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For them to survive crisis they are equipped with the skills to; self-soothing, thinking of the pros and cons, improving the moment and looking for destructive things to do. They can also exhibit acceptance skills by turning the mind to accept, radical acceptance and willingness vs. willfulness.
Individuals with under this therapy are taught how to regulate their emotions. This is because most of those suffering from this disorder are known to be angry, depressed, intensely frustrated and anxious among other behaviors. The steps taught towards emotional regulation include; identification and labeling of emotions, identification of obstacles to any change of emotion, reducing of vulnerability to having an emotional mind, by having more positive emotional events, giving the patient the ability to control the current emotions and wherever a negative one presents itself he/she can take the opposite action, and lastly, he/she can apply the distress tolerance techniques taught (Heard, 2009).
Modes of Treatment
There are five clear components of treatment of DBT. They component include; individual therapy session to address and maintain the patients motivation for treatment, group skills training to increase the patient's capabilities, brief weekly phone calls to insure generalization of new skills, therapist consultation team to provide supervision and prevent burnout and lastly, administrative function to structure the environment so that effective treatment can take place (Westen, 2000).
Stages of treatment
Borderline Personality disorder being one of the conditions treated by Dialectical Behavior Therapy is more centered towards patient's egregious behaviors. Dialectical Behavior Therapy has four stages, pre-treatment stage; this stage basically deals with assessment of the patient's disorder, commitment to the treatment choice, and orientation to Dialectical Behavior Therapy (Heard, 2009).
The first one is based on reducing any present life threatening behaviors, quality of life threatening behavior and therapy-interfering behaviors and to enhance behavioral skills. The second stage revolves around improving the experience of a patient who has reached a state of desperation having managed to come through the damaging behavior which was present in stage one of the Dialectical Behavior Therapy treatments. The characteristic focus presented in this stage is the post-traumatic stress responses (McMain, 2001).
The third stage is meant to promote the patient to develop a positive attitude and a way to resolve the daily problems. Whereas the fourth stage consist of where the patient can now live in joy through his/her abilities to overcome the feeling of incompleteness.
With the different intervention measures put in place in Dialectical Behavior Therapy. The main strategies used are the validation and problem solving. These strategies tries to facilitate change by validating a patient's behavior and responses as understandable as possible while also associating it to his/her current life ordeals and which portrays an understanding of the patient's difficulty and suffering (Robins, 2001).
Problem solving strategy on the other hand majors on imparting the patient with the necessary skills for coping. In case the patient is not taking care of him/herself by taking care of the arising problems then, either he/she do not poses the necessary skills needed to solve the problem or there may be something hindering him/her to do so (Clarkin, 2007). When the patient doesn't solve his/her problem, because he/she doesn't have the skills, then this can be solved by having skills training sessions. While, in any case he/she has the skills but doesn't use them, then, that situation may be because of environmental factors or maybe cognitive or emotional problem hindering treatment. The solution to this is by contingency management, cognitive therapy, exposure based therapies and pharmacotherapy, which are used in informal way into the therapy.
Some researchers have raised conflicting arguments that it is wrong for a primary therapist to a patient to recommend medication, whereas this may not actually be practical because he/she is not well conversant with the patient (McMain, 2001).
Effectiveness of Dialectical Behavior Therapy as a treatment option
A research carried out by Clarkin showed that the various existing borderline personality treatment approach currently being used such as the Dynamic Supportive Treatment, Transference-Focused Psychotherapy (TFP) and Dialectical Behavior Therapy, all of them have their own efficacy in treatment of Borderline Personality disorder (Clarkin 2007). In addition, in other clinical trials conducted to compare Dialectical Behavior Therapy to other forms of treatment, it was determined that Dialectical Behavior Therapy was more effective in the treatment of Dialectical Behavior Therapy since it led to reduction of various problems associated with Borderline Personality Disorder such as suicidal tendencies, feeling of hopelessness, self-harming behaviors and bulimic behaviors among others. But at the same time more research is needed to find out the effectiveness of Dialectical Behavior Therapy in treatment of other conditions other than Borderline Personality Disorder (Westen, 2000).
Cultural/legal issues surrounding Dialectical Behavior Therapy
Due to the disturbed nature of patients undergoing the Dialectical Behavior Therapy, the therapist sometimes is faces with ethical issues, for example patients with such conditions requiring Dialectical Behavior Therapy, they normally find themselves in trouble for some of the crimes they commit due to their emotional disturbance. These crimes which are sometimes domestic/relationship-based may go reported or not reported to the authority and when the same patient comes in for his/her sessions, he/she might confide in his/her therapist, and if the case was serious, the therapist might find himself in an ethical dilemma of whether to tell the police or to obey the patient autonomy (Heard, 2009).
Also, patients with Borderline Personality Disorder are sometimes said to be possessed by supernatural spirits because of some of the characteristic behavior they exhibit such as suicidal tendencies, fluctuating extreme emotions among others. In developing world's whereby such behaviors are still not viewed as conditions which need medical attention. These people are often discriminated and to some extreme instances, banned from living with people because they are believed to be possessed by unseen supernatural spirits which are not good.
All in all, Dialectical Behavior Therapy can best be applied effectively if the therapist him/herself incorporates it as part of his/her life because this therapy is not just a mere treatment but also a way of living. Though this is an expensive treatment, for a patient with that disorder to realize improvement of his/her condition, he/she should be committed to life changes even if some may seem impossible.
Clarkin, J.F., Levy, K.N., Lenzenweger, M.F., & Kenberg, O.F. (2007). Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study. The American Journal of Psychaiatry, 164(6).
Heard, M.A.S.H.L. (2009). Dialectical behaviour therapy: distinctive features: Routledge.
Westen, D. (2000). The efficacy of dialectical behavior therapy for borderline personality disorder. Clinical Psychology. Science and Practice, 7(1), 92-94.
Willem H.J. Martens. (2012). Therapy on the borderline: effectiveness of dialectical behavior therapy for patients with borderline personality disorder. Annals of the American Psychotherapy Association.
McMain, S., Korman, L.M., & Dimeff, L. (2001). Dialectical behavior therapy and the treatment of emotion dysregulation. JCLP/in Session: Psychotherapy in Practice,57(2), 183-196.
Robins, C.J.,Ivanoff, a.M.,&Linehan, M.M. (2001).Dialectical behavior therapy. In W.J. Livesley (Ed.), Handbook of personality disorders: Theory, research, and treatment.117-139).NewYork: Guilford.Robins, C.J., & Koons, C. R. (2004).Dialectical behavior therapy.[continue]
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