Modifying Behaviour Therapy to Meet the Challenge of Treating Borderline Personality Disorder

Abstract

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.

How applicable are mindfulness-based interventions to Muslim clients in the U.S.?

“…DBT can be conceptualized as the transaction between behavior therapy and Zen contemplative practice, held together with a dialectical philosophy (Wolbert, 2018). DBT interweaves aspects of mindfulness in its cognitive-behavioral therapy plans, which include four types of skills, that is, skills of mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance (Linehan, 2015).…”

“…DBT balances teaching the client ways to change their reality and accepting their reality (Linehan, 2015). DBT also acknowledges the connection between spiritual experience and the psychological benefits of mindfulness practice (Wolbert, 2018).…”

“…As to the compatibility of the mindfulness techniques in DBT for practicing Muslims, leaders of DBT (Linehan, 2015;Wolbert, 2018Wolbert, , 2021 believe that Zen is a practice, not a religion, and the mindfulness skills in Zen are applicable to people of different religions. The current review finds that the core mindfulness techniques in DBT, such as mindful observation, accepting reality, and staying mindful of the present moment are compatible for practicing Muslims.…”

“…If the client believes that their struggle with the current negative thoughts is a trial from God (Fischer et al, 2010), the therapist may ask the client if they believe that God has given them any positive thoughts and/or positive ways to deal with negative thoughts, to prompt for positive religious coping strategies. If the client evaluates their negative thoughts as sinful, it may be helpful for the therapist to allow the client to process their thoughts from the religious lens and then explain to the client how negative thoughts do not define their identity (Wolbert, 2018). If the therapist insists that the client should not evaluate their thoughts as sinful but rather nonjudgmentally, the client may perceive that the therapist is deprioritizing the importance of their practice of religious reframing.…”