A Short Intro To Dialectical Behavioral Therapy

Skills, Skills, Skills: The Only Way To Go

Writer’s Reflection
Some years ago a fascinating discovery about the brain was widely reported in the news. Research conducted in England was coming out that appeared to stand previous scientific understandings of the human mind on their head. Stroke victims paralyzed on the right side of their bodies, were regaining use of their previously useless limbs. When their brains were examined with a special kind of xray, doctors found something amazing: the damaged parts of the brain were repairing themselves! And how did this miracle come about? To bring this about, the researchers immobilized the functioning arms of the patients for twelve hours at a time. For these twelve hours patients were expected to feed themselves as well as do all the activities that they would normally do but only with their injured arm. Guess what?! Within hours these previously ‘dead’ arms were back at work! What was previously a permanent disability was no more. Such is the power of determination that it can inspire growth when none was thought possible. And when determination and the skills that you’ll learn about are put together borderline personality won’t stand a chance.


Throughout this book, borderline personality disorder has been described as a group of destructive strategies to deal with very real and highly individual agonies and confusions. Thus in order to leave the most destructive aspects of borderline behind, one must find more effective strategies for dealing with the pain and confusion in living. More than needing a personality transplant, people with borderline personality disorder need ways to cope that respect their sensitivities and celebrate their unique abilities.

And this is what skills training can offer.

This of course was not always the case. For many years well meaning therapists tried to accomplish the worthy goal of healing the person with borderline through reflective therapy. The thinking behind this effort was that a healing supportive relationship could bring about the end of the pain.

Unfortunately, this approach didn’t work. Many patients got worse. They were hospitalized for long periods. Families, mental health professionals, and the patients themselves despaired of ever stopping the cycles of rage, self mutilation, suicidal behaviors and the chaos of borderline personality disorder. In effect, the therapy was undermining patients by making no effort whatsoever at helping them find a way in the world.

In the mid eighties, psychologist Marsha Linehan, bothered by the failure of talk therapy began to reconsider the whole treatment approach. She threw out “the book” so to speak and endeavored to find a new approach that would both help understand the disorder and provide some direction for treatment. Linehan observed that people with borderline personality disorder, more than needing a therapist who passively listened to the horrible complications of their lives, really needed practical assistance in calming their inner turmoil. Due to their exquisite sensitivities they needed real help in making sense of a world that they see as mad. In essence, Dr. Linehan discovered that far from being defective or ‘crazy’, people with borderline personality disorder were deep thinkers, confused by the pain and conflict that exists in the world. While most of us are able to make an uneasy peace such inconsistencies, these people by nature are bothered to no end by them.

Linehan put together a treatment program that taught emotional management skills and offered a sound philosophy for living at peace in their world. This program came to be called dialectical behavioral therapy or DBT. Dialectics refers to a practical philosophical discipline that concretely teaches how to live with the many paradoxes of life. One such paradox includes the desire for change with acceptance of the present moment. Another paradox centers around kindness and personal rights. Without understanding how to thrive in a world of paradox, patients remain stuck in a cloud of confusion that results in impulsive and destructive thinking and action.

Dialectics teaches us that two seemingly two opposed or paradoxical ideas can coexist.

Teaching philosophy however was of course not enough to tame the chaos of borderline personality disorder. Even with a grounded understanding of how the world works, people with borderline still had great difficulties in relationships, solving their problems, and managing their feelings. In response, Dr. Linehan developed a practical curriculum that teaches the skills necessary for positive relationships, solving the real problems of life, and finding joy in life. And because many of the most destructive dimensions of borderline personality disorder become habits with a life of their own such a self mutilation and suicidal behaviors, she developed techniques for creating new alternatives to take the place of the old ones.

The success of Linehan’s program is hard to dispute. People with borderline who have undergone dialectical behavioral therapy engage in far less self mutilation and require less hospitalization than those who receive standard talk therapy. They are more likely to be working and to report satisfaction in their lives.


The skills of DBT focus on the four areas that are the most problematic for people with borderline personality disorder. Without transforming these deficits into strengths, argued Linehan, all of the best intentioned therapies will fail. These skills are designed to empower and guide as people go about the very real business of making a life for themselves.

The skill groups are:
a. Mindfulness Skills
b. Interpersonal Effectiveness Skills
c. Distress Tolerance Skills
d. Emotional Regulation Skills
As detailed in the following chapters, the mastery of these skills will restore control in each of the characteristics of borderline personality disorder.