As a DBT therapist many clients walk through the door with symptoms of Borderline Personality Disorder. Many of the classic” symptoms that can affect interpersonal relationships as well as treatment effectiveness are discussed. Treatment through DBT clearly outlines, through skill usage, how to alleviate the pain of those symptoms and help clients feel relief. Some clients, however, may have what can be called “quiet BPD” or as a client described it to me once “the storm is on the inside and not on the outside for everyone to see”. It most certainly still is a storm that brings with it emotional disturbance , slow return to baseline, and intense fears of abandonment associated with BPD. Because outward behaviors appear more functional or in control, DBT may not be recommended readily.
In order to understand why DBT skills work so well in scenarios like this, it’s important to remember the nature of both “quiet BPD” as well as the skills themselves. DBT, at its core, is a model of exposure therapy. Mindfulness helps show clients that they can sit in full awareness of emotions and not react immediately. Instead observe and describe them before choosing a response. Emotional regulation skills rely on the client first understanding why it is important to feel (or be exposed) to these emotions and understand the mechanisms before labeling them and shifting to more functional emotions.
Interpersonal Effectiveness challenges the client to think about goals and approach difficult or uncomfortable situations with a structured and more effective pattern of behaviors. Lastly, Distress Tolerance helps provide the client with strategies for accepting and tolerating emotions when they are most painful. All of these skills require clients to be aware of avoidance, and instead expose themselves to the emotions that are so painful at times.
Doing this allows for and encourages real growth. Though painful, assessing the emotions that seem unbearable and confronting them, while understanding why you feel that way and how to better handle it in the future is of great benefit to clients with BPD. It builds strength from within and slowly depletes the need for strength from unhealthy external forces.
DBT allows client to be able to take responsibility for their emotions, which allows them to feel like they are in control of how they feel. This is good because it allows clients to avoid the feeling of not being in control or feeling helpless. It also encourages healthy reactions and coping mechanisms. By being mindful and setting goals to better their patterns of behavior clients can begin to heal and better process their emotions day to day.