Cognitive-behavioral Treatment of Borderline Personality Disorder

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Guilford Press, May 14, 1993 - Psychology - 558 pages
For the average clinician, clinic, or inpatient facility, individuals with borderline personality disorder often represent the most difficult and insoluble cases. The first volume to provide strategies proven effective in controlled clinical trials, this book is a comprehensive, integrated approach to therapy with this population. Marsha Linehan presents specific guidelines that creatively combine the best elements of behavioral, psychoanalytic, strategic, and other commonly employed modalities. A clinical innovator, she has analyzed the aspects of borderline into their component parts and developed a systematized approach to each of them. The first section of the book presents an overview of the disorder and lays out a theoretical framework to guide the therapy. The second describes in detail how to assess borderline patients and how to organize and prioritize treatment goals and behavioral targets. The core of the treatment is the balance of acceptance and change strategies, both within each therapy interaction and over time. For problem solving with borderline personality disorder, the book provides specific strategies for contingency management, exposure, cognitive modification, and skills training. The last component is further elucidated in the companion Skills Training Manual, which programmatically details procedures and includes client handouts for step-by-step implementation. Finally, to enhance interpersonal communication, Dr. Linehan presents three case management sets: consultation to the patient, environmental intervention, and consultation to the therapist. Addressing the most stressful patient behaviors that clinicians encounter, the book includes a step-by-step outlinefor assessing suicide risk, managing suicide threats, and working with chronic suicidal behavior. Integrative approaches for such specific problems as crises, noncompliance, and breakdowns in the therapeutic relationship are also discussed. Lucidly detailing effective techniques that can be replicated in clinical practice, this volume illuminates the internal experience of borderline individuals and provides clinicians with practical clinical tools for working with them. As such, it is an invaluable resource for all professionals who work with this difficult-to-treat population.

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This book is now over 16 years old and much of the content reflects the standard of care from an even earlier time period. Although this book is titled cognitive behavioral therapy it is actually a specialized from of CBT called dialectical behavior therapy (DBT) which has never been validated outside of the authors research.
In her own research patients were dropped from the study if they missed more then one appointment in a row regardless of the reason and after one year of weekly individual therapy and weekly group therapy most of her patients were still just as depressed as when they started. They reduced the number of hospitalizations but that was also a reason to be dropped from treatment as well.
The premise of the therapy is that women are raised in an invalidating environment who develop BPD but again there is no research to support this concept. The vast majority of women who exhibit self harm behaviors are actually abuse survivors but she doesn't address this as a cause. Dr Jobes more recent work with suicidal patients often results in relief in less then 8 weeks and there are not many more medications that can be used as an adjunct to therapy that were not included in her study (she is in fact doing an NIH study now to assess that).
There are much better books available for clinicians who want to use actual cognitive behavioral therapy for trauma clients and Axis II disorders but this a is a classic and a great addition to your library for reference.

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This book is pathetic. This book is written from a primitive view of what BPD really is. It talks about BPD as if it is a common disease that's spreading, when in reality that is simply not the case. BPD is a set of personality traits. It is uncommon--the author of this book describes it as common. It is not a disease. BPDs are simply a group of people that had similar experiences as adolescents or children and therefore developed somewhat dysfunctional personality traits. 


The Concept of Parasuicidal Behaviors
A Preview
Concluding Comments
Dialectical Dilemmas
Active Passivity versus Apparent Competence
Unrelenting Crises versus Inhibited Grieving
Concluding Comments
Targets Strategies
Part II Problem Solving
Part I Contingency Procedures
Part II Skills Training Exposure
Balancing Communication
Structural Strategies
Special Treatment Strategies
Suggested Reading

Dialectical Treatment Strategies
Part I Validation

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About the author (1993)

Marsha M. Linehan, PhD, ABPP, is Professor of Psychology and Adjunct Professor of Psychiatry and Behavioral Sciences at the University of Washington and Director of the Behavioral Research and Therapy Clinics, a consortium of research projects developing new treatments and evaluating their efficacy for persons with severe mental disorders and multiple diagnoses. Her primary research is in the application of behavioral models to suicidal behaviors, drug abuse, and borderline personality disorder. Dr. Linehan is the recipient of the 2012 American Psychological Foundation (APF) Gold Medal Award for Life Achievement in the Application of Psychology.

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