Beauty and the Borderline

A Journey towards Integration

Dialectical Behaviour Therapy: An Introduction

Marsha LinehanFrom Ontario Shores Centre for Mental Health Sciences, Borderline Self-Regulation Clinic, Client Information Package:

What is Borderline Personality Disorder?

Characteristics of BPD include unstable interpersonal relationships, self-image, and emotion, as well as patterns of impulsive behaviours.  Individuals with BPD first experience these symptoms beginning in early adulthood, and the symptoms tend to continue for years.

Borderline Personality Disorder Symptoms

  • Fear of being left or abandoned by loved ones or friends
  • Imagining or believing that others are leaving, even when they are not
  • Attempts to avoid abandonment
  • Intense relationships with lots of conflict, and/or breakups
  • Frequent arguments with friends and loved ones
  • Often feeling disappointment in loved ones
  • Feeling like you don’t know who you really are as a person or what you believe in
  • Engaging in impulsive behaviours
  • Making suicide attempts or gestures
  • Engaging in acts of self-harm without intent to commit suicide
  • Experiencing intense negative feelings in reaction to day-to-day situations
  • Feelings of intense sadness, irritability, or anger that can last for hours or days
  • Chronic feelings of emptiness, feeling no emotion, or feeling like there is nothing inside

People with BPD experience their symptoms almost daily for years.

Understanding the development of BPD

The biosocial theory of BPD development (Linehan, 1993) states that some individuals are born more emotionally sensitive and vulnerable than others.  As a consequence, these individuals have: (a) heightened emotional sensitivity, (b) inability to regulate intense emotional responses, and (c) slow return to emotional baseline.  In addition, when these individuals grow up in an environment that is intolerant and essentially invalidating of their emotional responsiveness they learn that their emotions are “bad” and that they should hide their emotions.  The combination of biological emotional dysregulation and an invalidating environment leaves these individuals unable to develop “effective” behavioural responses to cope during emotionally challenging events.  Consequently, these individuals do not learn how to understand, label, regulate, or tolerate emotional responses and instead learn to fluctuate between emotional inhibition and extreme emotional lability.  These individuals also fail to learn how to solve the problems contributing to these extreme emotional reactions.

Clients in the Ontario Shores Borderline Personality Self-Regulation Clinic receive individual weekly counselling sessions with a trained DBT therapist, weekly classes in the four skills categories of DBT, and as-needed phone coaching.  Clients must observe all rules to remain in the program.

The primary material for DBT Skills Training comes from Skills Training Manual for Treating Borderline Personality Disorder by Marsha M. Linehan, PhD, ABPP.

Goals of Skills Training

To learn and refine skills in changing emotional, thinking, and action patterns associated with problems in living, that is, those causing misery and distress.

Behaviours to Decrease

  1. Mindlessness, confusion about self
  2. Impulsiveness, craving to escape from present
  3. Labile (up and down) emotions, mood-dependent behaviour and thinking
  4. Interpersonal difficulties or chaos

Behaviours to Increase

  1. Core mindfulness skills
  2. Distress tolerance skills
  3. Emotion regulation skills
  4. Interpersonal effectiveness skills

Each week, participants in the program fill out a Diary Card, tracking their moods, urges, dug and alcohol use, skills used, and reward for using skills.  Ideally, each participant tracks their progress daily on the Diary Card.  An explanation of how to use Diary Cards is here.

If you want to follow along as I learn about and practice the exercises AND you want a very accessible Handbook with printable worksheets you can fill out, the Dialectical Behaviour Therapy Skills Handbook from Fulton State Hospital is excellent.


One comment on “Dialectical Behaviour Therapy: An Introduction

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