Dialectical Behavioral Therapy (DBT): Is it Enough?

We recently featured an article which provided an extensive list of DBT inpatient facilities. Our reporter, Kara Kelly, spent considerable time researching these places and the result is a valuable resource for you. Readers since then have also suggested a few other DBT centers and hospitals, and we've added them to the bottom of Kara's article for you.

I also received a lot of feedback on that article from folks who have benefited by non-DBT treatment options and it occurred to me that I've given most of my airtime to only one recovery alternative.

Up front, to set the record straight, DBT is not the best treatment option for Borderline Personality Disorder. It is one of many, and arguably not the best for some. However, it is possibly the most widely-available option in the United States at this time, one I used, and I have also seen it transform many lives in my on-line classes.

With DBT alone, I would not have a life worth living, because, while the skills reduced my symptoms enough to be able to move on to the next stage, it did not assist me in developing a strong sense of self nor a game plan for getting my relationships, body and career on track. I used life coaching to help me get in touch with who I was and what I wanted in life. The result of coaching, and also some non-DBT therapy, is that people and circumstances now don't knock me off course--I know me, and that remains constant.

So what exactly is DBT and where might it fall short?

DBT is a compilation of practical, yet brilliant, skills to be practiced each week, with one building upon the other. The most important of the skills is mindfulness, which is the ability to focus entirely on the present, while pushing all distractions away. This skill is the foundation for taking control of your thoughts, which ultimately changes your brain chemistry and your behavior and also serves as a distress tolerance skill in and of it-self.

The others skills range from how to communicate an objective effectively to tips for distracting oneself from distress. The result of mastering the DBT skills has been, for me, that I am a much calmer human being, and one who can now hold opposing viewpoints and objectives (dialectics) at the same time.

Recently I spoke with Dr. Bob Friedel, author of BPD Demystified, about his observations about our article on DBT treatment options. Dr. Friedel is my go-to for advice on medication, and also he has great information on treatment options in both his book and on his website, which is: bdpdemystified.com. He responded by saying,

"I [like] the list of facilities by Kara Kelly (such comprehensive lists are difficult to come by). However, I am not too keen on her opening statement, 'As you probably know by now, Dialectical Behavior Therapy (DBT) is currently the most effective method of treatment for those suffering from Borderline Personality Disorder (BPD).'

This has not been clearly demonstrated to be the case, and provides inaccurate information and false hope and discouragement to many patients. Many patients require medications and other forms of psychotherapy because they do not respond to CBT and drop out. Therefore, the above statement is particularly discouraging to them and to their loved ones. If this is the most effective method of treatment and it doesn't work, where do they go next for help? It is useful to check the drop out rates of DBT in various studies, and how many include subjects who are treated with medications simultaneously.

There is no panacea for the disorder as the symptom presentation and the severity vary considerably from one patient to another".

What he is saying is that "one-size does not fit all."

We are unique humans, and no one model fits everyone. I hope this gives you hope that there is an option out there for your unique personality, and one that fits your desires for your own recovery.

His statements are amply supported by research. In a study published in the June 2007 issue of The American Journal of Psychiatry, Transference-Focused Psychotherapy produced a positive change in the most variables studied (10 of 12), while Dialectical Behavior Therapy only produced positive change in 5 of the 12 variables.

A series of three major outcome studies have shown that many patients with Borderline Personality Disorder can achieve full recovery across the complete range of symptoms, and in one, Schema Therapy was shown to be more than twice as effective in bringing about full recovery as a widely-practiced traditional treatment (Transference Focused Psychotherapy).

So, to help us make informed choices, this will be my first in a series of articles with practical information about all the treatments out there for BPD. The next installment will be on Mentalization, a form of treatment I will be trained in next month by the inventors, Dr. Anthony Bateman, and Dr. Peter Fonagy. That article will appear in my February newsletter.

Until then, you can get a jump start on your recovery by attending one of my retreats in the beautiful The Woodlands, TX or by reading the BPD Recovery kit found in our bookstore.