Bridging the Personal and Professional Self as a Dialectical Behaviour Therapist: Therapist Development in Aid of Work with Clients with Emotion Regulation difficulties.

Abstract

This research uses exploratory methods to consider the professional development of Dialectical Behav-ioural Therapy (DBT) therapists in their work with treating people with emotion regulation difficulties, most of whom have a diagnosis of Borderline Personality Disorder (BPD). Four research projects joined together through the dialectical philosophy that underpins DBT underpin this thesis. A dialectical philos-ophy, which espouses the interconnectedness of all things and the ever-changing nature of reality and truth through transactions, ties together the importance of the transactions between therapists as people personally and with professional development trajectories, as well as the experiences of people, in this case, those who are not delivering DBT, , with a diagnosis of BPD. The thesis focused on gathering data on the occurrences of stigma and stigma resistance on the part of people with a diagnosis of BPD as well as establishing a greater understanding of DBT therapists as people who may have their encounters with mental health difficulties and thus may operate as “wounded healers”. The thesis researcher takes the theoretical stance that understanding these two separate and interconnected perspectives augments the therapists' ability to provide adherent DBT. Therefore, Chapter One examines the prevalence of internal-ised stigma in people with BPD in a highly medicalised cultural setting of Vienna, Austria. Results of the study query the applicability of the standard measure of internalised stigma for people with BPD, namely the ISMI. Additionally, data on internalised stigma in a sample of people with schizophrenia collected one decade earlier in the same setting of Vienna, Austria, suggests that people with BPD in this geographic context experience significantly more internalised stigma. Chapter Two mirrors aspects of Chapter One in its examination of DBT therapists’ own experience of mental health difficulties and stigma. A significant portion of respondents to this survey report a history of mental health difficulties and/or having engaged historically in the behaviours targeted for treatment in DBT. The chapter includes a discussion of how this information could conceivably shape the practice and delivery of DBT. In continuing with the theme of therapist development, the thesis researches the feasibility of measuring adherence to the model in DBT Consultation Team meetings. Delivery of comprehensive DBT with fidelity to the model requires weekly DBT Consultation Team Meetings as one of the functions and modes of treatment. In weekly DBT Consul-tation Team Meetings, therapists live the dialectic of DBT by focusing on themselves and their reactions during the delivery of DBT by applying all of the strategies and techniques of the treatment to themselves. This research suggests that standard measures of adherence to the model in DBT, namely the DBT-Adherence Coding Scale (DBT-ACS) and DBT-Adherence Checklist for Individual Therapy, can function ef-fectively to assess the work carried out in the Consultation Team meetings. Finally, reflection on data gathered from these measures and specific education on the processes of consultation team meetings cor-relate with greater adherence to the model in consultation team meetings. Finally, the last empirical chapter examines the therapist's use of informal exposure in their own life and the impact of this experi-ence on the use of this strategy in session. Informal exposure’s underuse as a change strategy in DBT po-tentially hinders the clients’ ability to obtain the behavioural control that results from the ability to expe-rience their emotions as passing phenomena that need not be avoided and, therefore, may impede pro-gress toward creating a life worth living. Strategies that increase its use benefit therapists themselves in consultation team meetings and would undoubtedly profit clients as a lack of avoidance leads to greater flexibility and more options. The research concluded, however, that for this small group, using self-directed exposure did not yield increased use of exposure in DBT. Post-intervention changes in the Multi-dimensional Experiential Avoidance Questionnaire (MEAQ) and Difficulties in Emotion Regulation Scale (DERS) Scores occurred.

Date of Award	9 Jan 2024
Original language	English
Awarding Institution	Bangor University
Supervisor	Rebecca Sharp (Supervisor) & Michaela Swales (Supervisor)