DBT WITH BORDERLINE PATIENT

PRESENTER: HALIMA SOMOSOMO

REG: HD/MUH/T. 266/2014

FACILITATOR: MARTINA KLANT

DATE: 4TH / JUNE/ 2015
 contents

 INTRODUCTION TO DBT
 CORE ASSUMPTION OF DBT
 FUNDAMENTAL OF DBT
 CHARACTERISTICS OF DBT
 TREATMENT TARGET
 DBT FORMULATION
 SKILLS FOR DBT
 INTRODUCTION
 Dialectical behavior therapy (DBT) is a specific
type of cognitive-behavioral psychotherapy
developed in the late 1980s by psychologist
Marsha M. Linehan.
 DBT was designed specifically for individuals
with self harm behaviors, such as self cutting,
suicide thoughts, urges to suicide and suicide
attempts.
 Dr Linehan found that most individuals
identified with these issues were women who
carried the diagnosis for Borderline Personality
Disorder hence DBT is associated with BPD.
 CORE ASSUMPTION OF DBT
 Patients are doing the best they can.
 Patients want to improve.
 Patients need to do better, try harder, and be
more motivated to change.
 Patients may not have caused all of their
problems, but they are responsible for solving
them.
 Fundamentals of DBT
 DBT is targeted at clients with emotional 
vulnerability  and  poor  ability to modulate  
strong emotions.
 Vulnerability:

a. Very high sensitivity to  emotional stimuli
b. Very intense response to emotional stimuli
c. A slow return to emotional baseline following
emotional arousal
 Characteristics of DBT
 Support-oriented: It helps a person identify their
strengths and builds on them so that the person can feel
better about him/herself and their life.

 Cognitive-based: DBT helps identify thoughts, beliefs,

and assumptions that make life harder: “I have to be
perfect at everything.”, & 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”.

 Collaborative: It requires constant attention to

relationships between clients and staff. DBT asks
people to complete homework assignments, and to
practice skills such as soothing yourself when upset.
 TREATMENT TARGET
 Life-threatening behaviors: First and foremost,
behaviors that could lead to the client's death are
targeted.
 Therapy-interfering behaviors: This includes any
behavior that interferes with the client receiving
effective treatment.
 Quality of life behaviors: This category includes
any other type of behavior that interferes with
clients having a reasonable quality of life.
 Skills acquisition: This refers to the need for clients
to learn new skillful behaviors to replace ineffective
behaviors and help them achieve their goals.
 DBT FORMULATION
 Practically, formulating and planning
treatment works better if you use concepts in
three concepts. Such as

o Asses using stages and treatment targets

o Look for patterns of controlling variables for
each primary target.
o Use task analysis to generate mini- treatment
plans for key common links.
 DBT…
 DBT is divided into four stages of treatment.
Stages are defined by the severity of the client's
behaviors.
 Pre treatment
 Focuses on orienting the client to the treatment,
gaining their commitment, creating a hierarchy
of behaviors to be worked on in therapy and
identifying what the client considers is a life
worth living
 DBT…
 Stage 1
The client is miserable and their behavior is out
of control: they may be trying to kill
themselves, self-harming, using drugs and
alcohol, and/or engaging in other types of self-
destructive behaviors.
The goal of Stage 1 is for the client to move from
being out of control to achieving behavioral
control.
(use the four targets of treatment in DBT)
 DBT..
 Stage 2,
They're living a life of quiet desperation: their
behavior is under control but they continue to
suffer, often due to past trauma and
invalidation. Their emotional experience is
inhibited.
 The goal of Stage 2 is to help the client move
from a state of quiet desperation to one of full
emotional experiencing. This is the stage in
which post-traumatic stress disorder (PTSD)
would be treated.
 DBT..
 Stage 3
The challenge is to learn to live: to define life goals,
build self-respect, and find peace and happiness.
 The goal is that the client leads a life of ordinary
happiness and unhappiness.
 Stage 4
For some people, a fourth stage is needed: finding a
deeper meaning through a spiritual existence. Linehan
has posited a Stage 4 specifically for those clients for
whom a life of ordinary happiness and unhappiness
fails to meet a further goal of spiritual fulfillment or a
sense of connectedness of a greater whole.
 SKILSS USED IN DBT
DBT includes four sets of behavioral skills.
 Mindfulness: the practice of being fully aware and
present in this one moment focusing on one thing in
that moment without  judgment, the ability to discern
 emotions, verbal descriptions of events,
appraisals and judgments of events, memories, 
perceptions of events from each other
 Distress Tolerance: how to tolerate pain in difficult
situations, not change it
 Interpersonal Effectiveness: how to ask for what you
want and say no while maintaining self-respect and
relationships with others
 Emotion Regulation: how to change emotions that
you want to change
 REFERENCE

 Koerner, K. (2012). Doing Dialectical Behavior

Therapy: A Practical Guide. New York.
London.