What's it like for someone with borderline personality disorder to receive dialectical behavior therapy (DBT) treatment?

There are so many different elements to touch upon within this answer that I hope I can do them justice. I am choosing not to answer anonymously so anyone reading this can feel free to contact me directly to discuss my experiences further in depth because I am very keen to help anyone considering or going through DBT. Initial Thoughts, while waiting for DBT to start Thoughts about myself: What's wrong with me? I can't believe I have a mental health illness. I am so scared, I feel so alone. I am lucky enough to have great friends who sympathise, but no matter how hard they try, they can't empathise because they will never feel what I am feeling, my thought processes are different. And therapy? Do I want to admit to myself that I am actually crazy, that I need therapy? Am I actually ready to accept that there is something wrong with me and to seek treatment that I can do justice to? Thoughts about group: I don't want to be in a room full of crazy people. I will have to do 1 hour of individual therapy and 3 hours of group every week. How will I manage with time off work? How will I spend 3 hours every week in a room full of crazy people? Yes, I have to go to therapy - but I'm a highly functioning BPD. I don't want to be confined to a room full of crazy people. What if they are really off the hook? What if I become like them? (notice the massively negative judgements, I was terribly scared) First few weeks of DBT Walking into the room, I will filled with trepidation. There were two keys things I want to address here: I had preconceived negative judgements about people who would be in the room. And then it started. When other people in the group talked, it was like they could see inside my head - they were articulating thought, feelings, emotions that I had felt my entire life that no one had been able to understand. Thoughts, feelings, emotions that got me consistently branded as a drama queen. And there were other people who thought about things in a similar way? What a revelation! I had finally found a group of people that could actually empathise, not just sympathise. I don't believe in the wishy washy hoo ha of sitting on the couch while discussing feelings with your therapist. But the course structure was practical, it wasn't the wishy washy talking about your feelings, it was a specifically designed approach with a predefined structure exactly like going back to school. The entire DBT course was divided into four modules, each lasting for 6 weeks, thereby making one course of DBT six months long - we would have to repeat the course twice for reinforcement. We were given homework, received handouts, had lectures and participated in group discussions about what we were studying. It was taught it bite sized pieces that was easy to understand and really resonated with me. Halfway through DBT: They always tell you it gets worse before it gets better, which I always thought was a load of bollocks. I was sailing through, I was doing well. Till I wasn't. I had a really big nervous breakdown, partially triggered by the fact that I hadn't really accepted therapy and trying to make a change in myself, I was sailing through classes being the A student putting on the facade I have learnt to my entire life. DBT is HARD WORK!!!! I wanted to give it up, I was concerned it wasn't working. Then I realised how seriously I had to take it for it to actually help me get better. It was when I started taking it seriously that I realised what terribly hard work it was. It wasn't just four hours of therapy each week, it was consistent hard work every minute of everyday, attempting to incorporate skills in my daily life. It was difficult to open myself up to people in group and the facilitators and my individual therapist, to just let them in and be completely transparent - I cried in group every week. It was emotionally draining and would leave my exhausted for the entire remaining day so I learnt to not make any plans after group and go home and spend time on my own to let myself think and heal. Life after DBT It feels like I have been locked up in a cage my entire life and someone has given me the key to set me free. Or like the black dog* (video at the bottom of this answer) has been sitting on me my entire life and all of a sudden he has gotten up and left. My head was always full of chaos, thoughts drifting here and there, not being able to focus on one thing at a time, everything was a struggle, everything was unfair - and now? Now my mind is quiet, it's a quiet and peaceful place like sitting in the middle of a park with the sunshine warming your face. I used to have a never ending, deep, empty sadness inside myself and nothing could take it away. And now? I don't remember the last time I felt sorrow. I am not saying I am consistently happy all the time, I am not. But I am stable, I am level... I am the most, normal (for lack of a better word) that I have ever been or dreamt of being my entire life. It is intense hard work everyday. I have to take out a few minutes of each day to practice mindfulness skills and time out each week to go through DBT skills in detail. I have to consciously try and incorporate them in my daily life and evaluate my reactions based on what I have learnt in the past two years. Everyone around me notices the change in me. My family, my friends, even people I have known for years who don't know about my diagnosis and ensuing DBT comment on what a different person I am. They can't put their finger on it, but just say I seem like I am more at peace now. DBT has changed my entire life in the space of two years. I never thought I would ever be able to live like a normal person but now I can cope with life using my skills well enough to be as close to being stable and in wise mind as I have ever been in my life. I would encourage everyone with  BPD diagnosis to pursue DBT but please always remember, that it is INTENSELY hard work. You have to put your heart and soul and sweat and tears into it but if you do it right, it will pay off in the end and change your entire life. I know it did for me. Good luck x *The Black Dog of Depression (referenced above)

I felt relieved in a way. No, at first I felt resistant, then scared, and THEN relieved. and confused. DBT is actually done like a class more so than a therapy and usually with a group of people. The skills that you learn are pretty basic for most people but somehow we missed them. Like how to soothe yourself, how to have interpersonal relationships that aren't dramafied. It feels confusing because even after three years of doing DBT I still had a hard time doing any of it in the moment, instead of reverting to old patterns. Relief was because it was nice to know there was finally some way to address the illness that didn't just involve not killing myself....

There is a great book called 'Buddha and The Borderline' written from just that perspective. I work in the field and frequently incorporate principles of DBT into therapy, though generally not with borderlines. I found the book to be insightful and viewing the process from her perspective was enlightening. -I just wanted to add to, and agree with, one of Suzanne's comments about DBT being a skill set everyone can use to some extent. I agree completely! Much like the twelve steps of AA, there are principals, exercises, and ideals, within that, when practiced and incorporated into our lives, can lead to nothing but good. For example, the DBT skill of "shelving it" is one almost every male I know could use (including this one). The concept of putting a problem aside in a box until we can come back to it and deal with it in a more centered state of mind is completely foreign to most men who feel the need to fix things this second. No human being has ever made their best decisions at either end of the emotional/rational spectrum and this is just one of the skills DBT incorporates to address that.

It's actually a relief to meet different people who have similar but different issues. There's people with different degrees of BPD. I'm a highly functional one so I was always amused and grateful for the structured class. It was also interesting to see what would happen if I didn't keep myself in check. I skip some weeks but the workbooks are helpful when I'm having a meltdown.

DBT requires going through the full course of modules multiple times. At first the skills (if applied) will minimize reactivity and facilitate emotional stability. Once emotionally stability is maintained go through the modules again with a strong focus on mindfulness. Become aware of the spaces between each thought. Become aware that a thought is only a thought. Become aware that an emotion is temporary. Start to actively observe where negative judgements occur and find alternate explanations. Once observe and describe without judgement becomes the dominant interpretation of thoughts, repeat the modules to work on interpersonal skills. For some going through all the modules one time is sufficient. However, I doubt that is the norm. DBT works. To see the effects in a person it takes time, practice and qualified practitioners who are also strong group facilitators. DBT is not a process group where individuals speak without order or for indefinite lengths of time. DBT is a structured group therapy with clear actions to practice -- and it absolutely requires skillful and trained professionals who maintain the groups focus and balance with accountability and self-acceptance. I've done DBT with 6 different practitioners (there are 2 per each group). Only one (with a PsyD and experience with Linehan in Boston) has truly demonstrated definitive expertise and above-average consistency with the facilitation and teaching techniques. From her my eyes were opened. A practitioner who has trained under her has similar quality but slightly less consistency.

What is important to understand about BPD is that it stems from abuse. More than 70% of the time from sexual abuse, but obviously not all of the time. What I understand when it comes to BPD and myself is that I was so severely emotionally abused that I was never given the opportunity to learn how to regulate my emotions as a child. I was in a constant state of hyper vigilance and developed these behaviors to protect myself from the onslaught of abuse. I never learned how to properly express negative emotions because I was never allowed to. This led to severe disregulation of my emotions as an adult. Essentially my brain never learned how to turn off the protections that it put up and I had to relearn all of those things.I was “forced” into DBT when I was 18. I had just taken a leave from school due to a suicide attempt. Going to DBT was a stipulation of me having a place to live. At first, I hated it. It felt so infantile. I always described it as going through kindergarten all over again. I knew logically that I should already know how to use all the skills that we were being taught and it was so infuriating that at 18 years old, it was so hard for me. I came into the lecture three times a week for three hours and had an hour of individual therapy every single week and I absolutely hated every second of it.At first.I didn’t do any of the assignments that we were given, I only took time (where we talked with the group for the last hour) because I was required to take it at least once a week. I was the youngest person in my group, the next oldest being about 35. I resented these women because I wasn’t like them. I resented that anyone thought I could possibly turn into them when I was older.But then the things that we talked about in the lecture started to make sense. And I started to see how my BPD was controlling my life and making it impossible for me to hold a job, relationships, or live on my own. It landed me in the hospital more times than I can count and my arm is scarred to hell with self harm scars. I can’t really pinpoint the moment that it clicked, but when it did, it was as sudden as the switch of a light being flipped.DBT helped me learn that my thoughts were irrational sometimes and that was okay. It showed me how to better communicate with my boyfriend to the point that we have our own “language” now because of how hard it is for me sometimes to handle things and talk to him about stuff. Sometimes I’ll even ask him, “Hey so this thing happened. I am extremely mad about it and this is what I am thinking. Can we talk about it to see if maybe I’m being a bit irrational?” It has created a much more healthy relationship between us and my friends.I am doing much better now, though not great. As far as my BPD goes, I can say it is “under control”. I still think the same way and I still jump to conclusions and still have identity issues blah blah blah, but I handle everything better. I compare it to slamming on the breaks in a car. Before, my reaction time was awful. I wouldn’t think to slam on the breaks until the accident, or emotional break down, had happened already. I didn’t think to slam on the breaks until hours after an incident. Now, it takes me minutes or even seconds to slam on the breaks. Something awful happens and my first thought is still, “I would be better off dead let’s be impulsive and swallow all these pills,” but instead of letting those thoughts take over and acting on them, not slamming on the breaks until I’m in the hospital, the thought pops into my head and then I can immediately say, “Woah there, Chels. Your internet isn’t working. That doesn’t mean you should swallow pills.” (An exaggeration but I digress.)I would recommend DBT to anyone who has emotional regulation issues, not just people with BPD. It is a learning experience. And VERY HARD. It is a lot of therapy and a lot of work and sometimes you need to own up to things about yourself that you don’t like, but I can say my quality of life is better having done it now than if I had stayed stubborn and resisted it.

From personal experience, DBT is not for everyone. It didn’t help at all for me unfortunately as it was stuff I was pretty much familiar with. It also didn’t help the person doing the therapy wasn’t the greatest at it.