Restoring hope and a life worth living - the power of DBT
You've made my journey worthwhile. You've given me hope for a life worth living, and proof that recovery is possible.
You made this journey possible. Even when I denied it, you're helping me sometimes.
The words inside a Christmas card, given to Dr Victoria Taylor by 22-year-old Rhiannon last year, speak volumes about the power of Dialectical Behaviour Therapy (DBT).
Having been a patient at St Andrew’s Healthcare for two years, Rhiannon - who has Borderline Personality Disorder (BPD) - says that DBT “without a doubt saved my life”.
“I am living again. I am smiling again,” says Rhiannon, who has been able to return to her native Ireland.
For Dr Taylor, this real-life example shows what can be achieved through the comprehensive DBT approach delivered by St Andrew’s.
Through its Women’s Service DBT programme, which engages women from across the UK at its site in Northampton - and is underpinned by sector-leading research conducted on site - lives are transformed with the support of the team
"When a person is overwhelmed with feelings of hopelessness and struggles to visualise a life for themselves that isn’t about all-consuming suffering, we as therapists are the caretakers of that hope for people,” says Dr Taylor, Consultant Clinical Psychologist and DBT programme lead.
“I feel really strongly about the responsibility to hold on to that hope whilst they take the necessary steps to recovery that then facilitate them once again being able to consider a meaningful life for themselves.
“It’s a very hopeful therapy - and through our comprehensive approach, we are genuinely supporting people to rediscover a life worth living. DBT isn’t a suicide prevention treatment, it’s a life enhancing therapy. We as therapists work to support people to build a life that they want, not to simply exist.”
The delivery and impact of DBT
For women with complex presentations, who are impacted by conditions including BPD and complex PTSD - often both, the support of St Andrew’s can be life-changing, and crucially life-saving.
Through its dedicated Silverstone DBT unit, women aged 18 and over are supported by a multi-disciplinary team and DBT therapists to make lasting change to their lives - and at the root of the lasting change is the comprehensive approach to their recovery journey
While DBT is offered in a number of settings, the St Andrew’s treatment programme includes all five functions: enhancing capabilities; enhancing motivation; ensuring generalisation; structuring the environment and DBT consultation.
Dr Taylor believes that by employing a comprehensive approach lasting outcomes can be achieved,
“There are lots of contexts where DBT is being delivered and patients believe they have received DBT,” she says.
“But often we see there aren’t the resources or funding to be able to offer certain aspects of the treatment, or the context in which the service is being delivered doesn’t fit with having the option to offer a comprehensive DBT programme.
“The impact of this is that people don’t experience the full benefits of the treatment, it can significantly dilute what the therapy has to offer. It’s often DBT simplified down to just being about learning coping skills.
“People can then leave services with some knowledge of DBT, but really not having experienced the benefits of combined group and one-to-one therapy delivered by a team, with support to make use of the strategies in a manner that can have a significantly positive impact on their lives.
“Our focus is on comprehensive DBT programme delivery, treatment by an expert team - with DBT therapists from a variety of professional backgrounds, including Occupational Therapists, Social Workers, Clinical Associates in Psychology and Nursing which I think really enriches our formulation of an individual’s difficulties.”
DBT, developed by Dr Marsha Linehan in the 1980s, combines elements of cognitive behavioural therapy (CBT) with concepts of mindfulness and acceptance, and operates on the dialectical principle, which means balancing opposing ideas or concepts. In DBT, this often involves finding a balance between acceptance and change.
The treatment is structured in stages, initially targeting ‘life threatening behaviours’ and behaviours that ‘interfere’ with treatment, and then progresses to addressing symptoms and issues that compromise the patients quality of life, including the treatment of other coexisting diagnoses using the recommended evidence based treatment.
Ahead of the programme beginning, the pre-treatment stage is a particularly important step to gauge suitability and readiness for the 12 months ahead. Pretreatment seeks to solidify commitment to the treatment programme.
“A person’s willingness is critical to this, and in DBT there are a lot of stylistic strategies that help to encourage and enhance somebody’s motivation and engagement in treatment,” says Dr Taylor.
“Our overarching goal in DBT is achieving a life worth living, and as part of pre-treatment, we spend a lot of time trying to clarify what that would look like with patients.
“It’s about getting to the heart of what would give someone meaning and purpose, what will keep them going when we recognise that despite our best efforts life can at times be very painful!”
“In those very difficult moments, where people may have given up hope of their lives being different, when they communicate that they have had enough, it’s very important for us to be able to say, ‘What about your life worth living goals?’
“We can help them remember another moment where they had different goals that they wanted to achieve, to own their own bakery say, or return to full time education, remind them of the places they would really like to visit, or the family connections they would like to have for example.
“So we can identify what problems we need to support people to solve in that moment so that dream of having their own bakery comes back into their mind as something that is really meaningful to them. A possibility rather than just a consideration.”
Ongoing advances through research
As well as the comprehensive treatment delivered by St Andrew’s, its DBT provision is continually advancing through its work with the charity’s Centre for Developmental and Complex Trauma (CDCT).
The on-site CDCT has partnered with the DBT service since 2020 to support its ongoing development through data-driven insight, which enables it to focus on establishing and meeting the trauma needs of patients.
Its work, led by centre director Dr Deborah Morris, enables the service to continue to develop and better meet the needs of its patient population, says Dr Taylor. This level of insight is not available in many other settings.
“There is a lot of discussion around the overlapping symptoms in BPD and complex PTSD and we as a service wanted to understand our patient group better,” says Dr Taylor.
“We worked with the team on a prevalence study and established that just over 60 per cent of our current patient population met the criteria for both diagnoses. It’s very important we know that so that we can be more targeted in our support and treatment offerings.”
Further invaluable insight was gained through the CDCT’s work in establishing the impact of BPD and complex PTSD symptoms on functioning.
“This work found that it wasn’t necessarily the most severe symptoms that impacted on functioning, it was specific symptoms,” says Dr Taylor.
“So, for example, we found that ‘sense of threat’ and ‘disturbances in relationships’ were two areas that significantly impacted on functioning.
“This kind of information allows us to fine tune our interventions and offer truly patient-centred care.”
St Andrew’s is well known for its research in a host of fields, with its knowledge helping to shape best practice within its own services and across the wider sector.
Indeed, the CDCT team will soon be co-hosting the fourth International Trauma Informed Care conference in conjunction with the British Psychological Society and Dr Taylor and her team will again this year be presenting their most recent research findings.
“We are heavily supported as clinicians by the CDCT in terms of being able to continually ask relevant research questions.
“Deborah and her team are always available to support our service in our quest to improve and adapt the interventions and support we provide through our research activity.
“It would be a lot harder for us, without this support, given the pressures clinically, to be able to do anything of this kind. For St Andrew’s, the insight gained through research ensures the ongoing delivery of evidence based services across its whole operation.”
To find out more about St Andrew’s Personality Disorder Services click HERE and to discover more about The Centre for Developmental and Complex Trauma including information about their forthcoming conference visit the web page HERE.
Built with Shorthand