DBT Doesn't Work

The industry standard for Borderline Personality Disorder doesn't produce results

For years now, DBT or Dialectical Behavioral Therapy has been the industry standard for treating Borderline Personality Disorder or BPD. I'd be curious to know how or why it became the industry standard because I don't know. I was told this was the industry standard many years ago when I started as a bonafide mental health profession many years ago. BPD is treated with DBT because, I assumed, it was helping people recover from the disorder.

So how does it hold up? If I were to give it a letter grade for how effective it is for curing BPD, I'd give it an F. I've actually met several individuals over the years who have essentially solved this complicated disorder and mostly recovered, at least to a degree and none of them have said that it was DBT that got them there.

DBT Origins

I was curious about how and why DBT became the industry standard so I asked AI about it. DBT was developed by Dr. Marsha Linehan who has been open about her own mental health issues including a possible case of BPD but it hadn't been formally recognized as a mental illness in her day so her exact mental illness isn't exactly known.

She's pretty old, born in 1943. She developed DBT specifically for BPD which was once seen as totally untreatable. As best as I can tell, DBT got a lot of traction because it was hailed as a long awaited answer to BPD back in the 80's when nobody had any idea about what to do. Now that it has been actively and widely used for several decades now, we can confidently say that it's totally ineffective.

The results just aren't there. I'm not trying to bag on Dr. Linehan but it's getting a bit old watching therapists push BPD patients into DBT when it's not producing results. Therapists tirelessly swoop in to rescue it and make excuses as to why it doesn't work or why it's supposed to. All of which is just a distraction that avoids this one concrete truth. It. Doesn't. Work.

Symptoms vs Problems

The trouble with DBT is that it only addresses the symptoms. BPD is, by far, one of the most complex disorders. It's widely misunderstood. One mistake BPD patients might make is assuming that therapists are well versed and embedded with an understanding of this disorder when the opposite is true. Most of them are totally lost when it comes to BPD which is one of the reasons why they quickly send them off to DBT. They just don't know any better.

DBT mostly addresses symptoms which is mostly emotional dysregulation issues. The dysregulated emotions aren't the problem, the problem is much deeper. The dysregulated emotions are only a symptom, in fact I consider that to be the most surface symptom which means that it's several layers removed from the real problem.

It's kind of like if someone had pneumonia, their lungs are deeply effected and sick but the doctor only give you cough syrup. In this case, the dysregulated emotions are much like the cough. Loud and obvious. Like a squeaky wheel, it gets the oil. The emotions get the attention. The trouble is the underlying issues aren't addressed whatsoever in DBT. It primarily sticks with the emotions which are just a symptom.

For example, DBT barely even recognizes what happens when the fear of abandonment is triggered and it does nothing to address why the fear of abandonment exists to begin with or the need to solve that issue. In my opinion, the fear of abandonment is getting closer to the real problem but is still more of a symptom than the real problem.

The Real Problem

So what's the real problem? What is going on with BPD? What is driving it and fueling it? Our biggest clue is with the third criteria for BPD in the DSM-5 which says, "Identity disturbance: markedly and persistently unstable self-image or sense of self."

The real problem is that the individual identity has essentially been shattered into pieces. There's no sense of self or core identity. Their persona or personality isn't truly formed. They seem to change from person to person on any given day or sometimes from moment to moment. Imagine that you have a bus full of people and each one of them, at any given time, might force their way behind the wheel and drive the entire bus to wherever it is they want to go. The bus goes back and forth, up and down, depending on who happens to be driving.

When your psyche is broken into a lot of pieces, this is basically what's happening. All of the distress and dysregulation is happening because of the interplay between all the different fragments, pieces or parts. Because they are working against each other, trying to serve their own agendas, the parts or fragments aren't integrated, they aren't working together so therefore, the person lacks integrity. They externalize their distress because they lack the ego strength to recognize their actions as their own, they're detached or dissociated from the fact that it's them causing the chaos because they are struggling to identify with who is driving the bus. It's as though somebody else is responsible for what's happening to them but they don't identify with it.

This whole dynamic and interplay between the different parts or fragments is the real problem. DBT doesn't even recognize that this dynamic exists. Psychologists and therapists don't recognize this problem either, there is no general consensus about what a personality disorder is and what drives it. I'm totally convinced that this is the problem that needs to be directly addressed and worked with.

Internal Family Systems

The solution, therefore, is to put the person back together, piece by piece. So how do we do that? Through this thing called shadow work which basically means that we need to work with the subconscious. Internal Family Systems Therapy or IFS is one simple and structured method that I prefer to use. I've already written an article about this, I believe IFS is likely to create much better results than DBT.

I don't believe that those with BPD should seek DBT. It's a waste of time and money. I believe they should seek a therapist who uses IFS instead. I've already had a few people chime in on this online who agreed with me. They told me they had been diagnosed with BPD and had tried DBT but ultimately landed on IFS where they got much better results.

If you ask me, the entire therapy world needs to shift. They need to abandon DBT for it's treatment of BPD and go with IFS instead. I realize how unlikely that is so I'm trying to use my own platform to spread this information.

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