Sunday, May 4, 2014

Dialectical Behavior Therapy versus Biblical/clinical therapy.

People who have a personality disorder meet a certain number of criteria for each type. No one really knows why this is so but it seems to be universal.  There is still debate about what is and what is not a personality disorder.

Borderline Personality Disorder was so named because Freudian and Neo-Freudian clinicians did not know if volatile behaviors of patients were a result of neurosis, (a term of Freudian origin) or a psychosis which means they would lose touch with reality. Persons who fell between these disorders were classified as having Borderline Personality Disorder. 
For years I was part of an evaluation team for an agency that did case management for those with severe and persistent mental illness. As a clinician in the mid-nineties our agency was overwhelmed with clients who had the disorder.  We really did not know what to do with them.  This resulted in a team from Kent County, MI going to Seattle, Washington to learn how to implement Dialectical Behavior therapy or DBT in our practice. We first went to Seattle in the Fall of 1996 and again in the Spring of 97.  We had the privilege of being taught by Dr. Linehan herself.  After our first training we were the first (as far as I know) to implement DBT in a case management setting in the world. And the model worked very well for us.  After completing many homework assignments we returned to Seattle to complete our training.


My team members and I became certified DBT counselors.  One colleague and I did group therapy and individual therapy. It actually worked and continues to work with this population. We saw a drastic change in psychiatric hospitalizations of those who had borderline personality disorder.
Christians believe that God is of one essence and exists in three Persons and He is their source of truth; this differs with Linehan’s world and life view.  You may ask how and why does it differ. The major reason is that as Christians, we believe the 66 books that make up the bible were "God-breathed" (theos pnuestos). Our belief is that God breathed His Word through the writers so that what they wrote, was then and is now, inerrant and infallible. 

Now, Dr. Linehan and I did not agree on everything.  As an evangelical Christian, I believe in the above explained absolutes.   Linehan is a Buddhist and believes there are no absolutes and has no apology for it. In my public practice and dealing with many types of people with different  creeds I was able to teach all the skills that are part of DBT. In the private sector, I teach a modified DBT. 

If I am practicing in the faith based culture a modified  form of DBT, many of Linehan's skills are maxims.   For example, if you are lonely and feel like cutting, then you could be encouraged to read a Psalm which talks about “God being a refuge, a very present help in the time of trouble.” If your mind is racing (in a borderline way not bipolar), you might be encouraged to "cease striving and know that I am God.” You also would be taught to "pour out your heart to God and trust in Him at all times." The LORD God of the Bible is a real Person. 

We agree with Linehan about using Distress Tolerance Skills to cope with emotional pain and the Bible gives all kinds of incentives, commands and reasons for why we would see distress as something meaningful, as having to be endured. Romans 5 would be a great example on the assurances that come from being justified by faith. DBT talks about a skill she calls “wise mind.” This is to help the borderline slow down and think reasonably. Emotional Dysregulation is a core belief of Linehan in regards to what is wrong with those who have Borderline Personality Disorder; Mindfulness has Buddhist origins. It has met with considerable success in helping the borderline patient.  But one has to be careful of mindfulness. It employs the use of being non-judgmental and keeping your mind completely open to anything that will help you.
However Scripture encourages us to gird up the loins of our minds and fix them completely on the coming of Jesus Christ to earth. ! Peter 1:13,16


If you have a personality disorder, one of the results is that you cut on yourself to cope with psychic pain which, biblically speaking, would be a sin. Psychologically, there are reasons why a person would do so and certain actions must be taken by the therapist to not reinforce this para suicidal act. Linehan would call “cutting” a maladaptive coping mechanism, not a sin because she does not believe in sin against a Holy Triune God.

I will cover more of this important topic in a future blog. If you have any questions or would like individual therapy, the cost is a little higher than average because of the skill required and the time intensity involved but HCM will always work with individuals on a case-by-case basis. There is hope for you and your loved ones. May God bless you and yours. We want to help you in any way that we can.

Rev. Steve Bloem does individual therapy for those with borderline personality disorder.  If enough are interested there are possible group therapies.