Dialectical Behavior Therapy

Developed by: Marsha M. Linehan


In the late 1970s, Marsha M. Linehan attempted to apply standard Cognitive Behavior Therapy (CBT) to the problems of adult women with histories of chronic suicide attempts, suicidal ideation, urges to self-harm, and self-mutilation. Trained as a behaviorist, she was interested in treating discrete behaviors; however, through consultation with colleagues, she concluded that she was treating women who met criteria for Borderline Personality (BPD).

DBT maintains that some people,due to invalidating environments during upbringing and due to biological factors as yet unknown, react abnormally to emotional stimulation. Their level of arousal goes up much more quickly, peaks at a higher level, and takes more time to return to baseline. This explains why people with Borderline Personality are known for crisis-strewn lives and extreme emotional lability (emotions that shift rapidly). Because of their past invalidation, people with Borderline Personality don’t have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.

Briefly, Linehan hypothesizes that any comprehensive psychotherapy must meet five critical functions. The therapy must: a) enhance and maintain the client’s motivation to change; b) enhance the client’s capabilities; c) ensure that the client’s new capabilities are generalized to all relevant environments; d) enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities; and, e) structure the environment so that treatment can take place.

Skills are acquired, strengthened, and generalized through the combination of skills groups, phone coaching (clients are instructed to call therapists for coaching prior to engaging in self harm), in vivo coaching, and homework assignments.

DBT also organizes treatment into stages and targets and, with very few exceptions, adheres strictly to the order in which problems are addressed. The organization of the treatment into stages and targets prevents DBT being a treatment that, week after week, addresses the crisis of the moment. Further, it has a logical progression that first addresses behaviors that could lead to the client’s death, then behaviors that could lead to premature termination of therapy, to behaviors that destroy the quality of life, to the need for alternative skills. In other words, the first goal is to insure the client stays alive, so that the second goal (staying in therapy), results in meeting the third goal (building a better quality of life), partly through the acquisition of new behaviors (skills).

~Excerpt from Behavioral Tech

Borderline Personality Disorder Resource Center at NewYork-Presbyterian Hospital has released the documentary Back from the Edge on YouTube.

"Back From the Edge" - Borderline Personality Disorder

NewYork-Presbyterian Hospital

Published on Feb 2, 2012

"Back From the Edge" offers guidance on treating Borderline Personality Disorder. The video was created by the Borderline Personality Disorder Resource Center at NewYork-Presbyterian.

Rethinking BPD: A Clinician's View

National Institute of Mental Health (NIMH)

Published on Jan 19, 2011

Dr. Marsha Linehan was featured in a series of lectures on Borderline Personality Disorder hosted by the National Institute of Mental Health in Bethesda, Maryland.  Dr. Linehan is a Professor of Psychology and Director of Behavioral and Therapy Clinics at the University of Washington in Seattle and is credited with developing Cognitive-Behavioral Treatment (CBT) for Borderline Personality Disorder.

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