Dialectical Behavior Therapy

Difficult To Treat Clientele

This particular therapy was developed for folks with challenges that are difficult to treat. The bottom line is to help them increase their freedom and independence by learning to regulate their emotions. Most of these individuals are emotion phobic, so the key is to help develop a wider range of emotions by improving self, behavioral, cognitive, interpersonal, and emotion regulation.

The pattern is for people with these challenges to be shut down emotionally, and then totally exploding at times. These people are vulnerable to their own emotional responses, and quite often are surrounded by an environment that invalidates them. But the key with dialectical behavior therapy is that they can overcome their developmental challenges.

When there is self invalidation, a person’s ability to learn and change cannot be sustained. They do not value themselves or trust their own experiences and emotions. They lack coping skills. They emotionally and mentally check out from the scene and become non participatory and unavailable.

A person with this type of disability feels trapped within themselves and doesn’t understand what’s going on so they are unable to function. They live in a world of extremes where they are either shut down or freaking out. They may have a crisis but are unable to grieve, because they actually don’t notice their emotions.

Dialectics

Dialectical behavior therapy is about organizing this internal chaos by developing some structure. It’s about waking them up to what their goals are; discovering goals that resonate with them. They learn to experience and handle two opposing forces at the same time. For example, being able to work with a difficult co-worker and still get the job done. They become able to see the shades of gray in the middle of different events and circumstances.

They learn to understand that two things can be true simultaneously, so they can feel bad but still do their work. Or they can be mad but still interact with the person. Learning to be aware and pay attention every single moment, so that they are not avoiding or resisting. They are able to be themselves and stay in relationship through the natural ebbs and flows of life.

Help Is Available

Should this type of therapy be helpful to family or others you know, there are many qualified practitioners and services available. You can find outpatient individual therapy, skills training groups, telephone coaching, therapist consultations, as well as more acute inpatient psychiatric services. Julie Brown, LICSW, is a trainer and consultant in this field.

But one thing to keep in mind is that the human process of getting better usually comes slowly. Each person must allow room for self correction. This is not a race. Each day and moment is significant.

Functions and Stages of Treatment

The functions of dialectical behavior therapy are to increase the capabilities of the person, improve motivational factors (want the person to be more effective), assure that there is a carry over to their environment on day to day basis, help them structure their environment, and then enhance all interventions and ability of the therapist to treat effectively.

Once a person agrees and commits to dialectical behavior therapy there are specific stages through which they pass. Initially it’s about addressing the severe behavior challenge and gaining some sort of behavioral control.

Then a person will most likely become depressed and feel a sense of quiet desperation. Next a person becomes aware and experiences the day to day challenges in living, going through the happiness/unhappiness cycle. And finally there is a sense of incompleteness that brings about the capacity for joy, freedom and authentic feelings of aliveness.

Treatment Strategies

The essence of any treatment strategy for this group of people is to counteract the polarization that they are experiencing, and balance problem solving with validation. Listen and accept what is being said without necessarily agreeing. Accept the person as they are in the moment, and accurately reflect back to them. Help them be willing to see what’s really going on by articulating unexpressed emotions, thoughts and behaviors.

A person learns to see that others would also be afraid if they were in their shoes. They gradually develop ability to be themselves, and talk from the heart. They learn to make personal connections with others. And all of this comes down to learning the art of mindfulness, or being in the present moment without internal distractions.

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