New Therapies, Future Hopes
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Marsha Linehan, a pioneer in DBT therapy, “The first thing we teach is to get control of their behavior. After that, we work on feeling better.”73 Meanwhile, other researchers are taking a different approach to attacking personality disorders. They are studying the anatomy of the brain, searching for clues that might suggest that personality disorders have biological causes. If it can be established that a personality disorder is caused by a brain defect, there is also hope that drug treatments or other therapies can be tailored specifically to the biological causes of the disorders.
Truth Through Discussion Dialectical behavior therapy—dialectical means “seeking truth through discussion”—is similar to cognitive behavior therapy, which has been employed by therapists for more than fifty years, typically to treat people who suffer from phobias and other irrational fears. A person who fears heights, for example, would be encouraged in his or her first session to take an elevator ride to the second floor. After getting comfortable on the second floor, the patient would be encouraged in the next session to ride up to the third or fourth floors. Eventually, after several sessions, the patient should be able to handle an elevator ride to the top of a skyscraper. Cognitive behavior therapy helps the patients confront what troubles them while gradually finding ways to overcome those issues. In other words, cognitive behavior therapy is all about setting goals and finding ways to reach them. A person too depressed to get out of bed in the morning may start cognitive behavior therapy by moving the alarm clock so that he or she would have to get out of bed to turn it off. That way, the depressed person takes the first few steps toward overcoming the feeling of anxiety that prevents him or her from getting out of bed. On the second day, the patient may be encouraged to place the clock all the way across the room, perhaps next to the clothes closet, so that he or she has to take several steps to turn it off. On the third day, the patient may be encouraged to get dressed.