The treatment of Borderline Personality Disorder (BPD) has been faced by many handles due to the nature of the disorder. However, research indicates that BPD patients have improved with time ( Paris, 2015). The study further demonstrates that professionals can modify Cognitive-behavioral therapy (CBT). CBT can be modified to an eclectic variant called DBT, which is vital for use in BPD treatment. The research identifies that BPD is a superior treatment method because is supersedes Treatment As Usual (TAU) method employed by the management in community clinics. Moreover, the approach was also superior to therapies administered by experts with experience treating BPD. Apart from DBT, there are other treatment methods mentioned in the research paper.
Subsequently, the study also explores episodes of client and therapist rated therapeutic alliance as predictors of borderline Personality Disorder (Bedics et al., 2015). The indicators identified in this study include nonsuicidal self-injury, introject, suicide attempts, and depression. The study was conducted for 101 women with BPD. The results showed that the therapists reported a working alliance early in the treatment process, and the interaction improved as treatment progressed. Multimedia models showed no significant differences in the client rating by treatment condition. The study aligned with the relationships predicted in theory, between the different characteristics of the therapeutic alliance in suicidal behavior and Dialectical Behavior Therapy.
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Dialectical behavior therapy (DBT) is acknowledged as a well-established treatment for BPD following an examination of mechanisms of change related to DBT ( Lynch, 2006). The report acknowledges that DBT is. The study shows evidence of findings by unveiling seven well-controlled randomized clinical trials across four independent research teams. The study identifies patient change as helping a patient to engage in a life-enhancing, functional behavior even during intense emotional moments. The author postulates that through the biosocial theory of BPD, the mechanisms can be narrowed down to a single process which reduces the tendencies of ineffective actions associated with dysregulated emotions (Lynch, 2006). The paper explores the following interventions and associated devices for change, dialectics, mindfulness, Targeting and chain analysis, and Validation. The journal article aims to offer guidelines on mechanisms of change by exploring the empirical and theoretically grounded research.
Additionally, a review by Feigenbaum, (2007), asserts that DBT has succeeded as a treatment mechanism for persons with BPT. However, she raises concerns as to whether the growth of the treatment method has barred the establishment of a sufficiently robust evidence base. She, therefore, explores the emerging evidence base while highlighting the strengths and weaknesses of the existing evidence base. The analysis helps in the modification of standard DBT for applications in different client populations and disorders. One of the essential items discussed in the review is the DBT principles ( Feigenbaum, 2007). The DBT model assumes that people with DBT lack fundamental self-regulation and interpersonal skills. Moreover, the model assumes that environmental and personal factors may frequently reinforce maladaptive actions or inhibit the use of behavioral skills.
DBT according to Swales, Heardt and Williams (2000) is a time-limited, structured treatment for cognitive behavioral disorders. For therapists, the treatment integrates concurrent skills training, team consultation, and access to skills generalization with individual psychotherapy. The research further postulates that the initial findings by Lynch (2006) suggested that the therapy additionally lowers Para suicidal episodes, attrition rate, and psychiatric in-patient days. The research, however, caution that experts who wish to modify or adapt the use of the therapeutic model should do so in the context of a theoretical model in which psychological processes underpin the treatment effects. Moreover, the experts should understand and pay attention to the merits and demerits of working within the NHS structure.
Key Points Analysis
One outstanding feature in the treatment process of Borderline Personality Disorder (BPD) that all five articles have critically explored is dialectics. Dialectic as a feature of the treatment occurs in three tenents. 1) the interconnectedness of the world, 2) That truth is a synthesis of diverging views, 3) Change is constant and inevitable. Swales, Herds, and Williams (2000) researched that the interconnectedness stressed an element of closeness and wholeness. The system of wholeness reminds professionals of the importance of considering the management and the change process as a whole systems approach. The second faced identifies that individual reality is composed of a set of theories and anti-theories that oppose each other. An agreement is reached when the opposing and proposing verdicts are synthesized. However, the synthesis of such opinions poses more dialectics dilemma. Moreover, throughout therapy, clients often develop a desire to stay the same since the situation makes them feel safe and recognizable, yet therapy is always about change.
Meanwhile, Borderline Personality Disorder (BPD) is a severe and prominent disease. Its symptoms include Chronic Suicidality, unstable relationships, affective instability, and self-harm. The disorder had challenged experts in the past twenty years, and now professional have designed new effective methods of treatment.
Bedics and his associates assert that DBT is one of the well supported and widely researched treatments for both suicidal behavior and Borderline personality disorder. Lots of research has been accumulated concerning BPD treatment using DBT, and the existence of such knowledge has allowed researchers to understand better how DBT works. Moreover, such insights have impacted the evaluation of theorized mechanisms of change, such as The therapeutic Alliance. According to Bedics, et all., (2015), the use of therapeutic alliance in the treatment of BPD promises improved outcomes. The report indicates the significance of clients' working capacity and clients' commitment to reducing suicidal behavior in DBT. Moreover, the research inspires future works with a focus on theoretically essential elements as they relate to therapist observable methods.
Research by Bedics, et al., (2015) echoes Lynch, et al., (2006), which revealed that researchers have contributed below par in findings related to mechanisms underlying patient change. Several pieces of literature document how DBT is an effective treatment method of BPD. The concern of researchers has now shifted, and many of them enquire into the processes by which therapeutic change occurs. Their inquiries raise concern on the mechanisms of change. Lynch et al., (2006) aligns with Bedics’ 2015 assertions that a deep understanding informs the understanding of the theorized mechanism of change of the concepts underlying DBT. Moreover, the study has revealed that the aspects of DBT that are unique and central to BPD treatment and its theoretical foundations and can associate with several potential mechanisms of change.
Other methods applicable in the treatment of Borderline Personality Disorder are outlined by Paris, (2015). The author proposes some psychotherapies that are viable for use in the contemporary world. Some of the psychotherapies the study discussed include. 1) Dialectical behavior therapy (DBT), 2) Mentalisation-based treatment (MBT), 3) Systems Training for Emotional Predictability, and 4) Problem Solving (STEPPS). He, besides, explores the uniqueness of each psychotherapy treatment. He reveals that each of the psychotherapeutic treatment methods is unique and differs in characteristics. However, he contends that the methods are also similar in offering treatments for emotional regulation, behavioral and interpersonal skills, and divergences. Also, the author aimed at showing how the principle of psychotherapy integration applies the research; and that the use of the principle in this scenario enables the trial of a variety of different treatment methods to achieve the best results.
Paris' (2015) findings answer Feigenbaum's concerns about whether there are common factors across effective treatment for BPD. Feigenbaum postulated that the four established randomized controlled trials, descriptive studies of the applicability of DBT, and many controlled studies have aided DBT to be a leading treatment method for BPD as well as being the most effective therapeutic model of current times. However, as more evidence of the therapeutic models continues to surface, experts have raised questions as to whether there is a model of treatment that is more effective than the other (Feigenbaum, 2007).
Feigenbaum furthermore, asserts that the principle of learning theory provides that behavior will continue or increase when reinforced either negatively or positively. The same behavior will cease or reduced when punished and will be extinguished if the previous reinforcement is withdrawn (Feigenbaum, 2007). Conversely, a DBT model stresses the identification of the relevant stimuli necessary for arousing dysfunctional behaviors through the contingencies which shape the maintenance and development of behavior and previously learned associations.
References
Bedics, J., Atkins, D., Harned, M., & Linehan, M. (2015). The therapeutic alliance as a predictor of outcome in dialectical behavior therapy versus nonbehavioral psychotherapy by experts for borderline personality disorder. Psychotherapy , 52 (1), 67-77. doi: 10.1037/a0038457
Feigenbaum, J. (2007). Dialectical behaviour therapy: An increasing evidence base. Journal Of Mental Health , 16 (1), 51-68. doi: 10.1080/09638230601182094
Lynch, T., Chapman, A., Rosenthal, M., Kuo, J., & Linehan, M. (2006). Mechanisms of change in dialectical behavior therapy: Theoretical and empirical observations. Journal Of Clinical Psychology , 62 (4), 459-480. doi: 10.1002/jclp.20243
Paris, J. (2015). Applying the principles of psychotherapy integration to the treatment of borderline personality disorder. Journal Of Psychotherapy Integration , 25 (1), 13-19. doi: 10.1037/a0038767
Swales, M., Heardt, H., & Williams, J. (2000). Linehan's Dialectical Bahavioural Therapy (DBT) for Borderline Personality Disorder: Overview and adaptation. Journal Of Medical health , 9 (1).
