What are Dialectical Behavioral Therapy and Borderline Personality Disorder?

By Rachel Gill – Consumer/Advocate/Linfield College Social and Behavioral Sciences Undergraduate

DISCLAIMER: The following information does not mean to diagnose or treat individuals.. READ in original formatting (PDF).

“People who believe they have the power to exercise some measure of control over their lives are healthier, more effective, and more successful than those who lack faith in their ability to change their lives.” –Dr. Albert Bandura, social psychologist

Dialectical Behavioral Therapy (DBT) is an evidence-based treatment designed specifically for Borderline Personality Disorder (BPD). The diagnostic statistical manual of mental disorders describes nine criteria for BPD. A person exhibiting at least five of the following DSM factors meets diagnostic criteria for BPD.

1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation [e.g., extreme and rapidly shifting feelings of Love and hate toward important relationships]
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms

What sets DBT apart from traditional “Talk therapy” is that you do not go in to a session, lie on a couch, pour out your heart to a therapist who writes secret notes, probes for childhood trauma, asks more questions than is necessary about your sex life, gives you drugs, and sends you on your way. While persons certainly talk about their woes in DBT, the idea is to overcome suffering not to relive it.

Furthermore, Marsha Linehan, DBT’s founder, suggests that talk therapy (which refers to traditional Freudian psychotherapy) may even increase emotional vulnerability in people with Borderline Personality Disorder, which explains why, before DBT, I would always leave a therapist’s office miserable and/or in tears. On the other hand, I have been in DBT for over a year now and have never left a session in tears. In fact, most of the time, I leave in a better state of mind than I come in with.

So, how does DBT work? Well, I go to an individual therapist once a week to work on reducing target behaviors with the intent of eventually extinguishing them. In DBT, safety and immediate danger dictate the specific order for assessing and addressing target behaviors. Four classes of behavior organize DBT’s treatment target hierarchy.

1. Suicidal Behaviors
2. Therapy-interfering Behaviors
3. Quality-of-life Interfering Behaviors
4. Increasing Behavioral Skills

At the beginning of each session, my therapist and I review a diary card that I fill out for each day of the week in between sessions to identify treatment targets and set an agenda for the session. Then by observing and describing, we attempt to come up with a solution for the issues of concern. Before the end of the session, we review the solution and if we both find it agreeable, I apply the solution during the week. This is homework (without the grades.)

Additionally, I also attend a group skills session once a week with other people in the program to build DBT skills. The main skill areas are mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness, and problem solving. The standard time for completing the standard DBT program is 6-12 months, after which, clients graduate and either leave the program, or move on to stage two, which is where I am at now in Portland DBT’s program.

In phase two, individual therapy is much the same. In-group skills training, the idea is to help each other solve specific, individual problems by applying the skills obtained in phase 1. In phase 3, (which I know the least about) clients join an exposure group where clients confront past traumas, currents fears, etc. in a safe, compassionate, carefully measured environment.

If you think DBT might be for you and you live in the Portland area, I highly recommend contacting Portland DBT (see below) I am currently in their program. However, if you are on OHP, getting authorization can be tricky. I am currently in litigation to try to change this, but that is another story. If you have any general questions, about DBT you can e-mail me, Rachel Gill, at mentalhealthnow@live.com. Stay well, my friends.

Portland DBT Program, PC 5200 SW Macadam Avenue, Suite 580 Portland, Oregon 97239 Phone: 503-231-7854 Referral Line: 503-290-3291 Fax: 503-231-8153 E-mail: referral@PortlandDBT.com


American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR (fourth edition, text revision). Washington DC: American
Psychiatric Association, 2000.
Linehan, M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: The Guilford Press.