If you’ve ever typed “types of therapy” into a search tool and felt more confused after reading the results, you’re not alone. Terms like cognitive behavioral therapy, dialectical behavior therapy, and EMDR can sound clinical and intimidating, but this guide helps you understand these approaches with definitions written for real people like you.

Whether you’re considering therapy for the first time, exploring options for a loved one, or simply trying to ask better questions when working with a therapist, we can help you through it all.

Why Knowing Your Therapy Options Matters

The beauty of therapy is that there is no one approach: it looks different for everyone, depending on their needs. The right treatment for someone navigating grief may look very different from what works for someone managing borderline personality disorder or processing childhood trauma. You may have heard of cognitive-behavioral therapy (CBT), which is very effective for many people, but it’s just one of many therapy approaches that trained professionals can use.

Knowing what’s available and which modalities address different needs empowers you to have informed, meaningful conversations with potential therapists or current therapists. It also helps you trust the process once you begin the healing journey.

The Most Common Types of Therapy, Explained

How Do You Know Which Type of Therapy Is Right for You?

The truth is: You don’t always know in advance, and that’s okay. Most skilled therapists are trained in multiple modalities and will tailor their approach to your specific needs, history, and goals. The most skilled therapists have a diverse toolkit of methods they can draw from, adapting their approach to match each person’s unique needs, interests, and developmental stage.

That said, going in with some knowledge gives you the ability to ask meaningful questions. When looking for the right therapist, or during your next session, try asking your therapist these questions:

Asking these questions will help you find the right fit for your healing journey, and a good therapist will welcome them.

A Quick Reference: Therapy Types and What They Address

There are so many therapeutic approaches out there, and we’ve only covered a few. Still, here’s a breakdown of the theories we discussed and what they can help support:

Taking the Next Step

Understanding these approaches is the first step in building a better you. Finding the right therapist is a significant part of improving your mental health, but you don’t have to do it alone. GoodTherapy’s therapist directory allows you to filter by therapy type, specialization, location, and more, so you can find someone who truly fits your needs.

If you’re still exploring whether therapy is right for you, our blog on what to expect in your first therapy session can help you get started.

Remember, reaching out is not a sign that something is irreparably wrong with you. It’s a sign that you know your well-being is worth investing in.

Many people believe that unstable relationships stem from “bad choices” in partners or needing to “calm down” and “be more mature.” However, the reality is much more complex. If you’re struggling with abandonment wounds, the challenges are not about a lack of willpower or a character flaw. Instead, they are about how your brain and nervous system are influenced by your past experiences. Many people intellectually understand that they are safe or cared about, yet their nervous system may still react as though abandonment is imminent. These reactions are often rooted in earlier attachment wounds and emotional survival strategies that developed long before the current relationship. These wounds often lead to emotional dysregulation and can deeply impact your relationships, with research showing that previous exposure to adversity and traumatic experiences, especially in childhood, can increase a person’s chance of developing long-term emotional difficulties. While many people experience occasional relationship insecurity, abandonment wounds tend to involve deeper fears of rejection, emotional instability, or being left behind. These fears can feel immediate and overwhelming, even in otherwise caring relationships. The good news is that therapies like DBT and Schema Therapy can help heal abandonment wounds and create healthier, more stable bonds.

Emotional Dysregulation & Relationship Dynamics

If you’ve had difficult past experiences, your nervous system may react more quickly and intensely to perceived threats in close relationships. When you feel “triggered,” it becomes harder to communicate clearly, calmly, and effectively. This is known as emotional dysregulation, characterized by feeling anxious, sad, or angry; having trouble concentrating and sleeping; and thinking about what happened. Learn more about emotional regulation.

Clinically, this may look like feeling calm and connected one moment, then suddenly overwhelmed after a delayed text, subtle shift in tone, or perceived emotional distance. The reaction is often less about the present situation itself and more about older emotional wounds being activated in real time.

See also: How Emotional Stonewalling Can Be Damaging

How Schemas Reinforce Abandonment Wounds

Schemas are deep-rooted core beliefs shaped by childhood experiences. For example, if you ever felt abandoned or couldn’t consistently rely on a caregiver, you may have developed the belief that abandonment is inevitable. In adult life, this can make rejection feel like it’s just around the corner, even when it’s not.

When schemas are triggered, you might react strongly out of fear or anger and later regret your actions. Recent research shows strong associations between both partners’ maladaptive schemas, suggesting mutual influence, with the emotional deprivation schema associated with reduced satisfaction for both partners, and the abandonment schema linked to decreased satisfaction for both individuals and their partners (Kover et al., 2024).

This often leads to a push-pull dynamic: craving closeness one moment, then withdrawing or lashing out the next. In some relationships, inconsistent reassurance or affection can unintentionally strengthen emotional attachment through a process known as intermittent reinforcement. When closeness or connection feels unpredictable, people may become increasingly focused on regaining those moments of emotional relief or intimacy, even when the relationship itself feels emotionally exhausting.

These patterns can also show up differently depending on attachment style. Some people respond to abandonment fears by seeking constant reassurance or closeness, while others withdraw emotionally, avoid vulnerability, or distance themselves to protect against rejection.

Further reading on GoodTherapy:

• Relational Hurt or Attachment Injury? How to Tell the Difference
• Attachment as Defense: How Trauma Shapes the Self
• Own the Inner Child: Breaking Free of Anxious Attachment

How DBT Helps Heal Abandonment Wounds

Dialectical Behavior Therapy (DBT) was originally created for people who feel emotions more intensely than others. Over the past 30 years, research on DBT has proliferated, with the vast majority demonstrating that it is effective at treating the behaviors that it targets. DBT doesn’t ask you to stop feeling deeply, it gives you tools to handle big emotions without letting them damage your relationships.

For instance, if your partner doesn’t text back for a few hours, fear of abandonment might trigger panic: “They’re leaving me. They don’t care about me.” Without skills, that panic could lead to emotional suffering, angry texts, or shutting down. One of the core goals of DBT is not to stop feeling deeply, but to create enough pause between the emotion and the reaction that you can respond intentionally rather than react from fear. In many situations, emotional regulation needs to come before productive communication can happen.

DBT teaches you to:

• Notice the rising emotion before it takes over.
• Use grounding and distress tolerance skills to calm your nervous system.
• Respond mindfully instead of impulsively.

Over time, DBT skills break the cycle of highs and lows, helping relationships feel steadier and can help you recognize that emotional intensity does not automatically mean danger is present. Recent meta-analysis research shows that PTSD-specific DBT treatments demonstrate moderate effects in reducing symptom severity and depression (Linehan, 2015).

Explore more about DBT

Related GoodTherapy articles:

• Empathic Curiosity: How DBT Builds Better Relationships
• How DBT Can Improve Your Communication Outcomes
• Interpersonal Effectiveness in Dialectical Behavior Therapy.

How Schema Therapy Transforms Abandonment Beliefs

Schema Therapy goes deeper by addressing why abandonment fears and rejection sensitivities exist. Schemas act as emotional blueprints formed in childhood, often running unconsciously in relationships.

Many people can recognize these patterns intellectually long before they are able to change them emotionally. Insight is important, but healing often also involves practicing new relational experiences repeatedly enough for the nervous system to begin feeling safe in different ways of connecting.

Take the Abandonment Schema: If early experiences taught you love wasn’t reliable, you may live with a constant fear of being left. Even small signals, like a partner being quiet, can feel like “proof” of rejection.

Schema Therapy helps by:

• Identifying old patterns that keep getting triggered.
• Re-parenting the wounded inner self.
• Practicing healthier ways of relating, such as expressing needs clearly.

Instead of thinking, “If I tell them I’m scared, they’ll leave,” you might learn to say, “When you don’t text back, I feel anxious and worry I might lose you. Can you reassure me?” This invites intimacy instead of conflict. One of the most meaningful shifts in therapy often happens when people begin expressing fear, vulnerability, or emotional needs directly instead of through shutdown, anger, protest behaviors, or reassurance-seeking. That shift alone can significantly change the emotional tone of a relationship.

Schema Therapy is especially effective for abandonment fears and personality-related struggles. Recent systematic review and meta-analysis research involving 587 participants found that Schema Therapy had a moderate effect size compared to control conditions in reducing symptoms of personality disorders (Young, Klosko, & Weishaar, 2003).

Healing abandonment wounds may also involve grieving unmet emotional needs from earlier experiences, not just improving communication in current relationships. Giving space to that grief can be an important part of building healthier attachment patterns moving forward.

Learn more about Schema Therapy.

The Bottom Line: Healing Abandonment Wounds is Possible

If your relationships leave you feeling emotionally exhausted, hypervigilant, or constantly worried about losing connection, it doesn’t mean you’re broken. It means your nervous system and old patterns are working overtime to protect you, sometimes in ways that backfire. Part of healing involves learning to pay attention to relationship patterns over time rather than reacting only to isolated moments of closeness, distance, or reassurance. With DBT, you can regulate intense emotions in the moment. With Schema Therapy, you can transform the deeper wounds fueling abandonment fears.

Stable, fulfilling relationships are possible. The right therapy provides tools, practice, and support to make healing abandonment wounds a reality. Healing often happens gradually through repeated experiences of emotional safety, self-awareness, and healthier connection. With support, people can learn that relationships do not have to feel unpredictable or emotionally overwhelming in order to feel meaningful.

• Kover, L., Pilkington, P. D., & D’Rozario, D. (2024). The association between early maladaptive schemas and relationship satisfaction: A dyadic analysis. Frontiers in Psychology, 15, 1460723. https://doi.org/10.3389/fpsyg.2024.1460723
• Linehan, M. M. (2015). DBT® Skills Training Manual (2nd ed.). Guilford Press.
• National Institute of Mental Health. (2025). Traumatic Events and Post-Traumatic Stress Disorder (PTSD). U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd
• Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A Practitioner’s Guide. Guilford Press.
• Zhang, K., Hu, X., Ma, L., Xie, Q., Wang, Z., Fan, C., & Li, X. (2023). The efficacy of schema therapy for personality disorders: A systematic review and meta-analysis. Nordic Journal of Psychiatry, 77(7), 641–650. https://doi.org/10.1080/08039488.2023.2228304

References:

1. Kover, L., Pilkington, P. D., & D’Rozario, D. (2024). The association between early maladaptive schemas and relationship satisfaction: A dyadic analysis. Frontiers in Psychology, 15, 1460723. https://doi.org/10.3389/fpsyg.2024.1460723
2. Linehan, M. M. (2015). DBT® Skills Training Manual (2nd ed.). Guilford Press.
3. National Institute of Mental Health. (2025). Traumatic Events and Post-Traumatic Stress Disorder (PTSD). U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd
4. Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A Practitioner’s Guide. Guilford Press.
5. Zhang, K., Hu, X., Ma, L., Xie, Q., Wang, Z., Fan, C., & Li, X. (2023). The efficacy of schema therapy for personality disorders: A systematic review and meta-analysis. Nordic Journal of Psychiatry, 77(7), 641–650. https://doi.org/10.1080/08039488.2023.2228304

Finding the Differences Between Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT)

Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) each play an important role in treating mental health issues. These two types of therapy fall under the umbrella of psychotherapy, also known as talk therapy. Throughout the therapeutic process, an individual facing challenges talks with a professional in a safe, confidential, growth-stimulating environment where they learn new skills on how to manage those challenges.

CBT and DBT are among the most common methods of psychotherapy used to treat mental health issues. While they share many similarities, they also have important differences.

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy, also known as CBT, primarily focuses on the relationship between thoughts and feelings. This line of thinking focuses on how thoughts impact feelings and how certain patterns of behavior can lead to mental health challenges. CBT also focuses on replacing unhelpful thoughts and behaviors with new actions and ways of thinking. Therapists often use CBT to treat mental health issues like depression, anxiety, substance abuse, and more.

Therapists use Cognitive Behavioral Therapy and work with clients to identify issues and challenges, uncover the causes, and establish new coping mechanisms, tools, and strategies to help get past or overcome them.

What is Dialectical Behavior Therapy?

Dialectical Behavior Therapy, also known as DBT, is a modified alternative to CBT. It was initially created to treat BPD (borderline personality disorder). Therapists often use DBT with clients who are experiencing suicidal thoughts or actions, but they have discovered new ways to treat other mental health issues through Dialectical Behavior Therapy.

DBT stresses the practice of mindfulness, increasing distress tolerance, strengthening emotional regulation skills, and growing relationships. Clients work with their therapist to uncover harmful thought patterns, accept them, and learn how to react to them healthily. Balance is critical in this form of therapy as clients work to accept their challenges and work toward change.

Differences Between CBT and DBT

Emphasis

The main difference between Cognitive Behavioral Therapy and Dialectical Behavior Therapy is a matter of emphasis: CBT focuses on thought patterns and their redirection; DBT focuses on balance and the relationship between acceptance and change. Both Cognitive Behavioral Therapy and Dialectical Behavior Therapy aim to ultimately help the client change their thought patterns.

Time

Cognitive Behavioral Therapy is usually completed after a short interval. These sessions focus on specific problems. With a set goal in mind, clients have something they’re working toward, and CBT is finished once they get there. DBT usually involves sessions over a more extended period of time where the therapist and client can consider the larger picture.

Setting

Another difference between CBT and DBT can be context. Cognitive Behavioral Therapy nearly always takes place in a one-on-one setting. The client and the therapist work together, and then the client will often have “homework” to take home. On the other hand, Dialectical Behavior Therapy can be used in both one-on-one and group settings.

Choosing a Method

Some therapists call upon multiple methods of therapy, also called modalities or models of therapy, which is often referred to as an eclectic approach; other therapists will choose the model they believe best to help each individual person; still others specialize in just one or two models. Both CBT and DBT are useful for treating a wide range of mental health issues. To determine which approach will work best for you, consult with a therapist. 

To connect with a therapist in your area, click here.

Recently there has been an increasing trend in my practice of parents reaching out to help their adolescents manage their emotions. Parents often tell me, “My teen goes from zero to sixty, seemingly without any provocation. Nothing I say seems to help. Discipline doesn’t have an impact.”

I think we all must remember that being a teen is not something most of us would like to repeat. It’s difficult to manage the various changes that happen all at once—physical changes, emotional changes, life changes. During the teen years, the brain develops at such a rapid pace that it puts the limbic system into fight, flight, or freeze mode. When the brain is in this mode, it is less able to access executive functions such as reason, logic, or the ability to use good judgment.

In addition to that, it’s also essential to consider the many things life throws in a teen’s path that can result in trauma, anxiety, depression, or general distress. In trying to navigate social situations, bullies and other stressors, school, various other responsibilities, and home life, as well as beginning (or continuing) the process of self-discovery, teens have a full plate indeed.

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Developing Skills To Manage Emotions

Fortunately there are skills teens can learn to help manage their emotions and the many changes they are facing. Managing emotions is one of the most important life skills a person can develop. I work with many adults who became stuck in adolescence while trying to learn to manage their emotions. As a result, they find their adult relationships difficult to navigate at times.

I believe one of the most important strategies to develop in managing emotions is the ability to identify feelings. Sometimes teens find it difficult to let themselves know what they are feeling, or perhaps they simply don’t know how to identify their feelings. Once they are able to identify and articulate their feelings, vulnerability comes into play, but often the vulnerability piece is avoided because of fear of rejection. Defense mechanisms such as criticism, defensiveness, blaming others, shutting down, or using anger to intimidate are some of the strategies teens may resort to in order to save face.

Learning to Accept Feelings

I believe it’s also of great importance for teens to learn how to accept their feelings. I often work with teenagers who want me to tell them how to make their charged emotions go away. I sometimes ask, “What would happen if you accepted your feelings?” The notion of accepting feelings is not one that is often seen as an option. What I see more often in teenagers is the underlying belief that if the feelings are accepted, they are settling for feeling that way on an ongoing basis.

I remind teens that emotions are not necessarily reality. Emotions can cloud the big picture, and when teens succumb to their emotions, they may lose perspective on what is real. I often encourage teens to pay attention to their self-talk. What do they say to themselves about their feelings? Self-talk is very powerful, and most of us engage in more negative self-talk than positive self-talk. Teens are no exception. But I encourage teens to give themselves permission to have their feelings, to stay in the moment (stay present) and to “be” with their feelings, even the ones that are uncomfortable. Doing so requires teens to learn to be mindful and intentional in processing their feelings and also to learn how to self-soothe. I encourage teens to give themselves permission to have their feelings, to stay in the moment (stay present) and to “be” with their feelings, even the ones that are uncomfortable. Doing so requires teens to learn to be mindful and intentional in processing their feelings and also to learn how to self-soothe.

Teens are often faced with things that are beyond their control, and this can result in anxiety, which is based in fear. What cannot be controlled may produce fear. The ability to discern what can be controlled and what cannot be controlled is important, and teens may find it beneficial to learn how to discern and then let go of what cannot be controlled. Admittedly, this is much easier said than done!

I also advocate for teens to find appropriate ways to express their feelings, negative and positive. Feelings must be released somehow, and the key for teens is to find ways to express them using techniques that will not harm them or anyone else.

There are numerous appropriate techniques teens can use to express their feelings:

• Teens can write about their feelings.
• Teens can express their feelings through art.
• Music helps many teens both realize and express their feelings.
• Physical activity can be productive in helping teens release their feelings.
• Crying is very beneficial at times; teens should know it’s okay to cry.
• Talking and processing emotions with someone trusted can be helpful for both releasing feelings and gaining perspective.
• Sometimes teens need to take some pressure off of themselves and “just be.” This should be allowed and encouraged.
• The empty chair technique, which I discuss below, can be very cathartic.

The Empty Chair Technique

The empty chair technique, cathartic in releasing feelings and understanding internal conflict, comes from Gestalt theory. If a teen is experiencing emotional dysregulation about another person or a social situation, the teen puts this person or situation into an empty chair, metaphorically speaking. The teen sits in the chair and takes the role of the other person, saying what they imagine the other person would say. The teen then switches back to their own chair and says what they want to say (out loud) to the person(s) they would like to express their feelings to.

I encourage teens not to worry about what they are saying when they use this technique. If they need to yell, they can yell. They can express their raw emotions without worrying about retaliation. The objective of this exercise is to help the teen understand the internal dilemma they are experiencing about the other person or situation.

What Can Parents Do?

I believe that generally, parents do the best they can. Sometimes, parents need the opportunity to learn effective parenting skills to navigate the many challenges that come with adolescence. Some effective strategies parents can use to support their teens in learning better emotional management may include:

• Using non-judgmental language. It is easy to assume we, as parents, know the intent of the behavior teens display, but sometimes we don’t. It is important to separate the intent of the behavior from the effect of the behavior and to not assume the intent of the behavior is negative.
• Avoiding all-or-nothing thinking and accepting there is sometimes a gray area
• Facilitating independence by providing assistance
• Providing choices and limits
• Be willing to renegotiate and choose priorities
• Providing firmness and gentleness
• Displaying acceptance and hope
• Validating by paying attention, helping your teen clarify their thinking, normalizing your teen’s feelings or behaviors, and displaying empathy and acceptance. When appropriate, offer self-disclosure and vulnerability when your teen is vulnerable.

Finally, self-care is an important skill for both teens and parents to learn. What do they need to take care of themselves? Exercise? A long bath? Rest? Healthy food? What do they need from another person they can trust? A hug, words of encouragement, or a shoulder (all without judgment) can be very healing. Teens and parents must learn to allow themselves to be vulnerable enough to reach out when they need emotional support and to practice self-acceptance while still remaining open to change.

References:

1. The empty chair – Gestalt theory at work. (n.d.). Retrieved from http://plaza.ufl.edu/jerez64/paper2.html
2. Parrott’s classification of emotions chart. (2013, June 29). Retrieved from http://msaprilshowers.com/emotions/parrotts-classification-of-emotions-chart
3. What is DBT? (n.d.). The Linehan Institute. Retrieved from http://behavioraltech.org/resources/whatisdbt.cfm

As a mental health therapist, I often work with people who have difficulty making and keeping healthy friendships, as well as other relationships (coworkers, family members, partners, and the list goes on and on). Among the struggles I often hear is not knowing how to sincerely connect with someone.

One way to connect is by giving sincere compliments.

Compliments are a great way to connect because they make both the giver and the recipient of the compliment feel good. People enjoy being around other pleasant people, so if you make someone feel good, that person may be more likely to want to spend more time around and with you.

It might sound simple on the surface, but the people I work with in therapy sometimes struggle with how to give sincere compliments to others. I offer the following four tips to keep in mind:

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1. Be Genuine

Don’t give a compliment if you don’t mean it. If you tell someone you enjoy something when in reality it disgusts you, and they find out later, it may hurt your ability to be trusted or be taken seriously in the future. You don’t want to be considered a liar, no matter how good your intentions are. Genuine behavior is generally appreciated, and people may be more likely to respect what you say if you truly mean it.

2. Look for the Good

People enjoy hearing positive feedback. By focusing on the good, or the benefit, of someone’s personality, skill, interest, or other area you wish to compliment, you make it easier for a receptive response. If you find it difficult to compliment someone sincerely in a certain area, try looking at the situation from their perspective and what may have influenced their choices.

3. Focus on Your Feelings

When you focus on the pleasant feeling the recipient of your compliment feels, it feels good to them as well. When someone brings joy, love, or another pleasant emotion to someone else, it often makes them feel that same emotion in return.

4. Keep It Simple

Keeping your compliments simple and to a minimum may help strengthen your connection to the other person. When you give too many compliments, or engage in giving grandiose, complicated compliments, it can feel uncomfortable and a little off-putting. Keep your compliments to one to three at a time. In these situations, less is often more.

Dialectical behavior therapy (DBT) offers an entire module focus on learning skills to improve one’s interpersonal effectiveness (the way one communicates and connects with others). One of the skill sets in this module is a great way to help people learn how to give sincere compliments. To remember these skills, DBT uses the acronym GIVE:

• Gentle: Have a soft, gentle approach to your tone, word choice, and attitude.
• Interested: Be genuinely interested in the person and the content of your conversation.
• Validate: Think about and let the other person know their experience is real and understandable, even if you don’t agree with it.
• Easygoing: Be flexible and have an easygoing manner.

An example of a sincere compliment using the GIVE formula is as follows:

• Gentle: “You’re a good friend.”
• Interested: “I really appreciated your help with my project the other day.”
• Validate: “It wasn’t easy, but we got through it. Your helpfulness is really great!”
• Easygoing: “Thanks, buddy.”

I’d love to hear your experiences giving and receiving compliments. Please share your most appreciated compliments below and how it felt to give or receive them.

Dialectical behavior therapy (DBT) is an evidence-based therapeutic model originally developed by Dr. Marsha Linehan. She found that traditional cognitive behavioral therapies did not always help people who experienced chronic suicidal ideation or symptoms of borderline personality. Since then, DBT has been found to be effective with several other groups of people, including teenagers.

One component of DBT involves group skills training in addition to weekly individual counseling. In the group setting, people can learn and practice skills in a helpful and supportive environment, with active peer feedback. (Individual counseling can then focus on how a person is applying the skills to their own life, as well as process any concerns or issues that pop up over the course of the week.)

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Positive Assumptions for Teens in DBT Group Skills Training

Many people know the playful phrase, “When you assume, you make an ass out of you and me.” Why is this? Because assumptions are unproven beliefs. If you assume wrongly, without taking the time to gather or confirm your assumptions with credible sources, it can hurt relationships. However, assumptions can benefit the therapeutic process when everyone agrees on the same positive assumptions.

The following are DBT’s Treatment Assumptions for Teens in a Skills Training Group. Agreeing to these assumptions is believed to be helpful for teens, their caregivers, and the skills trainers. The idea is to become more accepting, less judgmental, and to think and act more dialectically (one of the core concepts of DBT).

• Everyone in the group is doing the best they can. People are behaving, thinking, and emoting the best way they are capable at this time. It is hoped that, with time and practice, their “best” will improve.
• Everyone in the group wants to improve. People don’t want to stay feeling, behaving, or thinking the way they currently are. As humans, we are always striving to grow and develop in meaningful ways.
• Everyone needs to do better, and be more motivated to change. This assumption goes hand-in-hand with the first two assumptions. While people are doing the best they can and want to improve, they need to do (or behave) better and increase their motivation in order to make these changes.
• People may not have caused all of their problems, but they have to solve them anyway. The phrase “the best-laid plans oft go awry” applies here. If someone rear-ends your car, you may not have caused the accident or be considered “at fault,” but you still need to figure out how you are going to fix your car. The same concept applies to group members’ experiences. Note: For adolescents, given that they are underage, they may need to reach out to supportive adults to help solve problems that are beyond their control or ability to solve on their own.
• The lives of group members are painful as they are currently being lived. The average person experiences many challenges. However, if you consider the experiences that contributed to a group member being recommended and accepted to a DBT skills training group, it would be ridiculous not to consider that life may be extra hard and painful right now.
• Group members must learn and practice new behaviors in all important situations in their lives. It’s always awesome when a group member can master a skill in the therapy or group room. However, if you aren’t taking and using the skills all the other hours of the week you spend outside of these rooms, you aren’t getting the most bang for your buck. This means practicing and discussing your experience using these skills in daily life experiences.
• There is no absolute truth. This is a difficult concept to grasp and live. By valuing the validity of two viewpoints, even when they seem like polar opposites, people can learn to value and respect each other. This is a concept that is often further discussed and practiced when members learn more about how to think and act more dialectically.
• Teens and their family members cannot fail in DBT. This is a radical concept for some people. Often, people in therapy and their families are blamed for not being motivated enough, working hard enough, or trying hard enough. In DBT, blame is not effective (plus, you would never tell someone suffering from a broken bone that isn’t healing properly that they aren’t working hard enough to heal themselves). It may simply be time to consider a different course of treatment if things are not improving, just as an orthopedist may discuss a different treatment if a broken bone is not healing as expected.

If these assumptions make sense to you, and you are interested in enrolling yourself or your teen in DBT skills group therapy, I urge you to talk with your therapist or contact one about options in your community.

Reference:

Rathus, J. H., & Miller, A. L. (2015). DBT Skills Manual for Adolescents. New York, NY: Guilford Press.

In today’s world, it is hard to stay truly connected with others. We are so used to our digital, screen-to-screen interactions that having in-person, face-to-face conversations can feel difficult to manage.

Dialectical behavior therapy, also referred to as DBT, has an entire module dedicated to offering skills and ways to help people communicate more clearly and interact with others more meaningfully. This module is called Interpersonal Effectiveness and it focuses on how the way you communicate and engage with others impacts the outcome of your interactions.

There are three main skills sets within DBT’s Interpersonal Effectiveness module, each related to a different goal or priority.

Skill Set No. 1: GIVE

If it is important for you to keep and maintain the relationship you have, you will want to focus on the first skill set. DBT offers the acronym GIVE as a way to easily remember these skills:

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• Gentle: Being gentle means being kind and nonjudgmental. Keep a moderate or low voice. Keep from yelling, name-calling, or saying mean or hurtful things, even if you’re “just joking.”
• Interested: People love to talk and be listened to. If you act interested, people will want to keep spending time with you. Acting interested includes maintaining appropriate eye contact (no staring), nodding, and asking questions. Even better than acting interested is being genuinely interested. In my experience, you can always find something interesting or fascinating about a person by discovering what they are passionate about, or relating their story to an experience you’ve had.
• Validate: Everyone wants to be understood. When you validate someone, you are letting them know you understand their emotions, thoughts, and/or experience is real. This is not the same as agreeing with someone’s opinion. Validation is letting someone know you respect their experience.
• Easy manner: Chill out. Relax. Be flexible and easygoing. This doesn’t mean ignore or abandon your values, but realize that not everything has to be a battle to the death. People like to spend time with people who are easy to be with. If everything is an argument, or tensions continue to run high, people tend to end those types of relationships.

Skill Set No. 2: DEAR MAN

If you are wanting someone to do what you want, DBT recommends using the skills in the second skill set, often referred to by the acronym DEAR MAN:

• Describe: Before you can ask for you want, you need to describe the situation objectively. I highly recommend keeping this simple and behaviorally specific.
• Express: Express your emotions and opinions using “I feel” statements. When the other person knows what you’re feeling, you don’t leave them needing to guess or, worse, assume what your emotional experience is.
• Assert: Ask for what you want and say “no” clearly. The other person isn’t a mind-reader, so be as plain and simple as possible, even if it may seem obvious.
• Reinforce: Reinforce for the other person how responding to your request benefits them positively. If they know what’s in it for them, people are more likely to respond in the way we want them to respond.
• Mindful: Maintain focus on your goal. Don’t get sidetracked or off-topic. Ignore attacks, and avoid distractions.
• Appear confident: If you don’t look confident, it’s going to be difficult to be taken seriously by the person you are engaging with. Maintain eye contact, keep good posture, and don’t mumble.
• Negotiate: If all else fails, be willing to negotiate. Getting some of what you’re asking for is better than getting none of what you’re asking for. Ask the other person what they’d offer as an alternative solution to the problem. Also, know when to “agree to disagree” and walk away from a discussion.

Skill Set No. 3: FAST

Are you looking to maintain your self-respect after an interaction? You’ll want to refer to DBT’s third skill set in this module, FAST:

• Fair: Act according to the rule. Be fair to yourself and the other person.
• Apologies: Don’t offer apologies or over-apologize if you are just being you or when making a legitimate request. But apologize where appropriate, and don’t under-apologize if you’ve wronged or hurt someone with your actions, behaviors, or words.
• Stick to your values: If something is important to you, stick to it. Don’t change or “sell out” in order to “fit in,” get what you want, or avoid saying “no.” Sometimes, doing the thing that feels right can also feel most uncomfortable. This doesn’t mean you should avoid it.
• Truth: Be honest. Don’t lie, make excuses, or exaggerate circumstances. Take ownership for your thoughts, behaviors, and emotions.

If you keep these skills in mind, you should have little to no trouble keeping and maintaining important relationships in your life.

Reference:

Rathus, J. H., & Miller, A. L. (2015). DBT Skills Manual for Adolescents. New York, NY: The Guilford Press.

Have you ever felt like your emotions are so overwhelming they will never stabilize? Maybe you have an intense urge to return to unhealthy or risky behaviors to make yourself feel better. Dialectical behavior therapy (DBT) has a whole module that focuses on crisis survival skills. These are skills that help you hang in there, or cope, when emotions are overwhelming. It doesn’t make the feeling go away, but these skills can help you get through the intensity of these emotions.

Here is a brief overview of DBT’s crisis survival skills.

Distraction

These strategies are used to distract yourself from distressing thoughts, feelings, or situations that feel overwhelming. The acronym “ACCEPTS” can help with recall in the moment.

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• Activities: Do something. Read, play a sport, or clean.
• Contributing: Do something kind for someone else. Put the dishes away, write a thank-you note, volunteer your time.
• Comparisons: Compare your situation to someone else’s. This can help shift your focus away from your situation.
• Emotions: Making yourself experience a different emotion can help distract you. Watching funny online videos, listening to love songs, or catching up on your favorite soap opera are all examples of how you can distract yourself from overwhelming emotions.
• Pushing away: Don’t allow yourself to think about it. You can use a timer to set a limit on your thoughts or type it all out in an email draft (or go “old school” and write it on paper), and put it away so you don’t focus on it for the time being. This skill is a two-parter, though. When you feel more able to hang in there, go back and address whatever it is you pushed away. Otherwise, it will just keep growing.
• Thoughts: Distract yourself with other thoughts that make it difficult to think about anything else. Say the alphabet backward, count down from 100 by 7s or 3s, or do a crossword or Sudoku puzzle.
• Sensations: Intensify other physical sensations. Eat a strong mint, pet your dog, or squeeze a stress ball.

Self-Soothe with Six Senses

These strategies can help you feel better and in control by using your five senses (and a sixth: movement) to ground you to this person, place, time, and situation.

• Vision: Look at photos that put you in a good mood, or go to a beautiful place and admire the views in person. These can be related to friends and family, nature, animals, or more.
• Hearing: Listen to relaxing music or the sounds around you.
• Smell: Find smells that relax you. Lavender is a solid go-to if you need help getting started.
• Taste: Eat or drink something calming, such as mint or herbal tea. Focus on how pleasant it tastes.
• Touch: Touch something relaxing. Curl up in your favorite blanket or pet your cat.
• Movement: Move around. Dance, go for a run, or do some other exercise.

IMPROVE the Moment

You can’t necessarily change the fact something is happening, but you can change the way you feel, think, or react using these skills.

• Imagery: Use guided imagery, or even your own imagination, to visualize more pleasant outcomes or circumstances.
• Meaning: My mother loves to say “everything happens for a reason.” Being able to understand or acknowledge why something happened, or its purpose, can help you feel better about the fact it is happening.
• Prayer: You can either pray in the traditional sense or use this skill as a form of meditation or journaling. Basically, you can use prayer as a way to connect spiritually or reflect on past, current, and future circumstances.
• Relaxation: Indulge in something relaxing. Go to the beach, get a massage, or even take a nap.
• One thing in the moment: Focus on one thing in that moment. You can focus on your breathing, the sounds you hear, or the way your chair feels.
• Vacation: This can be an actual trip or a “mental vacation.” If you can’t leave the situation or you’re unable to take a physical vacation, escape in a book or a movie.
• Encouragement: Use positive self-talk. Pin inspirational quotes on your Pinterest page or write them in a journal. Reflect on how awesome you are. Reflect on what you’re doing well right now.

Pros and Cons

Considering the short- and long-term pros and cons to a decision can be helpful in deciding how to react to a situation or feeling.

TIPP the Scale

This is a newer skill set introduced in the latest update to the DBT Skills Manual for Adolescents. These skills are used when managing extreme emotions or urges. Using these strategies may help adjust your body chemistry.

• Temperature: Run cool water over your inner forearms or chew on ice to physically “chill out” and “cool down.”
• Intense exercise: Do 20 jumping jacks, 10 push-ups, or run in place for 1 minute.
• Paced breathing: Slow down and count your breaths. You can use “square breathing” (count to four as you inhale, hold for four counts, count to four as you exhale, hold for four counts, repeat).
• Progressive muscle relaxation: Concentrate on squeezing one muscle, then release. Move on to the next muscle group in your body. You can find scripts online that walk you through this or do it on your own.

It is important to note that one skill might not be enough depending on how intense your emotion or urge is. You might need to try a few to find what works best for you. As with anything, it’s also possible that something might work in one moment and not in another. Have a willing attitude as you give these skills a try, and partner with a therapist trained in DBT if you want support.

Reference:

Rathus, J. H., & Miller, A. L. (2015). DBT skills manual for adolescents. New York: The Guilford Press.

Dialectical behavior therapy (DBT) is generally described as a skills-based treatment, a type of cognitive behavioral therapy, and an intensive team-based approach to help people who have severe difficulties with emotion regulation. It has helped many people to manage their emotions, have better relationships, and create fulfilling lives.

When you look a bit deeper, though, at what the DBT skills actually do, they can be seen as opening the mind to curiosity and empathy. This empathic curiosity is the key to better relationships and increased positive emotional experiences. Curiosity—wanting to know—is paired with, and supports, the capacity to imagine the emotional experiences of other people.

So often—and this is reinforced by our social context—we make assumptions rather than being curious. In conversations with others, we think ahead to what we are going to say next, or we make interpretations about the meaning of what the other person is saying.

What if, rather than interpreting or analyzing another person’s words or actions, we were to remain curious about the many possibilities for what the person may be thinking or feeling?

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As children, we were naturally curious. We were constantly asking, “Why?”

Over time, many people lose that natural curiosity because it is often not reinforced by the environment. We are taught to be obedient, to not question, to do what we are “supposed” to do and leave it at that.

From a dialectical behavior therapy perspective, this stifling of curiosity is a part of an invalidating environment. We all experience invalidation in various ways, but people with difficulty managing intense emotions often come from social environments they have experienced as especially invalidating. If curiosity is ignored, judged, or criticized, you learn to stop expressing curiosity because it is not reinforced.

Why be curious? To start with, curiosity makes it possible for us to empathize with others. We wonder how another person may be feeling, what he or she may be thinking, and how he or she may be experiencing us. This allows us to tailor our responses based on this relational context.

Why be curious? To start with, curiosity makes it possible for us to empathize with others. We wonder how another person may be feeling, what he or she may be thinking, and how he or she may be experiencing us. This allows us to tailor our responses based on this relational context. Others experience us as empathic, and this leads to better-functioning relationships.

DBT’s mindfulness skills support this curiosity. It starts with observing—not judging, not evaluating, but simply using our five senses to take in the present moment. Then we put words to our experience by describing what we have observed. Mindfulness requires participating in the moment—just throwing yourself in—and letting go of whatever judgmental thoughts or distractions come up.

In a relational context, mindfulness takes an even deeper form. So often in our interactions with others, we become so lost in intense emotional reactions that we forget the importance of this person and the relationship in our lives. We may be focused on being right, even if that does not get us the outcome we are looking for. The mindfulness skills in DBT teach us to focus on being effective—on doing what works.

When communicating with another person, relationship mindfulness requires being present, holding in mind an imagination of the other person’s experience, and focusing on effectiveness (both short- and long-term). It requires a willingness to do what is needed, even if it’s uncomfortable or difficult. Most of all, relationship mindfulness requires not forgetting the authentic, valid experience of the other person as well as of yourself. Even if the other person has said or done something you do not like, his or her experiences, needs, and desires are valid. Even if your own emotional responses are difficult to tolerate, they are valid.

Empathic curiosity requires a conscious decision—to turn yourself toward the present moment and to open your mind to want to know that which is not always obvious or clear. Such a decision can change your relationships and your life.

Have you ever found yourself in such an emotional storm that you didn’t feel in control of what you were doing? When we are at our most vulnerable, we are most likely to act in the way that emotions make us want to act. As important as emotions are—they provide us with valuable information, connect us to one another, and more—they sometimes lead us down destructive paths. When this happens, it is often helpful to take a look at the situation to assess what happened, whether it was effective for us, and how we might do something different in the future.

Dialectical behavior therapy (DBT) provides us with an effective approach to look in excruciating detail at events in our lives that have not gone well so that we can better understand how such actions are connected to our emotions and to situations we encounter. It is an empowering approach, one that allows each person to become aware of emotional states in order to have choices—choices about whether to act in the way an emotion makes us want to act or to act differently.

This approach is called a behavioral chain analysis. This is an exercise you can do during a DBT individual session, but it’s also a skill you can practice on your own, outside of session. The DBT skills workbook includes worksheets to guide you along. It starts with a specific description of the problem. What happened? What event prompted you to do this? Even if you are not sure that whatever happened immediately before the problem behavior necessarily caused the problem, take note of it.

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It’s important to include an evaluation of how you were doing overall, before a distressing event or feeling came your way. Were you hungry or tired? Were you feeling run down physically? Were you upset about something that had happened the day before?

These underlying vulnerability factors make a difference. Emotional problems can’t be solved with logical solutions, so even if you know what to do, you first have to attend to your emotional needs.

Once you’ve assessed the underlying vulnerability factors, you’ll look at specific events in extreme detail. These are your “links” on the chain, and may include actions, physical sensations, thoughts, beliefs, events, and emotions.

Don’t forget to come up with a strategy to prevent repeating whatever did not work. Start with reducing your vulnerability to negative emotional events. This way, when difficult times come up—as they do for anyone—you will be in your healthiest state from which to respond.

Finally, the chain analysis includes a look at the consequences of what happened. The purpose of this is not to judge—there is no assessment of right or wrong, good or bad. Rather, you are assessing effectiveness. Did the behavior work? Did it serve your short-term and long-term goals? Did it cause any problems? This information can help you then fill in the “missing links,” the effective behaviors that will lead to an outcome more consistent with the life you want.

Don’t forget to come up with a strategy to prevent repeating whatever did not work. Start with reducing your vulnerability to negative emotional events. This way, when difficult times come up—as they do for anyone—you will be in your healthiest state from which to respond.

Also, make sure to repair any damage that was done. This will help to protect and strengthen your relationships. Don’t get stuck in criticizing yourself, though. Repair any disappointments by doing better next time.

While the behavioral chain analysis is a skill that you can apply on your own, it is often helpful to receive coaching in this technique from a therapist trained in dialectical behavior therapy. You can search the GoodTherapy.org directory to find someone who has knowledge and experience in this approach.

After practicing the chain analysis in therapy, you’ll have a skill that you can apply in your life outside of the counseling room. This will help you to better understand yourself, how your brain works, and how to become more in control of your actions while also taking care of yourself and attending to your physical and emotional needs.

Marsha Linehan’s groundbreaking introduction of dialectical behavior therapy (DBT) through her 1993 treatment and skills training manuals has brought effective therapy to many people living with the symptoms of borderline personality. Linehan worked with women who had histories of suicide attempts, self-harm, frequent experiences of crisis, and difficulty managing intense emotional states. She found that the people she worked with in therapy experienced standard cognitive behavioral therapy as invalidating due to its consistent emphasis on changing thoughts, emotions, and behaviors.

Dialectical behavior therapy is a type of cognitive behavioral therapy that is based on a balance between acceptance of where a person is right now together with the need to push for change to help the person have more effective relationships and manage emotional states. The “dialectical” in its name refers to a philosophy in which seemingly opposing ideas can exist at the same time. We’re constantly balancing needs, values, and ideas that may appear to be opposites. Our task is to find the synthesis in these differing ideas.

A key component of dialectical behavior therapy is skills training, which includes the teaching and application of skills in mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance.

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Mindfulness practice is nothing new—it is a core component of many religious traditions—but increasingly we are able to study and measure its brain benefits.

In the years since Linehan released her first treatment and skills training manuals, DBT has been tried and tested in many settings, including with people who do not have borderline personality but who are living with other mental health conditions such as depression, anxiety, and addictions.

The skills training and treatment model of DBT is applicable to people living with a range of mental health conditions. Practicing mindfulness helps people with and without mental health conditions to improve well-being, attention to the present moment, and increasing positive emotional experiences while decreasing negative emotions and distress. This is why people with depression, bipolar, anxiety, eating disorders, and other mental health conditions may benefit from mindfulness practice and the other skills that form dialectical behavior therapy.

DBT for Depression

Dialectical behavior therapy offers skills specifically designed for people dealing with depressive feelings. DBT empowers people with depression to add positive emotional experiences to their lives in order to have better relationships and experience more joy. DBT includes evidence-based behavior activation skills to give people concrete tools to use when feeling depressed. By knowing what works, people with depression can take charge of their lives and do what they need to feel better.

DBT for Bipolar

People with bipolar often benefit from therapy to help them learn skills for tolerating distress and managing intense emotions. There is such an overlap between the symptoms of borderline personality and bipolar that some experts have proposed that borderline personality be considered part of the bipolar spectrum. People with bipolar often benefit from help managing stressors that can increase vulnerability to depression and mania.

DBT for Anxiety

Dialectical behavior therapy gives people skills to live in the present moment and to observe, alter the intensity of, and change feeling states. People with anxiety benefit from being able to tolerate intense feelings and modify behaviors in order to create new emotional experiences. Mindfulness skills in DBT give people with anxiety the tools to set aside worries about the past or future in order to address what is happening in their lives right now.

DBT for Addictions

The new DBT skills manual, published in 2014, includes a section on skills for tolerating distress in people with addictions. Linehan includes in this category not only people with addictions to alcohol and other drugs, but also people who are addicted to gambling, sex, shopping, and more. The skills are based on a philosophy of dialectical abstinence, which uses the understanding that harm reduction and abstinence are both important and can coexist on an individual’s path to recovery.

DBT for Eating Disorders

People with eating disorders benefit from skills to regulate intense emotions and to pick up on trigger emotions that lead to behaviors that cause problems. DBT views food restriction and binging and purging as attempts to manage painful feelings. The skills training component of DBT offers new skills to regulate these difficult feelings.

Dialectical behavior therapy is based on learning theory and is not diagnosis-specific. People with a wide range of problems have found DBT helpful. If you think DBT may be for you, don’t delay in seeking out a therapist trained to offer this effective evidence-based treatment.

The diagnosis of “borderline personality disorder” carries profound stigma for many people. Even some mental health professionals use the term pejoratively, which is not difficult considering that the diagnosis itself implies that someone’s personality is flawed. In reality, the flaw lies within the diagnosis—not to mention all the painful and agitating symptoms that come with it.

I will go into more depth about these challenges, but first a definition is in order.

What Is ‘Borderline Personality Disorder’?

People who are diagnosed with borderline personality tend to have problems with unstable self-image, moods, and relationships. They may experience suicidal thoughts, self-harming behaviors, displays of anger or irritability, and periods of intense sadness or despair called “dysphoria” (the opposite of euphoria).

To receive a diagnosis of borderline personality, a person must meet at least five of the nine characteristics below. Keep in mind while reading the list that, in order to qualify for the diagnosis, the person’s symptoms must be longstanding and inflexible, not just occasional ways of relating to life:

1. “Frantic” attempts to avoid abandonment
2. Intense and turbulent relationships, with a tendency to alternate between seeing the other person as all good or all bad
3. Unstable sense of self, which could lead to radical changes in major aspects of identity such as career, religion, or sexual orientation
4. Frequent suicidal thoughts or self-harming behaviors, such as cutting
5. Impulsive behaviors in at least two other areas, such as substance abuse or binge eating
6. Wild mood swings with extremes of anxiety, irritability, or dysphoria
7. Persistent feelings of emptiness
8. Intense anger or rage that is often close to the surface
9. Brief periods of paranoia or dissociation when under stress

I have seen more than one writer refer to borderline personality as the equivalent of emotional hemophilia: when a person with borderline personality experiences a hurt, even a small one, the emotional bleeding is profuse. The suicide rate for people with borderline personality is about 10%. Most people—up to 90%, by some estimates—with borderline experienced neglect or abuse, particularly sexual abuse, during childhood. Individuals with borderline personality commonly view themselves as inherently defective, bad, or broken.

For many years, borderline personality disorder was considered untreatable. Now, decades of research and treatments have illuminated the errors in such thinking. For one thing, we know that many people “grow out” of the disorder as they age. For another, a great many people with the diagnosis respond positively to treatments such as dialectical behavior therapy.

Stigma and Borderline Personality

All personality disorder diagnoses are controversial. The mere phrase “personality disorder” situates the problem in the person’s personality, rather than neurology or life stressors (including trauma). GoodTherapy.org’s founder, Noah Rubinstein, LMFT, has even explained why he views personality disorder diagnoses to be flawed:

“I believe that by labeling a person as personality disordered or, in its more gentle form, stating that a person has a personality disorder, we are essentially claiming one’s personality, their person-hood, their essence, is fundamentally flawed. What else are we, other than our personality? Such a diagnosis is very, if not absolutely, likely to produce more shame, worthlessness, and rejection in a person who probably has enough of it already.”

I agree with his analysis. In some ways, the situation is even worse for people diagnosed with borderline personality. Any mental health diagnosis can engender feelings of shame, or of being “fundamentally flawed.” On top of that, feelings of shame and badness are both symptoms and consequences of borderline personality. This can create a vicious cycle, as if the diagnostic label alone confirms the feelings of defectiveness that came well before the diagnosis.

Too often, some mental health professionals add to the stigma. It is well known that some clinicians have applied the label “borderline” merely because they do not see an individual improving, or the individual poses challenges such as expressing overt anger toward the therapist. For some therapists, it is easier to blame the client for treatment’s lack of success than it is to look at the clinician’s own inability to help.

Another source of stigma concerns others’ tendencies to judge the person, rather than the person’s behaviors. Some, though certainly not all, people with borderline personality may cope or express their pain in ways that hurt those around them. They may yell or even be physically violent, make unrealistic demands, display intense sadness or anger at what seems a disproportionately small provocation, or even attempt suicide or hurt themselves in ways that make another person feel manipulated.

It helps to keep in mind the fundamental, excruciating pain that often underlies borderline personality disorder. Marsha Linehan, the psychologist who created dialectical behavior therapy, compares the behaviors of people with borderline personality disorder to those of people with painful cancer who will do anything to reduce their pain. The cancer patients may cry, scream, or attempt to “manipulate” others in order to get their pain medication. But we seldom view their efforts negatively, because we understand their abject suffering. Their behaviors make sense.

So, Should the Diagnosis Be Abolished?

I agree with other critics that the label “borderline personality disorder” can compound an already painful situation for people, especially the newly diagnosed. But I also find value in the diagnosis—not the name, but the concept.

Before diagnosis, people with borderline personality often feel bewildered. They may deeply experience their internal chaos yet find that few people understand. I have worked clinically with many people who felt soothed when they learned their problems fell into a distinct category that millions of other people shared. These people felt they were no longer alone.

Once people have a name for a condition, they can more easily find information about challenges and ways to heal. They can find other likeminded people in online support groups. Also, diagnoses enable clinicians to better treat people. Clinicians can draw from a large body of research on borderline personality to identify the best treatment options for individual clients.

The diagnostic label deserves to be changed, but the construct itself should remain, as long as it is supported by continued research. Some researchers, like the psychologist Judith Herman, think that borderline personality actually is a type of posttraumatic stress, and should be reclassified as such. But the idea has not gained much momentum in the field of psychiatric diagnosis.

Changing the name, too, is a pipe dream for now. The American Psychiatric Association only months ago released its first overhaul in almost 20 years of the Diagnostic and Statistical Manual of Mental Disorders, and the group never seriously considered altering the name. That is a shame. The name of a diagnosis should describe the problem—in this case, problems regulating emotions—not the personality. Others have proposed alternate names. My preferred label is one proposed by Dr. Linehan, “Emotion Dysregulation Disorder.”

What Can We Do to Diminish the Stigma?

Use the word “borderline” appropriately. Do not use the word “borderline” as an insult. This especially applies to mental health professionals. I have worked in the mental health field for almost 20 years, and it is disheartening how many times I have heard a professional say “She is so borderline,” or “What a borderline.” Borderline is an adjective to describe a series of symptoms, not a person. And it certainly is not a noun.

Be clear that stigma is undeserved. When we discuss how stigmatizing the diagnosis of borderline personality can be, it is necessary to make clear that the stigma is unfounded. Despite appearances or assumptions, the label does not truly mean that somebody’s personality is flawed. We need not buy into the pejorative meaning.

Exercise compassion. Whether you know somebody with borderline personality or have the symptoms yourself, always keep in mind the underlying pain and anger that can drive behaviors. This is not to say that people with borderline personality are not responsible for their behaviors and cannot make changes. Rather, a compassionate stance helps diminish shame. It also emphasizes the possibility that people can learn more constructive ways to manage their emotions.

Avoid stereotypes. The diagnosis of borderline personality captures a very heterogeneous group. Only five of the nine diagnostic criteria are required for a diagnosis. Two people with the diagnosis could have only one symptom in common. In fact, there are 256 different possible symptom combinations for borderline issues, and every person who has been diagnosed with borderline personality has his or her own unique stories.

Maintain hope. As I noted above, borderline personality need not be a lifelong struggle. The symptoms of borderline personality often mellow with age. Borderline personality disorder, as a diagnosis, also has the advantage of garnering significant attention among researchers, clinicians, and grant funders. New discoveries continue to be made.

More and more, we learn about effective ways to treat people who are diagnosed with borderline personality. These gains in knowledge lead to more hope: hope for people to heal, and hope for the condition, by whatever name, to elicit less stigma and more understanding.

References:

1. American Psychiatric Association. (2013). The diagnostic and statistical manual of mental disorders – 5. Washington, DC: Author.
2. Gunderson, J. G., Stout, R. L., McGlasham, T. H., Shea, T., Morey, L., Grilo, C. M., Zanarini, M. C. et al. (2011). Ten-year course of borderline personality disorder: Psychopathology and function from the Collaborative Longitudinal Personality Disorders Study. Archives of General Psychiatry, 68, 827 – 837.
3. Leichsenring, F., Leibling, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline personality disorder. The Lancet, 9759, 1 – 7.
4. Lilienfeld, S. O., & Arkowitz, H. (2012). Diagnosis of borderline personality disorder is often flawed. Scientific American. http://www.scientificamerican.com/article.cfm?id=the-truth-about-borderline
5. Linehan, M. M. (1993). Cognitive behavioral treatment for borderline personality disorder. New York: Guilford.