Dialectical behavioral therapy

Dialectical behavioral therapy (TDC). It is a psychosocial treatment developed by Marsha M. Linehan specifically for the treatment of people with borderline disorder , it is also used in severe borderline patients with a high index of suicidal behavior and in patients with other diagnoses.

The treatment itself is largely based on behavioral theory with some elements of cognitive therapy . Unlike cognitive therapy, it incorporates the practice of fullness of consciousness as a central component of therapy.


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  • 1 Essential parts of the TDC
  • 2 Objectives and goals of TDC treatment
  • 3 Organization of the TDC
    • 1 Stage I
    • 2 Stage II
    • 3 Stage III
    • 4 Stage IV
  • 4 Philosophical bases
    • 1 Biosocial Theory
    • 2 Cognitive behavioral therapy
  • 5 Sources

Essential parts of the TDC

There are two essential parts to treatment, without the competition of which therapy is considered not to “adhere to CDD”: An individual therapy in which the therapist and client discuss what will be treated during the week, recording it in the diary files and following a treatment based on their hierarchy. The treatment of self-injurious and suicidal behaviors is a priority, followed by those that interfere with therapy. Then issues of quality of life are discussed and finally work is done to improve one’s life in general. During individual therapy, the therapist and client work to improve the use of skills. Usually, each group of competencies and the obstacles to acting competently are discussed. Agroup therapy , which usually meets once a week for 2 or 2 1/2 hours, in which clients learn to use the specific skills that are divided into 4 modules: A central core based on the practice of “fullness of consciousness “, emotional regulation capacities, competences in interpersonal efficacy and capacity for tolerance to anxiety.

Objectives and goals of TDC treatment

The most important of all goals at TDC is to help people create a life that is “worth living.” What makes a life “worth living” varies from person to person . For some it is to get married and have children, for others to finish school, find a partner, be successful in their jobs, find a spiritual life or even buy a house. While all of these goals may be different, all consultants are tasked with keeping their behaviors, especially those that can put their lives at risk, under control.

Organization of the TDC

TDC organizes treatment in four stages with its own objectives. The goal of each stage is a particular type of problem, so it may be necessary to return to them at different times of therapy. These are the four stages and the problem behaviors associated with each.

Stage I

Go from having out-of-control behavior to being in control

Goal 1: Reduce and then eliminate lethal behaviors (eg, suicide attempts, suicidal thoughts, self-injurious behaviors).

Objective 2: Reduce and then eliminate behaviors that interfere with treatment (eg, behaviors that “wear down” people who try to help, sporadic fulfillment of assigned tasks, non-attendance at sessions, not collaborating with therapists, among others) This objective includes reduce and then eliminate the use of hospitalizations as a method of managing crises.

Objective 3: Reduce behaviors that affect quality of life (eg, depression, phobias, eating disorders, absences from work or school, neglect of medical problems, lack of money, poor housing conditions, lack of friends. And increase behaviors that lead to a fuller life (eg, going to school or having a rewarding job, having friends, having enough money to support themselves, living in a decent apartment, not feeling depressed and anxious all the time).

Goal 4: Learn skills that help people do the following:

  • Controlling attention so that they stop worrying about the future or obsessing over the past. Increase awareness of the “present” so they learn what makes them feel good and what makes them feel bad.
  • Start new relationships, improve current ones and end those that are problematic.
  • Understand what emotions are, how they work and how to experience them so that they are not overwhelming.
  • Tolerate emotional pain without resorting to self-injurious or self-destructive behaviors.

Stage II

From emotional closure to fully experiencing emotions

The main objective of this phase is to help the client experience emotions without having to disassociate, avoid life, or develop symptoms of post traumatic stress (EPT). The latter are related to very traumatic moments in the lives of people that are still lived painfully today and cause discomfort. At TDC, we say that the one who enters this phase has control over their behavior, but is in “calm despair”. Teaching someone to suffer in silence is not the goal of any treatment. In this phase, the therapist works with the client to treat the EPT and teaches him to experience all his emotions without denying them and allowing them to guide and guide him.

Stage III

Build a normal life, solve problems of everyday life

In this phase, the consultants work with daily problems such as marriage or couple conflicts, job dissatisfaction, professional aspirations, among others. Some consultants choose to continue with the same therapist to achieve these goals. Others interrupt therapy for a time and work on these goals without a therapist. Some choose to take a break and then continue working with a different therapist in another therapy class.

Stage IV

From sense of meaninglessness to feeling of fullness / connection

Several people are likely to face “existential” problems despite having completed therapy up to phase III. Beyond having achieved what they were looking for in life, they may feel empty or incomplete. Some refer to this as “intellectual emptiness” or as “a feeling of emptiness.” Despite the lack of research in this phase, Marsha Linehan included her in realizing that many do find new meaning through spiritual paths, churches, synagogues, or temples. The consultants also change course in their careers or relationships.

Although the main phases and goals of treatment are presented in order of importance, we believe that they are interconnected. If someone commits suicide they will not get the help they were looking for to improve their quality of life. In this way TDC focuses first on life threatening behaviors. However, if the client stays alive, but never attends therapy, or does any of the assigned tasks, they will not get help to solve life-threatening problems, such as depression or substance abuse. For this reason, problems that interfere with treatment are the second priority in phase I. But attending therapy is certainly not enough. A client stays alive and goes to therapy to solve the problems that make him miserable. To have a full life, people must learn new skills, learn to experience emotions and achieve life goals. Therapy does not end until all of these goals are reached.

Philosophical bases

Biosocial Theory

Dialectical-behavioral therapy is based on the biosocial theory of personality functioning, in which borderline personality disorder is viewed as a biological disorder of emotional regulation. This is characterized by high emotional sensitivity, an increase in the intensity of emotions and a slow return to baseline emotionality. The characteristic behaviors and emotional experiences associated with borderline personality disorder are, according to this theory, the expression of this biological dysfunction in an environmental setting experienced as disabling by the borderline patient.

Cognitive behavioral therapy

One of the many component components of CDT is cognitive behavioral therapy. TDC adheres to the scientific “ethos”. It uses self-supervision, with an emphasis on the here and now, and borrows heavily from dialectical-behavioral therapy, including the style of open and explicit collaboration between patient and therapist. Furthermore, the treatment has a manual, the “bible” of the TDC, which is the work of M. Linehan “Cognitive behavioral treatment of borderline disorder” (1993a). (She says her publisher insisted on calling it “cognitive behavioral treatment” because she thought that a title that included the word “dialectic” would have less chance of getting good sales, particularly in the United States .


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