Dialectic Behavioural Therapy
The dance between the two poles
The word Borderline Disorder often sends a chill down the Spine, even the most experienced therapists, tend to call in sick or try to avoid the wards like Republicans avoiding logic.
To be truthful, they are a cumbersome lot, these borderliners. Moody, changing their opinions like Chameleons changing colors to avoid a predator, when just cutting yourself open is an equivalent of opening a cold can of Heineken in a hot Australian Summer, and Suicide is just a argument away. These rhythmic Gyration between life and death , between pessimissim and outright Determination , can get under the skin of the most experienced Therapist. So when Lysha Neehan popped up on the stage and said that she has a solution, i think Galileo saying that earth revolved around the sun would have been received with more Optimism. But like always time played the litmus Paper role and for us budding Psychiatrist it is the cornerstone to treating Borderline disorders.
When I have flamed your curiosity and set your longing Therapist grey matters on fire. Let us dive right into it. Dialektic thinking pattern is best described through the Phrase , “ a dance between two poles”, This cornerstone rises from the perspective that every subject has a thesis and a antithesis, to be simply put when you will sit down for a therapy session you would be playing the role of a ruthless yet compassionate Teacher who would push you to your limit and still support you the moment he realizes you are going to fall down and this tension that arises from the two polarising approaches, would be the driving energy, which will motivate your patient to change his dysfunctional behavioral Patterns. Sounds incredibly demanding isn’t it, no it isn’t. It is the theory which is
Now let’s get to the boring part, the entire theory of it, what I would certainly recommend reading up, in your free time (Lol!!!) is the Conditioning theory from Skinner, it does play a major role in this therapy. And i would be considering that you would be working in a borderline Station, why this perspective is important is because DBT can also take place in an OPD sitting and the structure is quite different. SO lets consider the Patient is there, his battle Scars discretely hidden behind a thick hoodie, hair colors that change in the wink of an eye, giving you a look trying to find out what is different in you, in comparison to the 10 other therapists who have already tried and failed in giving him the wonder cure. STOP!!! Rewind!!! One thing at this point, that is important for you to reflect and understand is the fact that there would be a filtering process, a Pre-Therapy session which would take place to proof the willingness of the Patient. Let me explain this, when Lysha Neehan developed DBT she was actually finding a way to work with extremely suicidal patients, after years of trying to find a way to motivate the Patients , she realised the biggest Motivation was actually telling them that she had cure for their problems, and I mean it quite literally here, she told them that she would get rid of their problems , but the only prerequisite they would be signing a contract, in which they would promise that during the therapy they would not commit suicide. Oh my dear Plebians, aren’t the simplest things the answer to the most complicated questions. That is the Horcrux, which you will be holding on, as you go through the therapy with the Patient, one of the most important leverage, that you have, as you will be oscillating between motivating him to change and simultaneously validating his problems.
So in this post i have tried introducing you the concept of DBT, a concept which has been over the years proved to be one of the most potent therapy methods in the treatment of borderline disorder and more importantly , instilled my belief once again in the fact that psychiatry is not a branch revolving around 4 groups of medications, but the art of crafting your way through the thought process of the person sitting in front of you.
In the next post, i would be going through the detailed steps, till then, May the force be with you.
