A Journey towards Integration
From 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
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
Behaviours to Increase
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.