Borderline Personality Disorder

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”.