The process of recovery and change in a dialectical behaviour therapy programme for youth

Abstract

Dialectical behaviour therapy (DBT) is an effective treatment for borderline personality disorder and suicidal behaviour. However, it is a complex programme involving individual therapy, participation in skills training groups, and phone coaching aimed at improving emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. Little is known about what elements contribute to its effectiveness, or the characteristics of those who complete the programme and achieve recovery. In this study, six participants in a dialectical behaviour therapy programme for youth were interviewed at three time points over their recovery journey. The transcribed narratives were analysed using inductive methods, and the core processes related to recovery were elucidated and described: ‘Becoming a cheerleader for DBT’ and ‘Learning the language of DBT and consolidation of skills’. Indicators of recovery included having a sound working alliance with the primary therapist and others involved in the programme and noticing meaningful improvements in problem areas which they attributed to particular skills and improved capacity to regulate emotions. The rich narrative description provided by participants might inspire some to remain engaged in a dialectical behavioural therapy programme or clinicians to consider promoting a positive view of the prognosis for borderline personality disorder.

Nursing people diagnosed with Borderline Personality Disorder: ‘We all need to be on the same hymn sheet’

“…The antidote to the apparent self‐perceived skills deficit in supporting inpatients with BPD is in part and quite predictably education of all staff about the nature of BPD and how to coach people in skills. Nurses have a long history of being primary therapists in high fidelity skill‐based DBT programmes (Lakeman & Emeleus 2020; Lakeman et al . 2020).…”

Towards online delivery of Dialectical Behaviour Therapy: A scoping review

“…The length of DBT programmes vary but typically people with a diagnosis of BPD are enrolled for more than 6 months and there appears to be a dose response. The longer the engagement in the programme the better the outcome (Lakeman & Emeleus, 2020 ).…”

Experiences of dialectical behaviour therapy for adolescents: A qualitative analysis

“…A meta‐synthesis of qualitative analyses on perceptions of the process and impact of DBT among adults with BPD and a more recent study analysing the recovery process among six young BPD patients in a DBT program both highlighted the importance of a therapeutic alliance between the patient and therapist (Lakeman & Emeleus, 2020; Little et al, 2018), something that according to previous studies may not be easily achieved for this patient group (Morris et al, 2014). In contrast, it is acknowledged that self‐harming patients often have a negative experience of health services overall (Eriksson & Åkerman, 2012; Law et al, 2009; SBU, 2015; Taylor et al, 2009), which may be explained, at least in part, by negative attitudes among health professionals towards patients with self‐harm (Saunders et al, 2012).…”