The Theoretical Basis For

When Marsha Linehan is asked to tell the story of her development of dialectical behaviour therapy (DBT) she says that she did not set out to invent a theoretical orientation for the treatment of borderline personality disorder (BPD). Linehan was treating suicidal clients, attempting to use standard behaviour therapy with them. However, it was not successful for many of the clients. They would present at an individual psychotherapy session with one problem, such as panic disorder and Linehan would choose an empirically supported treatment for that problem. When the clients returned for the next session they would not have completed the prescribed homework because other problems would have surfaced. Linehan realized that standard treatments were not working because the problems of the clients changed from session to session and moment to moment. Her laboratory developed DBT from an attempt to find a means of prioritizing the multiple problems presented by clients who engaged in non-suicidal self-injurious behaviors, as well as attempts to help clients and therapists to regulate emotion in the presence of intense emotional suffering (Linehan, 1993a,b).

Dialectical behaviour therapy was developed in a clinical laboratory lab where all of Linehan's and, later in the development of the treatment, her students' therapy sessions were videotaped. The sessions were independently coded with each therapist response being labelled as helpful or not helpful. Over time, the method of balancing acceptance of clients at a given moment while pushing them to change behaviours that were dysregulated was identified as being a dialectical practice. This chapter will describe the dialectical underpinnings of DBT because dialectics is one characteristic that distinguishes DBT from other cognitive-behavioural therapies. A discussion of the structure of the treatment, including its modalities, will be followed by an overview of the current research on DBT.

Handbook of Evidence-based Psychotherapies: A Guide for research and practice. Edited by C. Freeman & M. Power. Copyright © 2007 John Wiley & Sons, Ltd.

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Eliminating Stress and Anxiety From Your Life

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