there and that's when I was finally seen as progressing.

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  20. I know that this forum is about DBT but I would like to share with you my experience of another therapy that has worked better for me. I know this will not be everyone’s experience but I think BPD sufferers should know that if DBT is not working for you then there ARE other options available.
    DBT, similarly, did not work for me. Like you, I was a “good student”. I did my homework, filled out the worksheets and the diary cards, showed up for class on time, raised my hand, and answered the questions correctly. I quickly came to understand the logical and methodical (almost algorithmic) thinking that my DBT therapist expected in our individual sessions and I was able to give him the answers that he expected. He became cold and irreverent when I tried to turn to him for support during difficult times. Shame and self-hatred were perfectly acceptable means of maintaining behavioral control. By the end of treatment I was able to keep my head down, do what I was told, hold down a job, and not bother others.
    However, on the inside I remained miserable, angry, and lonely and I needed to try something else. I am now trying Transference Focused Psychotherapy, a psychoanalytic type of therapy designed specifically for BPD and NPD(Narcissistic Personality Disorder), in which the transference (the emotional attachment that the patient develops in relation to the therapist) is used as a catalyst for change. It’s not traditional psychoanalysis as it is only 2x/week and we sit face to face and talk. This therapy is also quite different from DBT as it hasn’t proved to be a steady progression of symptom improvement. In fact, I plummeted a bit initially because of the onslaught of emotions that the transference evoked in me. I never realized to what lengths I had gone to avoid feeling…anything at all! While some of the focus is about my life when we talk it always comes back to what is going on between myself and the therapist in the moment. He helps me recognize the anxiety, shame and even anger that I experience in relation to him in the room, however, I am not asked to change my negative feelings or use skills to chase them away, instead, he tolerates my frustration as I grapple with the contrast between strong negative feelings and the safe and supportive environment created in the session. This is a very emotionally demanding therapy that is often unsettling and never easy, however, I feel positive changes within myself on a deeper level as I learn to tolerate both my positive and negative experiences as a whole and relate better to myself and others.
    I am sure that TFP is not for everyone and, for that matter, it is not widely available I just happen to live in a very metropolitan area where it IS available. I’m also sure that DBT works for many as many of the people in my DBT group benefitted greatly from it. I do not like that DBT is advertised as a miracle “cure all” for people with BPD…I was made to feel as though I were lacking in moral fiber when I did not feel I was improving. If you suffer from BPD and DBT is not working for you I think it’s important to know that there ARE other treatments available such as schema-focused therapy, Mentalization Based Therapy(both of which I know little about, but perhaps it’s worth looking into), and TFP. We can’t give up hope!

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  21. Hi,
    when i suffered any problem. my mind got lots of negative thing. but i am wandering to read this blog because it help to recover me this blog. thanks for post this article. dbt therapists



    thanks

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  22. I am doing DBT right now, as part of an out patient treatmetn for my depression. I can't really tell you if it works or not, I have only done it for two weeks, but the group has been helpful for me to share the things I have kepted in. The DBT part of the group seems kind of silly to me, as I am so depressed, that I have trouble doing even little things.
    I am concerned about those of you who said you were yelled at or shamed, this is not my experience at all. It is done in an accepting and loving enviorment. I am greatful for the group, but I don't think DBT is for me. I have also done CBT, and I didn't like that.
    I don't have much knowledge of DBT but it has helped many in our group, and I am willing to give it some more time, as I need help. If it doesn't work, I will try something else.
    If any time in any therapy you feel you are being shamed or unsafe, I would say get out and find someone else. My understanding is that DBT is short term relief, it is not for long term, it is ways to find coping skills for the moment you are in distress, and ways of trying to deal with it. Some of it seems so simple. I have tried many other therapies that didn't work.
    I say if you are hurting try it, you don't have much to lose, if it doesn't work or doesn;t jive for you, try something else.
    I know how hard it is. I want to feel better, and make progress. I have not found the right tools for that yet, but if I give up, I will never know if there is something out there that can help.
    I am glad for all those it works for. I have to wiat to see

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  23. I'm a 46 year old male who was diagnosed when I was 19. I've had CBT and psychotherapy from two therapists up until 2011. In 2011, I moved to a new area and took DBT for 10 months before I was removed for drug use (the DBT therapists deemed it excessive). That was a year ago and I'm amazed I'm still alive. The invalidation of being kicked out of therapy was the biggest emotional blow I have ever received in my life. Both therapists said there was nothing more they could do for me. I felt like I was abandoned all over again and my emotional response was frightening. Since then I stopped leaving the house, I have not bathed once, I stopped seeing my children and have given up completely. DBT is extremely dangerous if it doesn't work for you because if you are removed it sends the message that you are a hopeless case. DBT's dirty little secret is that it has never been proven to work on men. I emailed Marsha's office and they said they have some "anecdotal" evidence of it working on men but nothing published. So be careful with DBT because I'm far, far worse today than before I started it.

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  24. 44 y/o female here with recent diagnosis.

    I have recently been placed in a DBT program and so cannot comment as to whether or not it 'works'. I have not had success with therapy in the past (like yourself, I am often seen as high functioning however, I get annoyed at being told how high functioning I am because therapists tend to look at external indicators for that - job/career/degrees etc when, in actuality, my life is usually exploding or recovering from an explosion).

    My concerns about DBT are twofold: I have been given a social worker/therapist (I never knew the 2 could be combined) that I meet with individually and I can already see that she is nice lady, with good intentions, but I think I already confuse and worry her because I drag every conversation into an existential panic .... so much for mindfulness!

    I haven't done group but again, it is run by a woman and they tell me all the patients (?) are women - perhaps this will be a good thing but I have concerns around it. I also have concerns that DBT is trying to treat the behaviour/responses rather than look at the cause/s of said behaviour/responses.

    I was interested to read Jim Beam's post above re men and DBT. I have no idea why there seems to be a genderisation of DBT, or whether this is just my perception. What I do know is that Buddhism and the ilk is probably going to be somewhat lost on me.

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    Replies
    1. As a student of western philosophy I totally agree that there is an overall quality of existential emptiness in DBT. You ward off emotions at the pass with skills and try to avoid upsetting/stressful situations. You are left rolling with life's punches and trying to get by(anyone remember meursault?). I did nine months of DBT and only had symptom improvement...no ability to relate to others on a deeper level and an overall feeling of hopelessness.

      Delete
  25. Hi,
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    Thanks

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