While a good deal of research has been conducted on the factors associated with recovery, we still need a clearer understanding of the dialectic between behavior and attitude. This research uses semi-structured interviews with two groups of mental health consumers, one receiving more intensive ACT services and the other receiving less intensive case management services, to ascertain the illness management strategies used by those who have been transferred to less intensive services. Our research suggests that while engaging in community, vocational, and church activities are important, those who are further along the road to recovery have gained an understanding and acceptance of their illness that allow them to use these activities as effective illness management strategies.

Dialectical Behaviour Therapy can be conceptualized as the transaction between behaviour therapy and Zen contemplative practice, held together with a dialectical philosophy. When first developed, mindfulness practices had not yet been incorporated into psychotherapy. Marsha Linehan chose to augment behaviour therapy with Zen practice. This chapter begins with a brief history of Zen and discusses the need for an acceptance-based practice to balance behaviour therapy within the treatment. It describes the Zen beliefs contained in the four noble truths and precepts, and how these translate into the principles and practice of Zen. It then considers both the differences between and compatibility of Zen and behaviour therapy. Finally, it discusses how Zen practice modifies behaviour therapy in DBT. Most of the stories and anecdotes are from Linehan’s Zen Dharma talks given during her Zen Sessions held over the past ten years.

It is known that Assertive Community Treatment (ACT) is being used to treat people with borderline personality disorder (BPD), a puzzling trend given the lack of empirical support for this practice and the consensus that reserving ACT for a carefully selected population is critical to the sustainability of this costly intervention. Little is known about the contributors to this phenomenon and the ways in which ACT programs have adapted to the influx of patients with BPD. Many ACT programs in the US and Canada have integrated Dialectical Behavioral Therapy into the regular ACT programming, a practice that also lacks rigorous evidence of effectiveness. We provide a framework for policy-makers to decide on the optimal role of ACT in the continuum of care for people with BPD, and offer policy recommendations to address this phenomenon. There is an urgent need to generate the missing evidence and to improve and expand the services available to people with BPD, particularly those who are now being treated on ACT programs.