DBT challenges therapists

CrossCurrents

DBT incorporates treatment ideas that are considered radical by some therapists, for example, the notion of dialectical abstinence, which balances an insistence on total abstinence with a policy of total acceptance upon relapse to reduce the intensity and frequency of recurrent substance abuse.

Louisa Van den Bosch, head researcher with the DBT Project for the Amsterdam Institute for Addiction Research, says that what is really radical is that DBT challenges therapists themselves to expand their own methodology to become more effective therapists.

“I think DBT is not only about therapy; it’s about changing attitudes and taking patients seriously: asking them how they feel and helping them change the behaviour that they want to change,” says Van den Bosch. “It reflects changes in other parts of our society where consumers have more rights.”

Van den Bosch says DBT allows therapists to be creative and respond to individual needs. Therapists must use their own judgement, for example, if a client has relapsed to substance abuse prior to a skills training meeting but still wishes to join the group for the session. This can be threatening to therapists who would prefer “by the book” instruction about whether the client should stay for the meeting or be sent home.

“Some psychiatrists think this is something that crosses limits and that you should treat by guidelines all the time,” says Van den Bosch. “Our project is adding to this discussion.”

In a 2002 study published in the Journal of Addictive Behaviours, Van den Bosch and colleagues compared results of DBT for people with borderline personality disorder with and without substance use problems. Therapists initially refused to offer 24-hour phone consultation, thinking clients would abuse the privilege. The clients insisted on full access to DBT prescribed treatment, including phone access. Van den Bosch says the results were surprising. “Most therapists find they enjoy doing this kind of phone consultation,” she says. “They know patients will call if something is happening to them, so if they don’t call, they also know things are OK.”

After nine years as a DBT therapist and trainer, Van den Bosch says she has seen the popularity of DBT ebb and flow, but nowadays she says clients are asking for it.

“At first, these patients may have the attitude that there’s nothing left for them in this world,” says Van den Bosch. “It’s amazing to see these patients after a year.”

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