Cognitive-Behavioral Treatment of Borderline Personality Disorder

Rating:
Summary: Respectful to BPD individuals. Techniques used pragmatic
Review: As a person with Bipolar Disorder my psychiatrist recommended this book. I devoured it. For a text the reason it was actually enjoyable was because so many of the techniques of therapy I could incorporate on my own. The Dialectical Behavioral Therapy (DBT) is not limited to BPD. The Cognitive-Behavioral Treatment of which DBT is alongside, can be put into use immediately. Also, Linehan is respectful in her writing style toward patients/clients, with BPD. She is not quick to prescribe medications, (that being only a brief mention). Linehan's style is to focus on environmental reasons a person becomes BPD but not to the point where the client feels helpless to change. She respects people where they're at but wants to take them where they want to be-and that's by integrating positive thoughts about themselves into positive actions-skills training-to have steadier relationships in work and life. I highly recommend this book to anyone diagnosed with any mood or personality disorder.

Rating:
Summary: This is THE MOST EFFECTIVE psychotherapy method
Review: As soon as our county mental health clinic applied Dialectical Behavioral Therapy (DBT), our re-hospitalizations, crisis contacts, suicidal behavior and recidivism rates for our DBT patients went close to ZERO. This is the book I recommend as the start for anyone wanting to be effective in doing psychotherapy - including Psychiatrists, Psychologists, Social Workers, Marriage Family Therapists and Nurses. It empowers the therapist by giving him/her the skills to help severely mentally ill and difficult patients - not just ones with borderline personality disorder. For many, if not most, mental health programs, people with borderline personality disorder are traditionally frustrating, maddening, and looked on with disgust by therapists and medical staff. They are often rejected by staff and treated with anger because of the lack of adequate treatments for the disorder. Yet this is one of the most common mental illnesses. And persons with the disorder repeatedly are hospitalized for suicidal behavior - at large cost to the counties involved. Or worse, they are rejected for hospitalization and allowed to continue to be self-destructive. With DBT this is no longer the case. Therapists who understand DBT are confident and assured when helping seriously ill, constantly hospitalized patients. Therapist who don't often are frustrated, and rejecting of them. No other textbook in therapy is as detailed and well-delineated as this book. It is applicable to inpatient, outpatient, and emergency room settings. DBT works effectively in emergencies, with actively suicidal patients, to reduce the acuity of the situation. It is effective even in short (< 7 day) hospital stays. It takes about ONE YEAR to moderately understand Dialectical Behavioral Therapy. It takes about THREE MONTHS of reading and rereading the book to begin to grasp the concepts described in the book. This book is very "meaty" despite its slimness. The book has its own vocabularly (with an eastern philosophy view), which takes the reader out of the usual psychological jargon, which makes the book initially difficult to read. This accounts for the initial anger that readers may have with this book, unless they are aware of eastern philosophies. The book is NOT psychobabble. Chronic patients with years of psychotherapy actually are more accepting of DBT because it doesn't use the psychobabble they are used to and associate with therapeutic failure. The psychotherapy method described is THE MOST EFFECTIVE method I have ever found. It is NOT purely cognitive behavioral therapy. It is very psychodynamic it its point of view. What is interesting is that the therapists who (I find) naturally do Dialectical Behavioral Therapy (without knowledge of this form of therapy) are Psychoanalysts who are well-centered in their own personalities. A difficulty any therapist will have in performing Dialectical Behavioral Therapy, is that they will have to work on their own personality faults, blindspots, and Countertransferance, while treating patients. This is a part of DBT. This is crucial in order to perform DBT. But then, continuing supervision or on-going therapy of the therapist, is an important part of being a good therapist. Most therapists already know 80% of the content of this book. However, this book puts all the facets of the art of psychotherapy in the best delineated, and detailed manual, I have found. It is highly recommended.

Rating:
Summary: A Total Waste of Paper
Review: At first I thought the author, Marsha Linehan, was a mental patient herself or perhaps foreign-born because this book is so badly written. It's full of new age cliches, tossed in with Eastern mysticism and the author's own ramblings. The author repeats the same words and phrases over and over again, and is fond of making vague circular statements. I'm surprised that an academic like Linehan has such poor writing skills. Maybe a good editor could make sense of Linehan's gobbledygook. I certainly can't.

Rating:
Summary: Respectful to BPD individuals. Techniques used pragmatic
Review: I can't judge Marsha Linehan's qualities as a therapist or an academic, but as a writer she is atrocious. I turned to this book with high expectations since Linehan is often referred to as the maven of this field; I expected either solid science or a report of her practical experiences but was sorely disappointed. The author does make a few good points, such as splitting up the therapy between skills training and counselling, and the importance of therapist supervision, but this could have easily been covered in about 50 pages. The rest of the book is filled with pseudo - science and unintellegible psycho - babble in a treadmill of repetitions. To sort out one particular point of criticism, Linehan's research is solely based on parasuicidal women, but rather than trying to make a connection between this group and the rest of the BPD population (roughly one quarter of BPDs are, after all, men, and self - injurious behaviour is not the conditio sine qua non, despite its spectacularity), or emphazising the limitations of her competence, she simply takes a pars pro toto approach, even going so far as referring to patients solely in the female form. Basically she is saying: the majority of patients are female and self - injury is prominent, so if those two factors don't apply to you then tough luck, you are not on the map.

Rating:
Summary: Psycho Literature At Its Worst
Review: I can't judge Marsha Linehan's qualities as a therapist or an academic, but as a writer she is atrocious. I turned to this book with high expectations since Linehan is often referred to as the maven of this field; I expected either solid science or a report of her practical experiences but was sorely disappointed. The author does make a few good points, such as splitting up the therapy between skills training and counselling, and the importance of therapist supervision, but this could have easily been covered in about 50 pages. The rest of the book is filled with pseudo - science and unintellegible psycho - babble in a treadmill of repetitions. To sort out one particular point of criticism, Linehan's research is solely based on parasuicidal women, but rather than trying to make a connection between this group and the rest of the BPD population (roughly one quarter of BPDs are, after all, men, and self - injurious behaviour is not the conditio sine qua non, despite its spectacularity), or emphazising the limitations of her competence, she simply takes a pars pro toto approach, even going so far as referring to patients solely in the female form. Basically she is saying: the majority of patients are female and self - injury is prominent, so if those two factors don't apply to you then tough luck, you are not on the map.

Rating:
Summary: Fascinating!
Review: I found this book to be so fascinating and eye opening. Although this book is written for those who TREAT borderline personality disorder, I think it will be very helpful to those who have the disorder. I know it has been a great learning tool for me, and I suffer from BPD. Marsha Linehan shows an amazingly compassionate understanding towards the mind of a person with this disorder. I found myself astonished at her incredible ability to understand the way I think. I think the author is nothing short of a genius. The book is great...but it is complicated and it is not a good book for those who don't enjoy intensely intellectual reading. If you are looking for a book to give you quick facts, this is not the book for you. You must enjoy reading to get into this book.

Rating:
Summary: Effective for higher functioning, motivated borderlines
Review: I work in a residential treatment facility for SPMI (all clients also have at least one Axis I diagnosis), and most of our clients have too low of intellectual functioning to grasp many of the DBT concepts. As an intellectual and a practicising Buddhist, I enjoy Linehan's text (especially the focus on Zen aspects: primarily mindfulness). I have encountered many therapists who have succesfully utilized DBT with other client populations. Dr. Linehan has poured years of experience and research into this text. For my clients, I have to significantly alter and simplify many of the tennants of this treatment. If you are reading this, you know that Borderlines are a growing (and very timeconsuming) population of consumers and this text should be in the library of all mental health workers.

Rating:
Summary: Great book, but not without problems...
Review: NOTE: This review should probably really only be read if you have a reasonable level of understanding of Borderline Personality Disorder (BPD). If you don't have such familiarity, there will probably be some things in here that don't make sense, or at least have a significant potential for being misunderstood. Otherwise, read on.

I'm going to skip talking about the good parts of this book, other than to say that they are definitely there, and plentiful -- especially for professionals or "psych geek" types, but also for others... Instead, I'm going to talk about one or two of the problems that I've had with it, leaving the details of the good aspects to other reviewers.

Anyway, on to the problem side.... By far the thing that I personally have had the hardest time with in this book (and let me state right up front that I don't normally have a problem with this sort of thing -- but in this case I do) is her use of feminine forms of pronouns for _all_ references to anonymous people. She talks about this early on (Introduction, I believe, but I don't remember for certain), and explains that the motivation for that decision is that approximately 75% of BPD patients are, in fact, female, and therefore (with a few other factors also coming into play) going with the majority was the choice she made. When I first read that explanation, it seemed reasonable enough, but as I have been reading through the book, and finding bunches of stories which I (a male, in case you that was anything less than certain by now) very much related to, and was feeling very validated by reading about... until I would invariably get hit with a "she" or a "her", and, while I have no problem with the idea that I might have a lot in common with certain women (something I've felt to be true since long before I knew anything about BPD), or the use of the feminine form of a pronoun as if it were generic, in most situations... I would somehow find myself unable to avoid feeling incredibly invalidated by it here. If the usage was mixed up between masculine and feminine forms, (in a 75/25 split, or based on the actual gender of the person she was describing, if it was an individual, even when they were otherwise anonymous, or whatever), I don't think I would have any problem with her choice. If I didn't have BPD, I might or not have some amount of objection to this scenario, but it certainly wouldn't hit me so hard. But given the sensitivity of people with BPD (such as myself) to invalidation, and in particular my own (though I imagine I'm not the only one) insecurities with being male (something I often feel shame about, for a variety of reasons: I was abused by a male babysitter as a young child; rapes and other crimes which I hold in great contempt tend to be committed by males; various people I've known complaining (even directly to me) about how men are all jerks (which I frankly don't always feel any disagreement towards); etc.), it ends up being a huge blow, sometimes to the point of making me feel unworthy of being alive, and frequently making it painful for me to continue reading at that moment.

Interestingly, my next largest complaint about this book most likely has nothing to do with the book itself, per se. And that is simply that my psychiatrist doesn't seem to want to believe, as much as he sometimes points out symptoms of BPD in reference to me, that I actually have it, and that he should take that into consideration when determining a treatment plan for me. But, I talked with another psychiatrist today, and her opinion, after me telling her a bit about my complaints with him, came up with the conclusion that I should find someone else -- something I basically already knew, but which it was really nice to have an external validation of, especially given the fact that I know that sometimes BPD can cause a person to _unreasonably_ end such a relationship.

Anyway, I'm rambling... mostly to random people I don't even know... I think I'll leave things at that. I think I may have noticed other complaints about the book, but not enough that I'm remembering them just now, so they're clearly much further out on the radar.

I do recommend this book, and only mean for this to give a few minor cautions (and perhaps M.L. will read these comments, and find a different way to choose pronoun gender for any future versions and/or other books she might write on this topic.)

BTW, I haven't finished the book, but am roughly half way through, in case that's of relevance to anything I've said here.

Rating:
Summary: This book takes the struggle out of working with BPD
Review: This book is designed for use in skill training groups for BPD. The author offers advice on adapting it to be used in individual therapy however. Linehan is forging a place in the mental health field as the foremost clinican in dealing with BPD. The reader is immediately aware of the extensive amount of research that went into this book. The author is not writing about opinion, she is writing about the results of years of extensively scrutinzing the work of herself and others. On the downside the book has the amount and quality of information one would expect from a textbook. This is not light reading, it is however a page turner (as far as academic texts go) if you have ever felt inadequate when dealing with BPD. After applying the ideas in this book I found that BPD was not the same beast in treating than in the past.

Rating:
Summary: This book takes the struggle out of working with BPD
Review: This book is designed for use in skill training groups for BPD. The author offers advice on adapting it to be used in individual therapy however. Linehan is forging a place in the mental health field as the foremost clinican in dealing with BPD. The reader is immediately aware of the extensive amount of research that went into this book. The author is not writing about opinion, she is writing about the results of years of extensively scrutinzing the work of herself and others. On the downside the book has the amount and quality of information one would expect from a textbook. This is not light reading, it is however a page turner (as far as academic texts go) if you have ever felt inadequate when dealing with BPD. After applying the ideas in this book I found that BPD was not the same beast in treating than in the past.