A Short-Term Training Clinic Model for Dialectical Behavior Therapy (DBT) in Treating Borderline Personality Disorder (BPD): The Case of "Jane"

Dialectical Behavioral Therapy (DBT) is an evidence-based, long-term psychotherapy initially developed to treat Borderline Personality Disorder (BPD) patients and/or highly suicidal individuals. DBT involves four components: tailored individual therapy, phone coaching from the individual therapist, structured group skills training, and therapist supervision by participation in a "consultation team." While manualized, DBT is a multifaceted and flexibly applied treatment that balances interventions both for acceptance and maintenance (e.g., validating the patient in the present), and for change and progression (e.g., encouraging the patient to try on new, more healthy attitudes, emotions, and behaviors). The Dialectical Behavioral Therapy Clinic at Rutgers University (DBT-RU) is a research and training clinic that adapts the DBT Manual to provide short-term (6-months long), comprehensive DBT for community adults presenting with BPD and associated problems. The present project reports an example of the DBT-RU model in action, including the decision-making processes involved, by presenting the case of "Jane," for whom I was the therapist. At the beginning of therapy Jane was a 32-year-old, heterosexual, Caucasian, single mother of a 7-year-old son; and she worked as a medical technician. Her presenting problems met the full DSM-5 criteria for BPD. Her symptoms, following DSM-5 numbering, included: 1) frantic efforts to avoid abandonment; (2) recurrent unstable and intense relationships; (3) identity disturbance (in self and religious beliefs); (4) impulsivity; (6) affective instability; (7) chronic feelings of emptiness; and (8) inappropriate, intense anger. In addition, she reported past suicidal ideation that was "very strong." In line with Jane’s intense and challenging presenting problems, the process of therapy was complex with many starts and stops. However, over the course of therapy she showed important, substantial improvement, as reflected by both quantitative measures and qualitative indicators. To aid the reader in following the complex organization of this case study, an outline of it is presented in Appendix 1.