chapter  4
Driving Me Sane: Integrating CBT and Relational Psychodynamic Psychotherapy
ByARIELLE FARBER SHANOK
Pages 20

This chapter introduces the basics of Dialectical Behavior Therapy (DBT) and weaves vignettes from Meg's treatment into a practical and theoretical exploration. DBT is an integrative approach developed as a treatment for borderline personality disorder (BPD), specifically to target suicidality and self-injury. According to biosocial theory, BPD is considered likely to develop when someone with such an emotion system grows up in an environment that is chronically invalidating-where internal, private experiences are un-reflected upon and unseen. DBT is organized into stages. A pretreatment stage focuses on orienting a patient to DBT and building initial commitment to staying alive and decreasing self-injury. DBT and relational psychoanalysis each adhere to a model of mind organized by vertical divisions and dissociation. The overall clinical understanding is that change is possible if a person whose goals are being thwarted by ineffective or dangerous behaviors can engage in a validating and nonjudgmental therapy relationship.