While there are many treatment models for borderline personality disorder, the best studied treatment is a highly intensive form of cognitive-behavioral therapy (CBT) called dialectical behavior therapy (DBT). Developed by Marsha Linehan, PhD, this therapy, which has as its stated goal “getting a life worth living,” has five key components:
• Weekly individual therapy that is structured around a hierarchy of symptoms in the following order:
• Suicidal and parasuicidal (self injurious behavior such as cutting and burning) behaviors
• Therapy-interfering behaviors (such as frequent cancellations of appointments on the part of both the patient and the therapist)
• Quality-of-life-interfering behaviors (such as reckless spending, drugs and alcohol, eating disorder behaviors, sexual promiscuity, etc.).
• Weekly skills training groups, which are typically two and a half hours long, focus on teaching participants a broad range of cognitive and behavioral techniques to manage and regulate their emotions, to improve their interpersonal effectiveness (relationships), to stay present and mindful, and to make it through various crises without making the situation worse.
• Therapists who do DBT meet weekly in a consultation group to ensure that they are sticking to the model and to provide “therapy for the therapist.”
• In the DBT model, phone consultation to the client means that the person can call her therapist for coaching. Hours must be agreed upon, as maintaining a positive and real relationship with the therapist is critically important.
• Accessory services as needed, typically including psychopharmacology (medications) and whatever organizational interventions might need to be made to maintain the structure and intensity of the therapy.
DBT has been studied extensively in individuals with borderline personality disorder, and there are case series to report its benefit in people with bipolar disorder who have co-occurring borderline personality disorder; other studies are ongoing.