ABSTRACT
DBT conceptualizes the recovery of clients from BPD and associated comorbidities as following a series of stages. In the treatment manual Linehan (1993a) ®rst described three stages of treatment; pre-treatment, Stage 1 and Stage 2. She has since added Stages 3 and 4 and described how a staged approach to treatment may apply to clients with problems other than BPD (Linehan, 1999). In this more recent thinking, clients may enter treatment at any stage, depending upon the severity and complexity of their dif®culties. Following pre-treatment, which addresses assessment, orientation and commitment, clients with a BPD diagnosis enter Stage 1. This stage of treatment assists clients to achieve behavioural stability, by reducing threats to life and other severely destabilizing behaviours. After Stage 1, clients may progress through some or all of the remaining stages or decide to end treatment. Stage 2 focuses on emotionally processing the past and is especially relevant for clients with a past history of trauma. Stage 3 aims to assist clients to return to ordinary levels of happiness and unhappiness. Problems at this stage of treatment are of low to moderate severity and have only a moderate impact on clients' functioning, in comparison to Stage 1 and 2 problems. Stage 3 problems may include marital, education or employment dif®culties. Stage 4 aims to enhance the capacity for joy and focuses on assisting individuals for whom ordinary happiness and unhappiness remains insuf®cient and who continue to experience a degree of meaninglessness or absence of connectedness. At this stage, long-term insight-oriented therapies may prove bene®cial, as may spiritual or religious practices. The DBT therapist and treatment programme may work with clients through Stages 1
and 2, resources and expertise permitting. healthcare systems, in general, will rarely treat problems; rather private therapists and voluntary-sector organizations may provide services to address these dif®culties. Orienting clients with BPD to Stages 3 and 4 of treatment may assist them in navigating the later stages of recovery.
