Skip to main content
SpringerLink
Log in

The Application of Dialectical Behavior Therapy for Patients with Borderline Personality Disorder on Inpatient Units

  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

Inpatient treatment of individuals with borderline personality disorder (BPD) is typically fraught with difficulty and failure. Patients and staff often become entangled in intense negative therapeutic spirals that obliterate the potential for focused, realistic, and effective treatment interventions. We describe an inpatient treatment approach to BPD patients which is an application of Dialectical Behavior Therapy (DBT), a cognitive-behavioral therapy for patients with BPD which has been shown to be effective in reducing suicidal behavior, hospitalization, and treatment dropout and improving interpersonal functioning and anger management. The inpatient DBT staff creates a validating treatment milieu and focuses on orienting and educating new patients and identifying and prioritizing their treatment targets. Inpatient DBT treatment techniques include contingency management procedures, skills training and coaching, behavioral analysis, structured response protocols to suicidal and egregious behaviors on the unit, and consultation team meetings for DBT staff.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Main TF: The ailment. British Journal of Medical Psychology 30:l29–145, 1957.

    Google Scholar 

  2. Gabbard G: The treatment of the “special” patient in a psychoanalytic hospital. International Review of Psychoanalysis 13:333–347, 1986.

    Google Scholar 

  3. Gallop R, Lancee W, Garfinkel P: How nursing staff responds to the label “borderline personality disorder.” Hospital and Community Psychiatry 40:815–819, 1989.

    Google Scholar 

  4. Sadovoy J, Silver D, Book HE: Negative responses of the borderline to inpatient treatment. American Journal of Psychotherapy 33:404–417, 1979.

    Google Scholar 

  5. Adler G: Hospital treatment of borderline patients. American Journal of Psychiatry 130:32–36, 1973.

    Google Scholar 

  6. Gunderson J: Borderline Personality Disorder. Washington,D.C., American Psychiatric Press, Inc., 1984.

    Google Scholar 

  7. Kernberg OF: Severe Personality Disorders: Psychotherapeutic Strategies. New Haven, Yale University Press, 1984.

    Google Scholar 

  8. Masterson J, Costello J: From Borderline Adolescent to Functioning Adult. New York, Brunner/Mazel, 1980.

    Google Scholar 

  9. Swenson C: Modification of destructiveness in the long-term inpatient treatment of severe personality disorders. International Journal of Therapeutic Communities 7:153–163, 1986.

    Google Scholar 

  10. Levine I, Wilson A: Dynamic interpersonal processes and the inpatient holding environment. Psychiatry 48:341–357, 1985.

    Google Scholar 

  11. Swenson C: Supportive elements of inpatient treatment with borderline patients, in Supportive Therapy for Borderline Patients. Edited by Rockland L. New York, Guilford Press, 1992.

    Google Scholar 

  12. Miller L: The formal treatment contract in the inpatient management of borderline personality disorder. Hospital and Community Psychiatry 41:985–987, 1990.

    Google Scholar 

  13. Bloom B, Rosenbluth M: The use of contracts in the inpatient treatment of the borderline personality disorder. Psychiatric Quarterly 60:317–327, 1989.

    Google Scholar 

  14. McKeegan G, Geczy B, Donat D: Applying behavioral methods in the inpatient setting: Patients with mixed borderline and dependent traits. Psychosocial Rehabilitation Journal 16:55–64, 1993.

    Google Scholar 

  15. Gallop R: Self-destructive and impulsive behavior in the patient with borderline personality disorder: Rethinking hospital treatment and management. Archives of Psychiatric Nursing 6:178–182, 1992.

    Google Scholar 

  16. Sansone R, Madakasira S: Borderline personality disorder: Guidelines for evaluation and brief inpatient management. The Psychiatric Hospital 21:65–69, 1990.

    Google Scholar 

  17. Wishnie HA: Inpatient therapy with borderline patients, in Borderline States in Psychiatry. Edited by Mack, IF. New York, Grune and Stratton, 1975.

    Google Scholar 

  18. Viner J: Milieu concepts for short term hospital treatment of borderline patients. Psychiatric Quarterly 57:127–133, 1985.

    Google Scholar 

  19. Nurnberg HG, Suh R: Time-limited treatment of hospitalized borderline patients: Considerations. Comprehensive Psychiatry 19:419–43 1, 1978.

    Google Scholar 

  20. Friedman H: Some problems of inpatient management of borderline patients. American Journal of Psychiatry 126:299–304, 1969.

    Google Scholar 

  21. Nehls N: Brief hospital treatment plans for persons with borderline personality disorder: Perspectives of inpatient psychiatric nurses and community mental health clinicians. Archives of Psychiatric Nursing 8:303–311, 1994.

    Google Scholar 

  22. Miller L: Inpatient management of borderline personality disorder: A review and update. Journal of Personality Disorder 3:122–134, 1989.

    Google Scholar 

  23. Beard H, Marlowe M, Ryle A: The management and treatment of personality disordered patients. British Journal of Psychiatry 156:541–545, 1990.

    Google Scholar 

  24. Davis MH, Casey DA: Utilizing cognitive therapy on the short-term psychiatric inpatient unit. General Hospital Psychiatry 12:170–176, 1990.

    Google Scholar 

  25. Rosenbluth M, Silver D: The inpatient treatment of borderline personality disorder, in Handbook of Borderline Disorders. Edited by Silver D, and Rosenbluth M. Madison, Connecticut, International Universities Press, 1992.

    Google Scholar 

  26. Sederer L, Thorbeck J: First do no harm: Short term inpatient psychotherapy of the borderline patient. Hospital and Community Psychiatry 37:692–697, 1986.

    Google Scholar 

  27. Silver D, Rosenbluth M: Inpatient treatment of borderline personality disorder, in Borderline Personality Disorder: Etiology and Treatment. Edited by Paris J., Washington, D.C., American Psychiatric Press, 1993.

    Google Scholar 

  28. Miller CR, Eisner W, Allport C: Creative coping: A cognitive-behavioral group for borderline personality disorder. Archives of Psychiatric Nursing 8: 280–285, 1994.

    Google Scholar 

  29. Linehan ML: Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, Guilford Press, 1993.

    Google Scholar 

  30. Barley W, Buie S, Peterson E, et al: Development of an inpatient cognitive-behavioral treatment program for borderline personality disorder. Journal of Personality Disorders 7:232–240, 1993.

    Google Scholar 

  31. Springer T, Lohr NE, Buchtel HA, Silk KR: A preliminary report of short-term cognitive-behavioral group therapy for inpatients with personality disorders. The Journal of Psychotherapy Practice and Research 5:57–71, 1996.

    Google Scholar 

  32. Bohus M, Haaf B, Stiglmayr C, Pohl U, Bohme R, Linehan M: Evaluation of inpatient dialectical-behavior therapy for borderline personality disorder. A prospective study. Behavior Research and Therapy 38:875–879, 2000.

    Google Scholar 

  33. Linehan, MM: Skills Training Manual for Treating Borderline Personality Disorder. New York, Guilford Press, 1993.

    Google Scholar 

  34. Linehan MM, Armstrong HE, Suarez A, et al: Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry 48:1060–1064, 1991.

    Google Scholar 

  35. Linehan MM, Heard HL, Armstrong HE: Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry 50:971–974, 1993.

    Google Scholar 

  36. Linehan MM, Tutek DA, Heard HL, et al: Interpersonal outcome of cognitive behavioral treatment for chronically parasuicidal borderline patients. American Journal of Psychiatry 151:1771–1776, 1994.

    Google Scholar 

  37. Lineha MM, Dimeff LA: Extension of Standard Dialectical Behavior Therapy (DBT) to Treatment of Substance Abusers with Borderline Personality Disorder (DBT-S): Treatment Procedures Manual. Department of Psychology, University ofWashington, 1996.

  38. Donat D, McKeegan G: Behavioral knowledge among direct care staff in an inpatient psychiatric setting. Behavioral Residential Treatment 5:95–103, 1990.

    Google Scholar 

  39. Donat D, McKeegan G, Neal B: Training inpatient psychiatric staff in the use of behavioral methods: A program to enhance utilization. Psychosocial Rehabilitation Journal 15:69–74, 1991.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Massachusetts Medical Center, USA

    Charles R. Swenson (Associate Professor of Clinical Psychiatry)

  2. Western Massachusetts Area, Massachusetts Department of Mental Health, USA

    Charles R. Swenson (Associate Professor of Clinical Psychiatry)

  3. Behavioral Technology Transfer Group, USA

    Cynthia Sanderson (Director of Training)

  4. Weill Medical College of Cornell University, USA

    Rebecca A. Dulit (Clinical Assistant Professor of Psychiatry)

  5. Department of Neuroscience, New York State Psychiatric Institute, USA

    Rebecca A. Dulit (Clinical Assistant Professor of Psychiatry)

  6. University of Washington, USA

    Marsha M. Linehan (Professor of Psychology)

  7. Behavioral Research and Therapy Clinics, University of Washington, USA

    Marsha M. Linehan (Professor of Psychology)

Authors
  1. Charles R. Swenson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cynthia Sanderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rebecca A. Dulit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marsha M. Linehan
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Swenson, C.R., Sanderson, C., Dulit, R.A. et al. The Application of Dialectical Behavior Therapy for Patients with Borderline Personality Disorder on Inpatient Units. Psychiatr Q 72, 307–324 (2001). https://doi.org/10.1023/A:1010337231127

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1010337231127

Search

Navigation