DBT : acceptance and change.

Lienhan(1993) presents the concept of Borderline Personality Disorder(BPD) with four approaches; 1) the single continuum approach , 2) biologically oriented approach, 3) eclectic-descriptive approach, 4) biosocial approach. The biosocial approach-emphasizing an interaction between an individual’s constitutional predisposition toward dysreguating emotions and an environment that invalidates the individual’s private experience(Hayes et al, 2004)-, is the theoretical foundation from which the author designed Dialectical Behavior Therapy(DBT) to treat individuals with BPD. According to the author, DBT is distinctive in several ways from CBT approaches to BPD, although most of DBT is application of CBT. DBT’s emphasis is on “dialectics”, which means the reconciliation of opposites in a continual process of synthesis(p.19). The synthesis in treatment occurs between acceptance and change. The therapist needs to accept the patient with a notion of unconditional positive regard, while coaching the patient to change. The therapist actively teaches the patient to accept him(her)self and to change to better regulation emotion, cultivate interpersonal skills, increase tolerance levels and so on. Over therapy period, more emphasis is placed on the process not the structure, while the therapist functions as a consultant to the person, which is core characteristic of the therapeutic relationship in DBT model.

The author introduces two studies showing the effectiveness of DBT with population of BPD. The first RCT investigated the treatment outcomes of DBT against individual psychotherapies. DBT participants reported a significantly less frequency of parasucidal behaviors, the low rate of treatment dropout, fewer days of hospitalization compared to TAU group. They were also rated higher on global adjustment by interviewers. However, interestingly, the participants did not report a success in accepting and tolerating both themselves and reality. But not surprisingly, accepting and tolerating seemingly problematic oneself or world is very tough task, even to an average people. The second RCT investigated the effectiveness of addition of group skills training to DBT as individual therapy is the usual therapy. It is found that the DBT group skills training is not efficacious.

According to Hayes et al(2004), there are more body of empirical evidence showing that DBT is effective in treating substance use eat-disorders as well as BPD. And growing consensus is made that DBT is the only empirically supported treatment for BPD. This can be attributed to Lienhan’s design of DBT with a focus on BPD, following her expertise dealing with parasuicidal individuals with BPD. The processes of how DBT was first designed and supported is one of exemplary ways to expand the list of ESTs. 1) Extracting remarkable resemblance of seeming different psychological behaviors and disorders through research work(e.g parasuicidal vs. BPD), 2) Integrating existing treatment approaches to best serve a specific population(e.g adopting “acceptance” form “Zen” and “change” from CBT), 3) Gaining evidence of the effectiveness of the treatment through RCTs and clinical trials.