DBT is a very structured method of therapy. If anything drives me nuts about it, that's probably it. And I know that Marsha Linehan wouldn't claim that DBT is for everybody. I have listened to a recording of her speaking about evidence-based therapy in which she talked about research (her own and others' also) on other evidence-based therapies for BPD. She recommended three options, actually. DBT; Mentalization-based therapy (which is a psychodynamic approach with good evidence); and "treatment by experts," which is simply treatment by someone with experience and a good track record, no matter what their method or orientation. All of these three, according to Dr. Linehan, were emperically shown to be effective treatments for BPD. There is some overlap in symptoms between BPD and PTSD, and some emperical basis for expanding the target population, but I'm less familiar with that evidence. Personally, I'm using DBT skills groups and some DBT strategies with teenaged boys with addiction and criminal behavior. Most of them don't have BPD (in fact, I'm not aware of any of them with BPD), but some of my clients with PTSD are responding to DBT very well. There are also some (especially kids with Oppositional Defiant Disorder or Conduct Disorder) who hate DBT. But then, those same kids seem to hate pretty much anything we try.

In that talk by Dr. Linehan, she also mentioned that after 2-3 years of DBT, some patients benefit from followup with psychodynamic therapy. She seems pretty inflexible at first glance, but she also seems more open to other methods than one might expect. I don't know if I'll ever practice strict DBT. I keep finding other methods that I want to draw from also. And I'm not entirely clear on how much I could do that if I were calling myself a DBT therapist. But EMDR has its place, and I've always liked psychodynamic therapy too, among others.

This post brought to you by Rap's other personality fragment, the academic/professional, who took over after Rap's previous post by "the whiner." Rap needs to give her ego fragments better names. These seem more functional than the numbering system originally proposed by Rap when T asked what Rap wanted to call them, tho.