“It is important to appreciate that once in hell, it is possible to climb out of it. -Marsha Linehan”

Marsha Linehan emphasizes that “the therapeutic relationship and therapist self-disclosure” is essential to DBT (DBT Skills Training Manual). She gives equal importance to “treating therapy-interfering behaviors of both client and therapist.” This is an example of the dialectical stance that recognizes and works with the transactional nature of the therapeutic relationship. A strong therapeutic relationship grows with each authentic meeting of client and therapist. In DBT Principles in Action, Charles Swenson identifies the need to “build a stronger attachment between patient and therapist through the compassionate and effective handling of early adversity in therapy.” as a key therapeutic task. The DBT therapist balances change strategies (such as problem-solving) with acceptance strategies (such as validation) to build an effective therapeutic relationship. The authors describe the impact of the relationship with their therapists.

Although I still lived in emotion mind the majority of the time, I understood more and more what the heck a wise mind was and what it might sound like. I developed an awesome relationship with my therapist, and when I couldn’t find a wise, compassionate, loving voice, I would borrow hers. Author 12 (p. 89)

I remember my first DBT therapy session, and I was scared to death. Even though I had not made progress, I still was attached to my other therapist, and I felt loyal to her. By the end of the first DBT session, I felt as though this might be a good thing. I started to really look forward to my sessions with my DBT therapist. But even though I looked forward to them, I found I couldn’t answer questions; I had never been asked to describe my feelings and thoughts. I had no idea what to say. I was always so emotionally numb–no feelings at all, just numb–and there were no other words to describe that. Author 22 (p. 159)

On the first day we met, I looked down at my shoes. My shame filled her small office, and she gently asked that I look at her. So I did. She showed me in her eyes that she held no judgement of me. If there were ever a remedy for the ill effects of borderline personality disorder, it is DBT. But DBT alone does not suffice, as I learned many years ago. A framework without a heart and a soul is nothing. For DBT to truly work, there must be a therapist who is truly committed from her heart and soul to the recovery of her client. Author 10 (p. 77)

The next entry of this series on Pearls from Beyond Borderline will focus on the process and outcomes of the authors in DBT.

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