Dialect Behavior
Therapy (DBT) is a system of therapies that help individuals to be mindful of
what they are doing while working on their individuals cognitive skills
(cognitive therapy). Group facilitators need to be able to identify individuals
with “Borderline personality disorder (BPD) which
is a severe condition comprising different symptom clusters, such as
self-injuring behaviors and suicidality, relationship problems, identity
diffusion, emotional instability, and feelings of emptiness”(Jacob, G., p. 373)
(italics authors). It is important to note that not all people with severe
behavior problems will have a BPD diagnosis, but empirical studies have shown
that DBT is a successful approach to helping individuals with severe behavioral
problems. The Individual’s thoughts, perceptions, and emotions turn into the
behaviors that are displayed.
One way to encourage
effect behavioral change is to influence the patients’ self-esteem, “at least
indirectly, via strengthening self-efficacy, self-concept clarity, or other constructs
related to a healthy sense of oneself” (p.374). Other techniques that are
successful in building self-esteem are: “Schema therapy (ST), mentalization-based
therapy (MBT), and transference-focused therapy (TFT);” however, “DBT and MBT
combine individual and group treatment, while TFT and ST are mainly
individualized treatments. However, ST can also be delivered in a group format”
(p.374). So, DBT reduces interpersonal/intrapersonal conflicts, along with self-injury
and suicidal behavior; MBT “enhances mentalization”, and ST lessons maladaptive
schemas (the themes we believe in based on events in our life). DBT, MBT, and
ST can be delivered in a group therapy.
Self-esteem
impacts individual’s behaviors either effectively or ineffectively. Some behaviors
that may be seen with low self-esteem are: “self-injuring behavior as a form of
self-punishment, or to interpersonal problems, such as withdrawal or defiance due
to self-devaluation and shame” (p.375). DBT does not address self-esteem (it
addresses mindfulness, distress tolerance, emotional regulation, and
interpersonal effectiveness). As a facilitator it is necessary to know and
understand more than one form of therapy, and to be able to change the
direction of the group based on the group needs and the goals of the group.
In the study, Group Therapy Module to Enhance Self-Esteem in Patients
with Borderline Personality Disorder: A Pilot Study, the researchers developed
“a
group therapy module to help to build self-esteem: (1) strengthen Self-confidence
by enhancing self-management, competencies, and social skills,
assertiveness training; (2) strengthen Self-acceptance by changing
evaluations of the self (e.g., cognitive restructuring or changing personal
values); and (3) strengthen Self-care by encouraging positive
experiences with oneself (e.g., develop positive activities and focus on
positive facets of oneself)” (p.375).
As
facilitators it is important to set the tone, and to express the behaviors that
will and will not be acceptable. The group needs to be effective, and the
members might need direction on how to effectively do this. Some members might
have a hard time accepting “the idea of their own needs being important…In
general, negative emotions related to self-care, such as guilt,
shame, and anxiety, is approached very openly. These
emotions are directly anticipated, addressed, and observed. Patients usually report
decreasing negative emotions if they repeatedly manage to act in a self-caring
way” (p.378).
Areas of self-esteem
that might be covered are: “Performance self-esteem covering
satisfaction with one’s abilities, competencies, and intelligence; social
self-esteem comprising items on feeling self-confident versus shy and
inferior in the presence of others; appearance self-esteem covering issues
like feeling attractive, good about oneself, and accepted by others” (p.
380-381). Focusing on self-esteem in group appears to “strongly” motivate the
patients (based on the results of the study).
When an individual’s
self-esteem is low, the group provides the individual with an opportunity to “Experience
understanding and feedback by other patients as more honest, genuine, and
helpful than the therapist’s empathy” (p.383). So, it is hard for the
individual to think of positive statements regarding themselves, and it may
also be difficult for the individual to receive the information from the other
members. But, “fellow patients, who could readily understand each other were
able to give and receive mutual positive feedback” (p.383).
An individual’s
thoughts and emotions may trigger an ineffective behavior in the group setting;
however, by focusing on self-esteem the individual will benefit in the long
run; as will the rest of the group. Facilitators have to look at the negative behavior – not as being
negative, but as being ineffective. That way they will not become frustrated
with the individual, because they will understand that the individual needs to
learn effective skills… that somewhere at sometime they adapted to their
thoughts, emotions, environment in a way that was ineffective.
Reference
