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HELPLINE
1- 888- 4-TARA APD
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BORDERLINE
PERSONALITY DISORDER
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Guidelines
for
Choosing
a DBT Therapist
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Answers
to Frequently Asked Questions
about Dialectical Behavior Therapy
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| WHAT
IS DIALECTICAL BEHAVIOR THERAPY? |
| DBT
is a method of cognitive behavioral therapy
that treats people with Borderline Personality
Disorder (BPD) developed by Marsha Linehan,
PhD. at the University of Washington. In DBT,
behavioral change is balanced by acceptance,
compassion and validation. |
| STRATEGIES
BALANCING ACCEPTANCE and CHANGE FORM THE “Dialectic”
IN DBT |
| Dr.
Linehan studied women who met criteria for
BPD – angry women, suicidal women, and
drug abusing women. She found that these clients
felt that their ability to change was being
over-estimated while the degree of their suffering
was being underestimated. She formulated strategies
to help them tolerate their pain while working
towards making a “life worth living”.
They were taught various skills that helped
them to tolerate their distress without resorting
to self-destructive behaviors. |
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"DBT IS A LIFE ENHANCEMENT PROGRAM, NOT A
SUICIDE PREVENTION PROGRAM." LINEHAN
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| DBT
is the only psychosocial outpatient treatment
for BPD that has evidence from randomly controlled
clinical trials demonstrating its success. |
What
is Personality Disorder?
Personality Disorders (PD)
are enduring patterns of inner experience
and behavior that are pervasive, extreme,
inflexible and maladaptive, have on onset
in early adulthood or adolescence, are stable
over time, and lead to distress and impairment.
A person with a PD is unable to deal with
people or problems constructively or to adapt
to the changing demands of the environment.
What is Borderline
Personality Disorder?
BPD is an “enduring pattern”
of emotional instability (moods that change
quickly and unpredictably), impulsive behaviors
(using drugs and alcohol, addictive behaviors,
overspending, driving recklessly, eating disorders,)
interpersonal instability (having trouble
sustaining close relationships, chronic uncertainty
about life goals,) and a propensity to self-injure,
threaten or attempt suicide in an effort to
solve problems. People with BPD experience
emotions intensely and are very vulnerable.
They are among the most intensive and extensive
utilizers of mental health services. BPD is
extremely painful to the patients, to those
who love them and is costly to all of society.
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For
Brochure
Guidelines
for Choosing
a DBT Therapist
Call 1-888-4-TARA APD
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BPD BEHAVIORS MAY BE MALADAPTIVE METHODS OF COPING
WITH CONSTANT EMOTIONAL PAIN OR AN ATTEMPT TO
DEAL WITH OUT OF CONTROL EMOTIONS.
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| DBT
ASSUMPTIONS |
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People
with BPD are doing the best they can.
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People
with BPD want to improve. |
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People
with BPD need to do better, to work
harder, and be motivated to change. |
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The
lives of suicidal BPD individuals are
unbearable as they are currently being
lived. |
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People
with BPD must learn new Behaviors. for
all aspects of their lives. |
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People
cannot fail in DBT. |
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Therapists
treating people with BPD need support |
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Families
coping with people with BPD need support. |
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Stress
related dissociative symptoms such as
paranoia; feeling as though they are
losing touch with reality; feeling victimized;
unable to accept responsibility. |
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BPD
is extremely painful to the patients,
to those who live with them and to society.
People with BPD experience emotions
intensely and are very vulnerable. They
are among the most intensive and extensive
utilizers of mental health services.
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KEYS
TO A LIFE WORTH LIVING
· Supportive relationships that will
nurture you
· Meaningful work |
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| CHARACTERISTICS
OF DBT |
| DBT
is Supportive: It helps a person
identify their strengths and builds on them
so that the person can feel better about
him/herself and their life.
DBT
is Cognitive: DBT helps identify
thoughts, beliefs, and assumptions that
make life harder: “I have to be perfect
at everything.” “If I get angry, I’m a terrible
person” & helps people to learn different
ways of thinking that will make life more
bearable: “I don’t need to be perfect at
things for people to care about me”, “Everyone
gets angry, it’s a normal emotion.
DBT
is Collaborative: It requires constant
attention to relationships between clients
and staff. In DBT people are encouraged
to work out problems in their relationships
with their therapist and the therapists
to do the same with them. DBT asks people
to complete homework assignments, to role-play
new ways of interacting with others, and
to practice skills such as soothing yourself
when upset. These skills, a crucial part
of DBT, are taught in weekly lectures, reviewed
in weekly homework groups, and referred
to in nearly every group. The individual
therapist helps the person to learn, apply
and master the DBT skills. |
| EXPLANATION
OF DBT TERMS
Behavior
Therapy: The aim of “Behavior
Therapy” is to help people try new ways
of thinking, feeling, speaking, coping and
doing things. Rather than focusing on the
past, it looks at the present situation.
It does not depend on the insightful discussions
characteristic of psychotherapy to solve
problems, although this can be valuable
in its own right. It focuses on a person’s
views and beliefs about their life, not
on their personality traits. It aims to
replace maladaptive methods of coping with
more effective ways of achieving specific
changes and goals, it helps a person to
get what they want or need while helping
them develop control of their life.
Dialectics:
DBT is based on the idea that
opposites can coexist and be integrated.
Thinking dialectically means recognizing
that both points of view in any situation
are valid and means constantly working on
balancing change and acceptance. |
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| HOW
IS DBT PRACTICED? |
DBT
is generally practiced as an outpatient treatment.
Researched DBT with data to support its use
includes:
1. Once weekly individual psychotherapy.
2. Two hour weekly psychoeducation skills
groups.
3. Consultation meeting for therapists.
4. Therapist available for phone coaching.
Ancillary Treatment
Pharmacotherapy, acute, inpatient psychiatric
treatment, day treatment, case management,
and family psychoeducation. |
REMEMBER, DBT IS NOT JUST SKILLS TRAINING.
A
program or person who says they do DBT but
only offers skills groups is not doing the
comprehensive type of DBT that is effective.
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HOW
TO KNOW IF A THERAPIST DOES DBT?
These
are the questions you should ask:
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Have
you completed a 10 day intensive
DBT training ? |
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Are
you a member of a DBT consultation
team ? |
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Have
you been supervised by an expert
DBT therapist? |
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Are
you familiar with the main sets
of DBT strategies (cognitive behavioral
therapy, validation, dialectics)
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Do
you teach skills, practice behavior
analysis, review diary cards,? |
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Do
you do phone coaching? |
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How
many clients have you treated
using DBT? |
The answer to
these questions should be yes.
You have a right to check on
the therapist’s credentials;
to know if the therapist is
licensed in his/her state; to
know the extent and nature of
the therapist’s education and
training; the extent of the
therapist’s experience in treating
clients with similar problems;
the therapist’s arrangements
for coverage or emergency contacts.
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DBT
TREATMENT TARGETS
| Pre-treatment
Targets |
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Orienting
and Agreement on Goal |
| 1st
Stage Targets
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Decreasing
or eliminating life-threatening
behaviors (suicide attempts,
suicidal thinking, self-injury,
homicidal and aggressive
behaviors) |
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Decreasing
or eliminating therapy-interfering
behaviors (missing sessions,
not doing homework, behaving
so that others burn out”.
using hospitalization as
a way handling crisis. ). |
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Reducing
or eliminating hospitalization
as a way handling crisis.
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Decreasing
Quality of life interfering
behaviors (eating disorders,
not going to work or school,
addiction, schronic unemployment). |
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Increasing
behaviors that will enable
the person to have a life
worth living. |
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Increasing
behavioral skills that help
to build relationships,
manage emotions and deal
effectively with various
life problems. These skills
are: Mindfulness, Interpersonal
Relationships, Emotion Regulation,
Distress Tolerance, and
Self-Management. |
| 2nd
Stage Targets |
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Decreasing
Post Traumatic Stress Disorder |
| 3rd
STAGE Targets |
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Increasing
respect for self |
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Setting
individual goals |
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Solving
ordinary life problems
4th STAGE Targets |
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Capacity
for Freedom and Joy. Although
these priorities are presented
in order of Importance however
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DBT practioners
believe they are all interconnected.
If a person does not stay
alive, they will not have
the chance to receive help.
If they don’t stay in
therapy, they won’t
get the help they need to
change their quality of life.
DBT aims to convince people
to stay alive, stay in therapy
and build a life worth living.
As the person makes a commitment
to life and to stopping self-destructive
behaviors, DBT provides them
with support in learning how
to create and keep a life
that is sustaining.
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WHY
IS IT IMPORTANT TO SEE A TRAINED DBT THERAPIST?
DBT may be the
most hopeful and helpful of any new therapy available
for people with BPD. Many people with BPD have
problems trusting others, have “failed in
treatment” or have been dropped by former
therapists. When DBT is not done as designed,
the results may not be the same, causing the person
with BPD to lose hope and trust and then be reluctant
to ever try DBT again. If DBT is not practiced
according to the research model that produces
effective change but is practiced “my way”
by a therapist without adequate training, it probably
won’t produce the same kind of results as
the research programs. Outcomes from this kind
of DBT will not justify additional DBT training
or new DBT programs in the community. Currently.
Dr. Linehan is working on a way to certify therapists
who practice DBT so that people can determine
if a therapist is truly qualified to practice
DBT. |
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Grassroots advocacy works!
Together
we can make a difference.
How
Can Families Learn Coping Skills?
TARA NAPD offers a Two Day
Coping Skills Workshop for Families
of People with BPD, which
teaches families about BPD, and how
to apply DBT skills in order to decrease
stress, improve communication and build
trust. To arrange for a workshop on
your community, please call TARA at
1-888-4-TARA
APD.
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| FINDING
A DBT PROGRAM? |
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Behavioral
Technology Transfer has a web site listing
therapists trained in DBT(www. behavioraltech.com
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The
TARA NAPD Helpline 1-888-4-TARA APD
will refer you to a DBT program and
send you information. |
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Call
the head of the nearest University Department
of Psychiatry or Psychology in your
community and ask for a referral to
a DBT program. |
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Call
the commissioner of the State, County
or City Office of Mental Health and
ask for a referral to a DBT program |
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| WHAT
TO DO IF DBT IS UNAVAILABLE? |
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Learn
all you can about BPD. Read Books from
the TARA Recommended Reading List. |
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Attend
self help meetings (AA or Recovery,
Inc). |
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Seek
out others with the same problem, organize
a study group in your community. |
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Start
a TARA chapter in your community. Contact
TARA for help in starting an affiliate. |
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| HOW
TO DEVELOP DBT IN YOUR COMMUNITY? |
| This
is the time for advocacy. TARA can help
and advise you on successful strategies
to create consensus for change and adoption
of DBT in your community. |
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