Today I was originally going to talk about Hospitalization, but frankly, the idea bores me at the moment so let’s look at something else.
Have you ever noticed that every therapist’s office has a couch? It’s almost cliché in a comforting kind of way. Hell, even my background has a couch/comfy chair. Subconscious foreshadowing? Intuition? Perhaps. So kick back. Pull up a cushion. Relax. And let’s talk about therapy.
There are a ton of different types and methodologies when it comes to therapy. Maybe, eventually, I’ll be able to discover what they all are in order to talk about them, but for now I want to take a look at the ones I know the most about which are also applicable to Borderline Personality Disorder: Cognitive Behavioral Therapy (CBT), Schema Therapy, and Dialectical Behavior Therapy (DBT).
What are each of these?
Cognitive behavioral therapy (CBT) is a psychotherapeutic approach: a talking therapy. CBT aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure in the present. The particular therapeutic techniques vary within the different approaches of CBT according to the particular kind of problem issues, but commonly may include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation, mindfulness and distraction techniques are also commonly included.
Dialectical behavior therapy (DBT) is a system of therapy originally developed by Marsha M. Linehan, a psychology researcher at the University of Washington, to treat people with borderline personality disorder (BPD). DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice. DBT may be the first therapy that has been experimentally demonstrated to be generally effective in treating BPD.
All DBT can be said to involve two components:
An individual component in which the therapist and patient discuss issues that come up during the week, recorded on diary cards, and follow a treatment target hierarchy. Self-injurious and suicidal behaviors take first priority. Second in priority are behaviors which while not directly harmful to self or others, interfere with the course of treatment. These behaviors are known as therapy-interfering behaviors. Third in priority are quality of life issues and working towards improving one's life generally. During the individual therapy, the therapist and patient work towards improving skill use. Often, a skills group is discussed and obstacles to acting skillfully are addressed.
A group component in which the group ordinarily meets once weekly for two to two-and-a-half hours and learns to use specific skills that are broken down into four modules: core mindfulness skills, interpersonal effectiveness skills, emotion regulation skills, and distress tolerance skills.
Schema Therapy was developed by Dr. Jeffrey E. Young for use in treatment of personality disorders. Schema Therapy is intended for use when patients fail to respond or improve after having been through other therapies. Schema therapy is a combination of many different therapy techniques, including Cognitive Behavioral Therapy, object relations, psychoanalysis, mindfulness, Dialectical behavior therapy, interpersonal relation skills, discussion one-on-one, group discussion, and constructivism. Schema Therapy also borrows extensively from a range of theoretical concepts and methods from Transactional Analysis (I’m not even sure what this is).
As opposed to some of the more widely known and popular therapy methods, Schema therapy is most often used and considered a specialty form of therapy in the treatment of personality disorders, most commonly borderline personality disorder. Schema Therapy is based on a theory that childhood and adolescent traumas are the most likely causes of Borderline Personality Disorder and other similar personality disorders. The approach of Schema therapy emphasizes patients, psychiatrists, and therapists building bonds of trust with each other.
Each one of these topics is HUGE. All containing vast amounts of ideas, techniques, theories…. Given my compulsive nature we may be exploring therapy for quite a while. I promise you this. If you’re at all interested in the deeper aspects of the psyche these are absolutely fascinating.
My therapist uses a combination of all 3 of these therapies but she specializes in Schema Therapy. I own a copy of the Practioner’s Guide and I’m going to be getting into a great deal of it, but hopefully in a way that is more accessible and easy to relate to. If I start to sound like a text book, please feel free to poke me.