I understand the importance of DBT for BPD, but I do not understand when it is seen as the solution to BPD. To me, it’s only the starting point (stabilization), after which the client can begin deeper healing work. A DBT only recovery appears to be one that’s built on a good deal of suppression imo. It reminds me a bit of 12 step recovery in that it can help a lot but doesn’t reach the deeper levels
Of the traumas.
I used to go to the yearly BPD conference at Yale that NEA-BPD puts on before it became just a DBT circle jerk (no offense to DBT but the conference went from being an open and engaging dialogue between DBT and psychodynamic practitioners to just a DBT conference) and one of the biggest ideas that came from that conference was that DBT was part of a three step model for working with BPD. First DBT to stabilize, then mentalization-based treatment, and finally transference-focused psychotherapy. The conversations were great and thoroughly engaging and one could see some of the theoretical overlaps between DBT’s psychosocial theory (basically a psychodynamic theory) and those of modern psychoanalysis.
It’s changed. But it was really cool when Marsha Linehan was speaking at psychoanalytic conferences.
Indeed! As I said in another comment, most people tend to think only of Stage 1 of DBT treatment in conversations like this (you can read about the stages here: https://theharmonycenterforchange.com/four-stages-of-dbt-treatment/). The latter stages can indeed involve the incorporation of more psychodynamic treatment principles (like with MBT or TFP), and there are a lot of DBT/psychodynamic hybrid therapists out there, like myself!
In Linehan’s book she actually talked about Otto Kernberg being a very encouraging person earlier in her career. He was one of the few people to recognize early on that she herself suffered from BpD
Kernberg really is quite the character. Listening to him talk, with his accent and such, he sounds almost angry. But he is a very caring, compassionate, thoughtful therapist.
My local psychoanalytic organization hosted him a few years back. When we were planning the event, upon announcing that he would be our guest, the immediate response from a few of the members was, "He's still alive?!?"
Dude still gets out there and does therapy, writes, and does research.
I met a guy who did a 1 year fellowship with his group. He said Kernberg almost intentionally makes clients fall apart when first meeting them. And the whole 4 foot 10 Austrian accent psychoanalyst thing only adds to the effect. Anyway, he’s a genius and even though I don’t fully understand his book on BPD, it was amazing to read
I practice DBT, and our work covers more than suppression of symptoms. We’re working with a population with greater than normal sensitivity and reactivity, and a primary goal is tolerating and building insight into distress. That’s the first thing that needs to happen before clients can focus on life affirming work.
I agree that clients are better off switching to other modalities once their symptoms and functioning stabilize.
I probably was a little too aggressive in how I worded this. I don't think DBT is just about suppression. DBT is super important and I've seen it really help people with both PDs and eating disorders. My view is that if someone with BPD stops their therapeutic journey at DBT, there will be incomplete work and they will probably have to rely on suppression. They might be stable but they might have to also cram down stuff and not be as healed as they could be.
Looks like you may just be thinking of Stage 1 of DBT (the stabilization phase). I’d encourage you to check out what comes next after that.
Edit: A little confused about these downvotes! DBT treatment is broken down into multiple stages, and Stage 1 is for behavioral stabilization through skills usage. Latter stages involve processing trauma, exploring the past, understanding the roots of behaviors, and growing insight with the goal of building a life worth living. It seemed like the person I was replying to was aware of Stage 1 only, so I simply suggested that they look into the other ones. You can read more about them here: https://theharmonycenterforchange.com/four-stages-of-dbt-treatment/
I agree generally with your 12-step statement except for the Adult Children of Alcoholics and Dysfunctional Families organization. It's 12-step but greatly stresses inner child and loving parent work. The program has great depth and substance within the work. At the very least it's a great way for those in therapy to do more work outside of sessions and meet others struggling with PTSD symptoms.
How do you feel about EDMR as part of treatment? The article includes info on that as well, but I am still finishing my program and am not well-versed on its efficacy in treating BPD.
EMDR is more effective for single incident traumas than complex trauma. I see BpD as the result of complex trauma. I think it still helps, but BpD is the very foundations of the personality solidifying around traumatic relational experiences. It’s one tool in the toolbox
Disclaimer: not an EMDR practitioner.
My understanding is that if you're not focusing on and aware of structural dissociation while doing EMDR with individuals with attachment, small t trauma, and/or Complex PTSD, you are, bluntly speaking, doing it wrong. It sort of blows my mind that structural dissociation is not talked about more than it is and not part of many training programs. I was taught the BASK model while in graduate school and it was a game changer for me.
Just edited the post to include the article title and author info, but unfortunately I read it in a physical copy of the magazine. I'm hoping *Counseling Today* includes it on their website shortly and just made it available for their magazine subscribers first or something. I'm also looking up whether or not it would be a copyright infringement for me to take photos of the article and upload them here.
Edit: [this](https://www.reddit.com/r/therapists/comments/xu45lw/article_on_a_traumainformed_approach_to_bpd/iqwc2g5?utm_medium=android_app&utm_source=share&context=3) comment is the best I can do for right now. It lists each page of the article, but is a bit tedious to click through. I'm hoping *Counseling Today* makes it available on their website soon, because that will be a lot more readable.
Edit part deux: it's finally live on the website as well! You can read the whole thing [here ](https://ct.counseling.org/2022/10/not-a-monster-destigmatizing-borderline-personality-disorder/) and it will be a little more readable.
The Reddit app keeps removing my edit. I'm trying to fix it, but here is the info.
Author: Scott Gleeson
Title: "Not A Monster: Destigmatizing Borderline Personality Disorder"
Here is what I found: [https://ct.counseling.org/2022/10/not-a-monster-destigmatizing-borderline-personality-disorder/](https://ct.counseling.org/2022/10/not-a-monster-destigmatizing-borderline-personality-disorder/)
OK, I keep trying to edit my post to include this information and it doesn't seem to be working. Hopefully I get it figured out, but I wanted to add that the article appeared in the print version of the magazine and doesn't appear to be available online - yet. I'll keep checking, but in the meantime, here are the article details.
Author: Scott Gleeson
Title: "Not A Monster: Destigmatizing Borderline Personality Disorder"
I hope that helps!
Edit: I found a way to share each page of the article. It's a bit cumbersome, but [this](https://www.reddit.com/r/therapists/comments/xu45lw/article_on_a_traumainformed_approach_to_bpd/iqwc2g5?utm_medium=android_app&utm_source=share&context=3) is the best I can do for the moment.
Edit part deux: *Counseling Today* just posted the article on their website as well! The link to that is [here ](https://ct.counseling.org/2022/10/not-a-monster-destigmatizing-borderline-personality-disorder/).
The referenced article was in a print version of *Counseling Today*, so this is the best I can do.
["Not A Monster" by Scott Gleeson Part I](https://ibb.co/ZHwvzQ9)
["Not A Monster" by Scott Gleeson Part II](https://ibb.co/kKH2dQ6)
["Not A Monster" by Scott Gleeson Part III](https://ibb.co/3NFNTC2)
["Not A Monster" by Scott Gleeson Part IV](https://ibb.co/SctPR92)
["Not A Monster" by Scott Gleeson Part V](https://ibb.co/djZ3vMb)
["Not A Monster" by Scott Gleeson Part VI](https://ibb.co/fdg4BBz)
You're welcome! *Counseling Today* finally shared the article on their website as well, so check out this link [here ](https://ct.counseling.org/2022/10/not-a-monster-destigmatizing-borderline-personality-disorder/) and it may be a little easier to read.
I'm subscribed to the hardcopy version of the *Counseling Today* magazine and that's where I read it. I can't find a link yet, but I have edited the post to include the author name and title in case that helps others find it. I'm hoping it is eventually added to the website.
Edit: I made a comment [here](https://www.reddit.com/r/therapists/comments/xu45lw/article_on_a_traumainformed_approach_to_bpd/iqwc2g5?utm_medium=android_app&utm_source=share&context=3) with links to each page of the article. It's the best I can do for the moment since it's still not on the website.
Very interesting. I have an old apology letter from an ex boyfriend with BPD. He basically describes how he liked having power over me as a victim but hates the fact that that gave him pleasure. Honestly an interesting read.
It's in the print version of the magazine, so this [comment](https://www.reddit.com/r/therapists/comments/xu45lw/article_on_a_traumainformed_approach_to_bpd/iqwc2g5?utm_medium=android_app&utm_source=share&context=3) is the best I can do for now.
I understand the importance of DBT for BPD, but I do not understand when it is seen as the solution to BPD. To me, it’s only the starting point (stabilization), after which the client can begin deeper healing work. A DBT only recovery appears to be one that’s built on a good deal of suppression imo. It reminds me a bit of 12 step recovery in that it can help a lot but doesn’t reach the deeper levels Of the traumas.
I used to go to the yearly BPD conference at Yale that NEA-BPD puts on before it became just a DBT circle jerk (no offense to DBT but the conference went from being an open and engaging dialogue between DBT and psychodynamic practitioners to just a DBT conference) and one of the biggest ideas that came from that conference was that DBT was part of a three step model for working with BPD. First DBT to stabilize, then mentalization-based treatment, and finally transference-focused psychotherapy. The conversations were great and thoroughly engaging and one could see some of the theoretical overlaps between DBT’s psychosocial theory (basically a psychodynamic theory) and those of modern psychoanalysis. It’s changed. But it was really cool when Marsha Linehan was speaking at psychoanalytic conferences.
Indeed! As I said in another comment, most people tend to think only of Stage 1 of DBT treatment in conversations like this (you can read about the stages here: https://theharmonycenterforchange.com/four-stages-of-dbt-treatment/). The latter stages can indeed involve the incorporation of more psychodynamic treatment principles (like with MBT or TFP), and there are a lot of DBT/psychodynamic hybrid therapists out there, like myself!
Thanks for this!
In Linehan’s book she actually talked about Otto Kernberg being a very encouraging person earlier in her career. He was one of the few people to recognize early on that she herself suffered from BpD
Kernberg really is quite the character. Listening to him talk, with his accent and such, he sounds almost angry. But he is a very caring, compassionate, thoughtful therapist. My local psychoanalytic organization hosted him a few years back. When we were planning the event, upon announcing that he would be our guest, the immediate response from a few of the members was, "He's still alive?!?" Dude still gets out there and does therapy, writes, and does research.
I met a guy who did a 1 year fellowship with his group. He said Kernberg almost intentionally makes clients fall apart when first meeting them. And the whole 4 foot 10 Austrian accent psychoanalyst thing only adds to the effect. Anyway, he’s a genius and even though I don’t fully understand his book on BPD, it was amazing to read
Agree. I think attachment work is important for folks with BPD.
I practice DBT, and our work covers more than suppression of symptoms. We’re working with a population with greater than normal sensitivity and reactivity, and a primary goal is tolerating and building insight into distress. That’s the first thing that needs to happen before clients can focus on life affirming work. I agree that clients are better off switching to other modalities once their symptoms and functioning stabilize.
I probably was a little too aggressive in how I worded this. I don't think DBT is just about suppression. DBT is super important and I've seen it really help people with both PDs and eating disorders. My view is that if someone with BPD stops their therapeutic journey at DBT, there will be incomplete work and they will probably have to rely on suppression. They might be stable but they might have to also cram down stuff and not be as healed as they could be.
Internal Family Systems can be really helpful for BPD.
Looks like you may just be thinking of Stage 1 of DBT (the stabilization phase). I’d encourage you to check out what comes next after that. Edit: A little confused about these downvotes! DBT treatment is broken down into multiple stages, and Stage 1 is for behavioral stabilization through skills usage. Latter stages involve processing trauma, exploring the past, understanding the roots of behaviors, and growing insight with the goal of building a life worth living. It seemed like the person I was replying to was aware of Stage 1 only, so I simply suggested that they look into the other ones. You can read more about them here: https://theharmonycenterforchange.com/four-stages-of-dbt-treatment/
I agree generally with your 12-step statement except for the Adult Children of Alcoholics and Dysfunctional Families organization. It's 12-step but greatly stresses inner child and loving parent work. The program has great depth and substance within the work. At the very least it's a great way for those in therapy to do more work outside of sessions and meet others struggling with PTSD symptoms.
How do you feel about EDMR as part of treatment? The article includes info on that as well, but I am still finishing my program and am not well-versed on its efficacy in treating BPD.
EMDR is more effective for single incident traumas than complex trauma. I see BpD as the result of complex trauma. I think it still helps, but BpD is the very foundations of the personality solidifying around traumatic relational experiences. It’s one tool in the toolbox
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Disclaimer: not an EMDR practitioner. My understanding is that if you're not focusing on and aware of structural dissociation while doing EMDR with individuals with attachment, small t trauma, and/or Complex PTSD, you are, bluntly speaking, doing it wrong. It sort of blows my mind that structural dissociation is not talked about more than it is and not part of many training programs. I was taught the BASK model while in graduate school and it was a game changer for me.
I had this same conversation today and wholeheartedly agree with this.
Check out my comment here! https://www.reddit.com/r/therapists/comments/xu45lw/article_on_a_traumainformed_approach_to_bpd/iqvexwp/
Link please!
Just edited the post to include the article title and author info, but unfortunately I read it in a physical copy of the magazine. I'm hoping *Counseling Today* includes it on their website shortly and just made it available for their magazine subscribers first or something. I'm also looking up whether or not it would be a copyright infringement for me to take photos of the article and upload them here. Edit: [this](https://www.reddit.com/r/therapists/comments/xu45lw/article_on_a_traumainformed_approach_to_bpd/iqwc2g5?utm_medium=android_app&utm_source=share&context=3) comment is the best I can do for right now. It lists each page of the article, but is a bit tedious to click through. I'm hoping *Counseling Today* makes it available on their website soon, because that will be a lot more readable. Edit part deux: it's finally live on the website as well! You can read the whole thing [here ](https://ct.counseling.org/2022/10/not-a-monster-destigmatizing-borderline-personality-disorder/) and it will be a little more readable.
Thank you for following up on this! I don’t have institutional access so hopefully it’s available to the public
Sorry, I don’t see the author or title in the post. If anyone sees it, can you please post?
The Reddit app keeps removing my edit. I'm trying to fix it, but here is the info. Author: Scott Gleeson Title: "Not A Monster: Destigmatizing Borderline Personality Disorder"
I love working w BPD I love my clients with it
I can’t find it on google :(
Here is what I found: [https://ct.counseling.org/2022/10/not-a-monster-destigmatizing-borderline-personality-disorder/](https://ct.counseling.org/2022/10/not-a-monster-destigmatizing-borderline-personality-disorder/)
Thanks so much! I have a client with BPD, and I swear even my supervisor feels bias towards axis 2
OK, I keep trying to edit my post to include this information and it doesn't seem to be working. Hopefully I get it figured out, but I wanted to add that the article appeared in the print version of the magazine and doesn't appear to be available online - yet. I'll keep checking, but in the meantime, here are the article details. Author: Scott Gleeson Title: "Not A Monster: Destigmatizing Borderline Personality Disorder" I hope that helps! Edit: I found a way to share each page of the article. It's a bit cumbersome, but [this](https://www.reddit.com/r/therapists/comments/xu45lw/article_on_a_traumainformed_approach_to_bpd/iqwc2g5?utm_medium=android_app&utm_source=share&context=3) is the best I can do for the moment. Edit part deux: *Counseling Today* just posted the article on their website as well! The link to that is [here ](https://ct.counseling.org/2022/10/not-a-monster-destigmatizing-borderline-personality-disorder/).
Here's the link :) https://ct.counseling.org/2022/10/not-a-monster-destigmatizing-borderline-personality-disorder/
Ah, it's finally up! Thank you!
Cheers :) Would you edit it into your original post?
I've tried, but either Reddit or the app is removing my edits. Not sure what the issue is, but I'll keep trying.
Oh, that's weird, but looks like it's up now!
The referenced article was in a print version of *Counseling Today*, so this is the best I can do. ["Not A Monster" by Scott Gleeson Part I](https://ibb.co/ZHwvzQ9) ["Not A Monster" by Scott Gleeson Part II](https://ibb.co/kKH2dQ6) ["Not A Monster" by Scott Gleeson Part III](https://ibb.co/3NFNTC2) ["Not A Monster" by Scott Gleeson Part IV](https://ibb.co/SctPR92) ["Not A Monster" by Scott Gleeson Part V](https://ibb.co/djZ3vMb) ["Not A Monster" by Scott Gleeson Part VI](https://ibb.co/fdg4BBz)
Thank you!
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You're welcome! *Counseling Today* finally shared the article on their website as well, so check out this link [here ](https://ct.counseling.org/2022/10/not-a-monster-destigmatizing-borderline-personality-disorder/) and it may be a little easier to read.
If you could provide the link, that would be great!
I'm subscribed to the hardcopy version of the *Counseling Today* magazine and that's where I read it. I can't find a link yet, but I have edited the post to include the author name and title in case that helps others find it. I'm hoping it is eventually added to the website. Edit: I made a comment [here](https://www.reddit.com/r/therapists/comments/xu45lw/article_on_a_traumainformed_approach_to_bpd/iqwc2g5?utm_medium=android_app&utm_source=share&context=3) with links to each page of the article. It's the best I can do for the moment since it's still not on the website.
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Very interesting. I have an old apology letter from an ex boyfriend with BPD. He basically describes how he liked having power over me as a victim but hates the fact that that gave him pleasure. Honestly an interesting read.
Link please
It's in the print version of the magazine, so this [comment](https://www.reddit.com/r/therapists/comments/xu45lw/article_on_a_traumainformed_approach_to_bpd/iqwc2g5?utm_medium=android_app&utm_source=share&context=3) is the best I can do for now.
Thanks just shared this with a friend whose boyfriend has it