Dr Linehan had direct personal experience of these problems as well as professional training and experience in well-researched behavioural therapies (see link re: Linehan’s personal history with this).  When she found that traditional behavioural treatments did not seem to work for certain clients she started incorporating eastern psychological theory and practices into her treatment. Through feedback from clients and observations about what worked in the treatment she developed DBT.  The resulting treatment was shown to be highly effective in reducing hospitalisations, helping people stay in treatment (preventing drop out) and reducing suicidal and self harm behaviours, and helping with problems such as depression, anxiety, drug and alcohol use issues, and many other problems.

Initially the treatment was researched as an effective treatment for Borderline Personality Disorder. Over time, however, DBT has been shown to be effective for other groups, such as adolescents with complex, multiple problem behaviours, binge eating, substance abuse and gambling.

In general, DBT tends to be applied when the core problem seems to be emotion regulation.  In DBT many problems, such as ongoing life threatening or self-harming behaviours are viewed as a person’s attempt in the moment to solve the problem of painful emotions. These and other behaviours develop in response to feeling overwhelmed, confused, or lost in emotions, or alternatively being cut off from them. The person learns ways of managing these emotions that may be effective in the short term, drugs for example, but cause more problems in the long term.

At present researchers are trying to work out which bits of DBT make it work and who is it most effective for. In Australia and around the world there are both comprehensive DBT programmes and programmes that have incorporated some of the principles of DBT into their treatment. Similarly, there are clinicians who have extensive, formal training in DBT, and those who incorporate some ideas from DBT in their work. The research indicates that therapists with extensive formal training in DBT achieve better outcomes for their clients, and that people who engage in one-on-one DBT therapy while also attending a DBT group get better outcomes. Furthermore, it appears that when family members and significant others attend a DBT group as well, outcomes are further improved.

Sounds confusing? Well It can be! Especially if the two people are in a discussion and both are trying to establish who is right. It can lead to conflict, things could get heated, and one or the other person may end up feeling unheard, invalidated, angry, dejected and so on. What if the people agreed, however, that they were both right and both wrong, and worked to find a common place that allowed for difference and at the same time allowed them to move forward effectively? That sounds like a good thing. That would be a dialectical solution.

Where it gets really interesting and indeed helpful is when people apply these ideas to themselves. How often do people try to work out whether they are right wrong, good or bad, smart of dumb, and so on. Applying a dialectical approach means letting go of this kind of stuff, accepting there may be truth in both views, letting go of the struggles these types of dilemmas cause, and trying to find a view that allows you to be effective in finding a way forward. It may sound easy but taking this view is very challenging at fist as it involves finding a whole new way of doing things. However, with practice it is a skill that anyone can develop.

The Biosocial Theory

Dr Linehan’s research and other research on the brain shows that some people tend to experience things more intensely, and as a result are more reactive to events than other people.  This can be something that is part of the person’s genetics or the product of early life experience.. Either way, the person has a higher degree of sensitivity to emotions, so that they are activated more easily, heightened in their response, and slower to come back down once activated.

It is important to note that it is not just the person reacting more intensely. That could sound like blaming! It is that their experience is more intense for all events, both pleasant and unpleasant. Dr Linehan refers to this as lacking an emotional skin, and likens it to a burns victim who experiences pain at the slightest touch.

Emotional sensitivity is not a problem in itself, In fact it has many benefits, such as increased intensity of love, passion, empathy and connection.  However, when a person does not know how to take care of their sensitivity they may learn to dull the pain through escaping or avoiding emotions. This can lead to extreme behaviours that have their own consequences, as well the by-product of maintaining the belief that the person cannot tolerate and cope with intense emotions.

The Role of Invalidation and Validation

When a person experiences emotions that are more intense than those around them they often different from others, and that can leave them feeling disconnected or alienated.  They may receive a range of messages from those around that they should tone down their emotions, such as being told they are ”too emotional”, or “too sensitive”.  They may then experience a sense of being rejected, not understood or punished for their emotional intensity.  Over time the person starts to believe the messages that their emotions should not be as they are, or that “hey are over reacting. They may then learn to distrust their own emotional experience and start to reject or punish themselves for their emotional experience. Dr Linehan says that you cannot ride and have control of a horse without being on the horse, so if you reject your emotional experience it is hard to learn how to manage it. This brings us to another dialectic in DBT; in order to manage or change our response to our emotions we must first accept that this is the experience we are having.

Skills

Part of the solution in managing ongoing intense emotional distress.

What does DBT suggest is the solution to ongoing intense emotional experiences? The experience of having intense emotional experiences has been likened to being equipped with a Formula One race car motor when everyone around you is driving a standard car. Most people learn how to drive in an ordinary car and so the advice most people get about driving relates to this. However, to drive a Formula One car you need more specialised skills, otherwise you are going to careen around, feeing out of control, and crashing.  Similarly, most people can get on a horse, do a few laps around the paddock, or even a trail ride, without too much trouble. However, it takes specialist skills to ride a thoroughbred racehorse. What’s more, and this is very important, to learn how to drive a Formula One car or ride a thoroughbred, takes time and practice. Similarly, learning to manage emotions that are more sensitive to the outside world requires learning and practising different skills.

DBT skills

Aguirre, B. & Galen, G. (2013). Mindfulness for borderline personality disorder: relieve your suffering using the core skill of Dialectical Behavior therapy. New Harbinger Publications. CA

Hoekstra, R. (2013). The Emotional Extremist’s Guide to Handling Cartoon Elephants: How to Solve Elephantine Emotional Problems Without Getting Run Over, Chased, Flattened. Hoekstra

Linehan, M.M. (2015) DBT Skills Training Handouts and Worksheets 2^nd Edition . The Guilford Press, N.Y.

Spradlin, S. (2003). Don’t Let Your Emotions Run Your Life: How Dialectical Behavior Therapy Can Put You in Control. Oakland: New Harbinger

Van Dijk, S. (2011). Don’t Let Your Emotions Run Your Life for Teens: Dialectical Behavior Therapy Skills for Helping You Manage Mood. Oakland. New Harbinger Publications

Websites

http://www.bpdresources.net/

http://www.dbtselfhelp.com

http://www.myborderlinelife.co.uk/

http://www.bpdcentral.com/

http://www.tara4bpd.org

http://www.buddhaandborderline.com/

http://www.mydialecticallife.com

http://www.behavioraltech.com/

http://www.borderlinepersonalitydisorder.com

http://www.my-borderline-personality-disorder.com

Books for those experiencing BPD

Chapman, A. L., & Gratz, K. L. (2007). The borderline personality disorder survival guide: Everything you need to know about living with BPD. New Harbinger Publications

Chapman, A. L., & Gratz, K. L. (2013). Borderline Personality Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications

Kreisman, Jerold; and Straus, Hal. (2004). Sometimes I Act Crazy: Living with Borderline Personality Disorder.  New York: Wiley

Kreisman, Jerold; and Straus, Hal. (2010). I Hate You – Don’t Leave Me: Understanding the Borderline Personality. New York: Wiley

Personal Stories

S.R. Blauner, S.R. (2003). How I stayed alive when my brain was trying to kill me: one person’s guide to suicide prevention. William Morrow Paperbacks

Johnson, M.L. (2010). Girl in need of a tourniquet: memoir of a borderline personality. Seal Press, California

Pershall, S. (2012). Loud in the House of Myself: Memoir of a Strange Girl. WW Norton & Company

Reiland, Rachel. (2004). Get Me Out of Here : My Recovery from Borderline Personality Disorder.  Hazelden City Center, Minn: Hazelden

Van Gelder, K. (2010). The Buddha & The  Borderline: My Recovery from Borderline Personality Disorder through Dialectical Behavior Therapy, Buddhism & Online Dating. Oakland: New Harbinger

DBT was designed to be a comprehensive treatment programme for people with more complex problems. The two core treatment aspects of DBT are the skills group and one-on-one therapy. At Sydney DBT we offer both skills groups and individual therapy, along with phone coaching, consult group, and programmes for families, friends and carers. In this way Sydney DBT offers one of the very few fully comprehensive, integrated DBT programmes in Australia.

The DBT skills group is aimed at helping people learn the core DBT coping skills that will allow them to manage their emotions, actions and thoughts effectively.

People who attend the skills group participate in an active process that helps them acquire new skills. This is quite different from most ‘psychotherapy’ groups, which focus in in-depth exploration and analysis of the person’s personality and past history. In DBT group we work on what is happening how, and how to develop ways of responding differently and effectively.

Over the twenty weeks participants learn four different sets of skills, these are Distress Tolerance, Emotional Regulation, Mindfulness, and Interpersonal Effectiveness.

Distress tolerance skills help people to withstand and overcome strong emotions and urges. They are central to managing problems such as drug and alcohol use, self-harm, suicidal urges and so on.

Emotional regulation skills help the person develop a more effective and liveable emotional world. The skills build emotional awareness and resilience, and help reduce vulnerability to problematic emotions.

Mindfulness is a common component of mots psychological therapies now days. However, it has been a part of DBT for many years. Mindfulness helps people to be more aware of, and engage more effectively with, their inner world. Through mindfulness people learn to step back and not get so caught up in unhelpful thoughts and feelings.

interpersonal effectiveness skills are all about relationships. They help people to form relationships more effectively, functional well and grow within relationships, and even end them in the best possible way if the need arises.

To find out more contact us at DBTintake@sydneyclinicalpsychology.com.au

There are many, many ways you can help, but from a DBT perspective there are perhaps four. The first is to understand the difficulties your loved one is experiencing from a scientifically validated approach, such as DBT. The theory behind DBT is solidly founded in scientifically based principles. The theory behind DBT is called the biosocial theory and you can read about it elsewhere on this website. This theory will give you a great understanding into what is happening for your loved one.

This second is to learn effective validation skills. In brief , validation is communicating that the person’s experience makes sense and is understandable in some way. The biosocial model explains why this is helpful. Validation is a core skill in DBT and central to helping people who come to DBT for treatment. Effective validation is a skill that can be learnt with practice, and in our experience major changes can come about when significant other develops the skills taught in DBT.

If you look in chat rooms, on YouTube, at blogs and other social media you will find people discussing whether to involve family members by disclosing difficulties. One common discussion is about whether to tell parents about self-harm or other problem behaviours. You find lots of advice from people to not tell parents or loved ones. This advice is driven by bad experiences or fears that: parents can’t be trusted, things might change for the worse afterwards, loved ones will get angry, they’ll tell my teachers/work and so on. These fears all centre around invalidation. The person fears that telling someone will be an invalidating experience. Invalidation and the fear of being invalidated can increase a person’s distress and make it harder to accept support. So learning how to validate, is crucial.

The third way you can help is to learn about change from a DBT perspective. Change is important for anyone wanting to overcome emotional problems. DBT has many changes strategies and teaches skills such as mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. If your loved one is in DBT you can really help by learning about the skills they are trying to build. You can learn how to encourage the use of these skills, and to reinforce them when the person puts them to use. It is also important to know how to balance supporting and encouraging change with validation when helping someone

The final way you can help is to look after yourself effectively. Caring for anyone with a psychological problem can be tough, and it becomes more demanding the more complex the problems. If you experience sleep problems for just a few nights it could negatively impact on your ability to be an effective support. Longer-term impacts can include depression, anxiety, problems with alcohol, and so on, all of which will definitely make it harder to be more effective. In the end you may develop burn out or compassion fatigue, and that will really make things tough.

Information for families on how to help:

• How to Help a Loved One with Borderline Personality Disorder – Part 1 | Part 2
• Families on the Line Using Dialectical Behavioral Therapy

The families, friends, partners and carers play a number of very important roles the lives of people with psychological problems. First and foremost, they can play an important role in supporting and helping their loved one cope with their problems and develop more effective coping skills.

Anyone who has been in a relationship of some sort with someone with a more severe or complex problem will know that interactions can at times be challenging. Even people with the very best intentions may do or say things that make things worse at that time. Frustrations can boil over into anger, harsh things are said, then there is guilt, regret and so on. Sometimes these interactions develop into long term patterns, while at other times that may result in the relationship falling apart.

People who attend the skills group participate in an active process that helps them acquire new skills. This is quite different from most ‘psychotherapy’ groups, which focus on in-depth exploration and analysis of the person’s personality and past history. In DBT group we work on what is happening how, and how to develop ways of responding differently and effectively.

There is also the problem of carer burden. Families, friends, partners, carers and so on can often develop their own problems as a result of their role. Depression, anxiety, problems with alcohol or drugs, can all be a consequence of carer burden. Often people feel guilty that they have a problem and will try to hide it, or they may not seek help even if they need it.

The DBT Family and Friends programme is aimed at these and other issues. Through the programme participants learn how to help their loved one more effectively and how to also help themselves.

The programme helps participants to:

• Understand complex and severe psychological problems from a DBT perspective
• Use the DBT perspective to develop an understanding of their loved one’s problems
• Understand what his going on in treatment for their loved one
• Develop skills that complement DBT therapy
• Apply DBT skills to their own emotions
• Model the skills taught in DBT in their relationship with their loved one
• Cope with their own feelings of guilt, anger, blame, regret and so on
• Develop their own self-care skills, including setting and maintaining boundaries

The programme runs once a week in the evening for twelve weeks. It involves a group of approximately fifteen people who are in some way involved with someone with the type of problem usually helped by DBT. The groups involve discussions, teaching, skills development, and homework. The groups are very supportive and focused on developing long lasting change.

To find out more contact us at DBTintake@sydneyclinicalpsychology.com.au

Katie grew up in a small beachside suburb in far north Queensland. Her parents and sisters rose early to surf everyday and loved the beach life. Summer was full of hanging out at the beach and evening barbeques. Her mum ran a local shop and her dad was a carpenter. Both were very involved in the community and surf-lifesaving. The family was well known and well liked and everyone called them easygoing people. Katie was pale-skinned, never liked the beach, and preferred to sleep in. She just didn’t seem to enjoy the same things as her family. She felt that she didn’t fit in no matter how much her family tried to include her. At school she didn’t identify with the surf culture and preferred to develop an alternative image. People didn’t describe Katie as easygoing. She seemed uninterested in everyone and unhappy as a teenager. Her parents tried to cheer her up but that pushed her further into being withdrawn and negative. She spent more time in her room alone longing to leave home. Katie started to self-harm to cope with her feelings of despair. She also binged on alcohol. At 15 she was hospitalised after she cut herself . Soon after she left home in Sydney. In Sydney she got a job but struggled to meet people. She continued to feel out of place and coped with self-harm and alcohol. Her family told her she was always welcome at home and asked her to come back. This made her more distressed.

Li’s mum and dad worked hard throughout their life and dad was often working during Li’s childhood. Her mum was always busy with housework and looking after the family. Dad was often tired and short-tempered. When Li was eight she was sexually assaulted by a neighbour. She was afraid of what her parents might say so told no one. She became withdrawn and cautious of people. The family thought it was ‘just Li’ and didn’t take much notice of the changes. As a teenager she experienced emotions very strongly, particularly fear of new people. She developed problems with trust and tended to get angry when people tried to get close to her. This led her to be bullied and to occasionally bully others at school. She had one close relationship with a friend at school but they fell out over a boyfriend, and her other friendships were not that supportive. At 15 Li became quite promiscuous. Her parents found out and were angry at her. They felt they had worked hard to bring her up the right way. There was a lot of conflict at home and Li started to self-harm. She wanted to punish herself when she felt she did things wrong as the guilt was overwhelming.

Sonja’s parents were hard working who built a very successful business. They had all the signs of success; a big house, cars etc. Sonja went to a private school and her parents had high expectations for her. They felt they had worked hard to get her a good education and that she should not waste it. They made her work hard and study. She did well at school but never felt it was enough. Her parents would punish her for not working hard enough but rarely praised her successes. They thought that hard work was the norm and that their daughter didn’t need to be praised for it. At 14 Sonja developed an eating disorder but her parents didn’t notice. They thought that she looked good and was being careful with her appearance. Soon after she started to self harm whenever her emotions became too greatintense felt “too strong”?. Her parents did not know she self-harmed and were in denial about her eating disorder. By the time she was sixteen Sonja was suffering from depression and had regular panic attacks.

VIDEOS FOR FAMILY

BPD from a client perspective

Tom – http://www.youtube.com/watch?v=gWU6vSYM4dU

Advice for mums and dads – http://www.youtube.com/watch?v=_b_QDENOOw8

Lets talk self harm – if can handle disruption in adds many good points, also put up sequel to friends of self harm, a bit focused on body image, however great points – http://www.youtube.com/watch?v=QrNXpV9-HPY

Interesting video about the effects of bullying – http://www.youtube.com/watch?v=Cx27wL7E6So

DVD

If Only We Had Known: A Family Guide to Borderline Personality

The five videos in the series are available in two formats. One is via streaming video which can be obtained at the website. http://www.bpdvideo.com. Each video can be viewed several times over the course of a month and cannot be saved. The cost is $14.99 per video.

The programs are also available on DVD via Amazon. The cost is $99.99 per DVD or $449.99 for the five part set.

Instructions for accessing the instant streaming videos and the DVD are located on the website.

NEABPD has a distance family psycho-education program called Tele-connections. It’s an offshoot of their location based Family Connections program. You can learn more about this from the NEABPD website http://borderlinepersonalitydisorder.com.

BOOKS FOR FAMILIES

Aguirre, B.A. (2007) Borderline Personality Disorder in Adolescents: A complete guide to understanding and coping when your adolescent has BPD. Fair Winds Press. 

Harvey, P., Penzo, J.A. (2009). Parenting a Child Who Has Intense Emotions; Diaectical Behavior Therapy Skills to Help Your Child regulate emotional Outburts & Aggressive Behaviors. New Harbinger Publications. CA

Hollander, M (2008). Helping teens who cut, understanding and ending self-injury. The Guiford Press. NewYork

Fruzzetti, A.E (2006). The high conflict couple; A Dialectical Behavior Therapy Guide to Finding Peace, Intimacy & Validation. New Harbinger Publications. CA

Manning, S. (2011). Loving Someone with Borderine Personality Disorder. How to Keep Out-of-Control Emotions from Destroying Your Relationship. The Guilford Press. NewYork

Porr, V. (2010). Overcoming Borderline Personality Disorder; A Family Guide for Healing and Change. New York, Oxford University Press

Brief written overview of the experience of emotional sensitivity:

• The Emotional Vulnerability of Borderline Personality Disorder

Finding a DBT therapist-brief overview of DBT and questions to ask to find a therapist:

• Finding a DBT therapist

BORDERLINE PERSONALITY DISORDER

An open letter – http://www.youtube.com/watch?v=KGXdxtZZisE

The quiet Borderline – http://www.youtube.com/watch?v=9CoASG8VseQ&list=PLKw8iI-cO80UjDQaKa8RwesDl_6GEO7pj

Compassionate documentary – http://www.youtube.com/watch?v=Ikl4GjQHPz4&list=PLKw8iI-cO80UjDQaKa8RwesDl_6GEO7pj&index=3

Back from the Edge, doco-with lots of supportive info for families and clients – https://www.youtube.com/watch?v=967Ckat7f98

WEBSITES

BPD family:

http://bpdfamily.com/index.html

http://www.borderlinepersonalitydisorder.com

http://www.tara4bpd.org/dyn/index.php

Who are the groups suitable for?

Our groups are for people aged 18 and over. 

All group participants need to also see an individual DBT psychologist while attending the group (not necessarily from our practice). This is because DBT has been shown by research to be most effective when learned through a combination of group therapy and individual therapy.

What does the programme cover?

The group goes through 4 modules: distress tolerance, mindfulness, emotional regulation and interpersonal connection. Each module involves learning core skills that have been shown to be effective in helping people manage their emotions more effectively.  

Where are they located?

Our groups are located in Newtown and Sutherland. 

Are the groups face to face or can I do it online?

Our skills groups are held face to face because we have found that they work much better that way. The rooms we use are large enough to hold 25 people while still complying with social distancing requirements, and the groups are not larger than 12-14 people. 

When are the group sessions held? 

The groups run two hours a week for twenty weeks, on different days of the week. Once you have been offered a place in a group, we will advise what days and times are available and do our best to meet your preference. 

How much is the cost?

The cost for the group is $140 per session, totalling to $2800. With a Medicare Mental Health Care Plan, you are able to receive roughly $660 in rebates If you wish to pay using private health insurance you would need to pay up front and claim it back – please talk to your health insurer about how much they would cover (please also note we are not a hospital setting, which may impact exactly what is covered). 

We also run subsidised groups funded by the Primary Health Network in both Newtown and Sutherland. 

What is the process?

You do not need a referral to participate in our groups. However, to claim a Medicare rebate you will need a referral from your GP, and so it is best to get one if you are able to do so. 

Once there is space available in an upcoming group we will call and invite you to come in for an assessment. The assessment fee is $280 and with a GP referral and Mental Health Care Plan a rebate of $141 is available. 

How long is the waiting list?

How long you may wait to start the group depends on when you contact us relative to when we are next running a group. As DBT groups run for twenty weeks, if you contact us just before a group starts you may wait twenty weeks, but if you contact us near the end of the group the wait could be much less. 

Where else can I find a programme?

There are a number of other programmes in Sydney that provide DBT skills-training and these include: St John of God Hospital in Burwood, Wesley Mission Hospital in Ashfield, and The Sydney Clinic in Bronte. Additionally, some Lifeline centres run programmes (particularly in Northern Sydney: Lifeline Northern Beaches and Lifeline Harbour to Hawkesbury). Public hospitals also run free groups, although their waitlists can be quite long. 

Can I see an individual / one-on-one therapist at your practice?

We have a number of highly trained clinicians who offer individual DBT. However, the waitlist for individual DBT with us varies from time to time and so it is best to check availability with us and also consider other qualified DBT therapists. 

The cost of an individual session ranges between $230-$310 depending on the psychologist. If you have a Mental Health Care Plan from your GP you can access a rebate of $141 per session for up to 10 individual sessions per year, on top of 10 group sessions. If you are interested in individual DBT therapy, please contact the clinic to speak to the intake officer.

I have a family member with BPD, can I join your group?

Our groups are therapy groups and therefore not suitable for family members, friends or carers. However, we also run a Family and Friends programme in both Newtown and Sutherland. You can find more information on our For Family and Friends page.  

Suite 211, RPA Medical Centre
100 Carillon Avenue
Newtown, NSW 2042
ph (02) 9517 1764 fx (02) 9517 1832