Dialectical Behavioral Therapy

Dialectical behavioral therapy is a form of psychotherapy developed by psychologists and frequently used in patients with borderline syndrome. In principle, it is a cognitive behavioural therapy, but it also works with meditation exercises to help the patient acquire a new way of thinking. Basically one can say that the therapy has two starting points.

The first is the dialectical approach, which involves recognizing opposing points of view, accepting them and trying to find a middle way. This can mean that patients have to perceive that in difficult situations they should not without exception react with excessive anger but that they accept the situation as such and try to have a conversation based on facts. The second approach, the behavioral approach, refers to such a change in behavior.

Here, for example, it is about rewarding good behaviour and thus promoting it. Dialectical-behavioral therapy is not only used for borderline patients but also for patients with eating disorders. The therapy can be carried out on an inpatient or outpatient basis, in individual therapy or in a group therapy.

In addition, there is a pharmacotherapy which works with the use of drugs. Here, for example, neuroleptics or antidepressants are administered to make it easier for the patients to start the upcoming therapy. Otherwise, the use of such drugs is not recommended for borderline patients.

More important is the individual therapy. During this time the patient should deal with his problems and try to solve them. In the individual therapy it is important that the patient and the therapist reach an agreement in which the patient commits himself/herself to cooperate in the best possible way and not to interrupt the therapy (unfortunately this is often the case with borderline patients) and the therapist in turn commits himself/herself to do everything possible to help the patient.

The patient should then keep a diary for a certain time in which negative events and suicidal thoughts as well as positive experiences are recorded. In addition to the individual therapy, there should always be an emergency telephone service available, as situations can arise during therapy in which no therapist is available and the patient feels overwhelmed. In these moments there should be the possibility to contact the therapist or another person who is familiar with the borderline therapy.

Following the individual therapy, group therapy takes place, which consists of five modules. One of these is inner mindfulness. Here it is important that the patient is able to describe and realize what he feels.

If the patient feels happy, he should be able to show this (for example by smiling) and also be able to communicate this to his surroundings, if he feels sad, he should also verbalize this feeling and so on. The next module is the so-called stress tolerance. Here it is important that the patient does not immediately overreact emotionally in stressful situations, but lets the situation affect him/herself first and then thinks realistically about whether the situation can be managed well.

The third module deals with the handling of feelings. Here it is important that the patient can classify the feelings that will come up in him. He should be able to differentiate between happy, hopeful, angry, sad and all other feelings.

This enables the patient to control every situation and every emotion. The fourth module is concerned with building a social network, i.e. with interpersonal skills. Here the patient should learn how best to approach people, how to get involved with them and also how to suffer a setback or disappointment once in a while, but which can be forgiven due to a friendship.

Here it is important that the patient learns that he or she can also be in the background to maintain a friendship. The last module deals with self-esteem. The patient has to learn that he himself is a person whom others and above all he himself should appreciate. That he is allowed to have positive thoughts about himself and that he can do something good for himself. All these modules should be developed and internalized in group therapy.