I’ll admit that when I hear that a client has borderline personality disorder (BPD), my first thought is, “Oh, this person is a trauma survivor of some sort.” And while not all people with poor emotion management, impulsive and destructive actions, intense fear of abandonment and an unstable self image have a history of complex trauma, it gets me to a non-judgmental place where I’m able to be very open to hearing someone’s story. And people can sense when you approach them with the assumption that they are very strong and are doing the best they can, as opposed some other attitude.
Some therapists won’t work with people who have borderline traits because many of the symptoms can be high maintenance for a therapist to deal with, especially if they aren’t prepared. Specifically, working with clients who self-harm, have intense mood swings, and are impulsive are not things that all therapists are equipped to deal with. Personally, I find clients who have these traits highly engaged and I usually enjoy working with them. When a clinician says “I don’t work with borderline patients,” they’re also saying they cannot work with people who have complex trauma. Because while the population isn’t the same, there is too much overlap to consider them completely separate populations.
Dialectical behavior therapy (DBT) was developed by Marsha Linehan as a treatment for borderline personality disorder. Borderline personality disorder occurs much more often in people who have a history of childhood trauma, particularly sexual abuse and incest, and many people, including Marsha Linehan, believe that BPD is caused by attachment trauma. Attachment trauma and complex trauma both include symptoms of disruptions of trust and attachment, difficult with emotion regulation, numbing and dissociation.
DBT addresses four areas:
Trauma therapy aficionados will notice that there is no processing component, so DBT works best as a phase 1 treatment: establishing emotional and physical safety, and building up coping skills. You can read more about the other phases of complex trauma therapy here.
For each section I will discuss:
- what each component is
- how it develops in a healthy environment
- ways that an unhealthy environment can impede its development and
- how DBT helps someone learn it
If you’re reading this after mid-January 2014, the hyperlinks in each topic area will get you to the rest of the series.