Borderline Personality Disorder
Borderline Personality Disorder (BPD) is a devastating and stigmatizing disorder. Many therapists refuse to treat this population due to the severe pathology involved. BPD patients’ extreme emotional and behavioral dysregulation including anger directed a
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Darcy C. Norling · Soonie Kim
Abstract: Borderline Personality Disorder (BPD) is a devastating and stigmatizing disorder. Many therapists refuse to treat this population due to the severe pathology involved. BPD patients’ extreme emotional and behavioral dysregulation including anger directed at the therapist and impulsive, life threatening behavior can be tremendously taxing on the therapist, not to mention heighten their ethical and legal risk. Dialectical Behavioral Therapy (DBT), a psychosocial treatment that combines cognitive-behavioral theory and methods with eastern meditative principles and practices, has changed this picture significantly. Several randomized clinical trials have demonstrated DBT to be the most hopeful and helpful of any new therapy available for people with BPD. As icing on the cake, it also provides a very stimulating and rewarding experience for the therapist. As such, many therapists are clamoring to learn the treatment. Although there is a wealth of information that describes the treatment itself, very little has been written regarding the necessary steps to provide it well. In this chapter we offer guidelines on how to achieve competency in DBT and further discuss how to move from beginning to expert status. The information presented has been gleaned over the last 15 years; from both formal training in DBT as well as personal experience providing full fidelity DBT “in the trenches”.
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Overview
Borderline Personality Disorder (BPD) is a debilitating disorder characterized by emotional and behavioral instability. The diagnosis of BPD is a chronic condition that traditionally has not responded well to standard community-based outpatient and inpatient treatment. Further, BPD is a stigmatized disorder resulting in negative attitudes and apprehension with regard to providing treatment (Lequesne & Hersh, 2004; Paris, 2005). One of the most challenging aspects is the fact that many clients with BPD engage in suicidal behavior. This fact greatly increases the anxiety of therapists, as they worry about the legal and ethical dilemmas that accompany suicide. In addition, many clients with BPD struggle to control their anger and experience high amounts of conflict within their relationships. Anger is often turned toward the therapist, creating increased emotional vulnerability in the therapist and consequently leading to high burnout rates. With the creation of Dialectical Behavioral Therapy, however, many of these concerns have been alleviated. Marsha Linehan has transformed the way in which individuals conceptualize and treat BPD, which in turn has resulted in less burn out for therapists and more successful treatment outcomes. Linehan and her colleagues have conducted many research studies which have resulted in less judgmental and more specific characteristics of BPD. These characteristics fall into the five J. Thomas, M. Hersen (eds.), Handbook of Clinical Psychology Competencies, DOI 10.1007/978-0-387-09757-2_31, © Springer Science+Business Media, LLC 2010
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