In 2016 I had a nervous breakdown.
I had neglected my mental health for decades; that combined with a global financial crisis and a traumatic divorce led to a collapse, with near-tragic consequences. By the time I emerged from my unraveling, I had been diagnosed with major depressive disorder, general anxiety disorder, and borderline personality disorder (BPD).
I threw myself into improving personal wellness. In my case it was a five-pronged attack: medication, therapy, diet improvement, socialization, and exercise.
Therapy has been the most life-changing.
My first experience with therapy was cognitive behavioral therapy (CBT). This talk therapy helped clarify my thoughts, beliefs, and attitudes, which, in turn, helped me manage my depression. CBT is a very structured therapy, with a limited number of sessions; after six months of weekly meetings with my CB therapist, it was time to move on.
In those six short months, CBT had given me tools to deal with both my depression and anxiety, especially the knowledge that the interpretation of events, not the events themselves, determine how we feel about them. Now I wanted something to help me manage my BPD.
Borderline personality disorder is a hugely misunderstood condition, but the National Institute for Mental Health (NIMH) defines it as “an illness marked by an ongoing pattern of varying moods, self-image, and behavior.” There are many symptoms of BPD, and a person does not have to have them all to be diagnosed. In my case, my history of unstable relationships, feelings of emptiness, feelings of disassociation, and rapid mood swings were indicators of BPD.
BPD has affected me from my youngest days, though I didn’t always know to call it that. My romantic relationships had always been tenuous thanks to my intense fear of abandonment. I pushed partners away before they had a chance to leave me. Long-term friendships were rare; I could idealize a person one moment, and despise them the next. I could go from elated to annoyed to quietly desperate in a matter of hours. I was reluctant to make long-term goals because I couldn’t predict who I’d be tomorrow, let alone next year.
In her search for BPD-targeted therapies, my girlfriend learned that researchers have found that only a handful of therapies are effective treatments for BPD. Dialectical behavior therapy (DBT), mentalization-based treatment (MBT), schema-focused psychotherapy, and transference-focused psychotherapy (TFP) have all been deemed effective in trials to induce BPD remission in a majority of patients.
I’d obviously had success with behavioral therapy in the past, so when I heard that dialectical behavioral therapy falls under the umbrella of CBT, I applied for a DBT program at a local hospital. After a couple of weeks on the waitlist, I was in.
I arrived early and anxious for my first meeting on a snowy February afternoon. After checking in with the front desk and filling out necessary paperwork, I slunk into a chair. My feet tapped nervously along with my fingertips. Like many with BPD, I vastly prefer familiarity when it comes to people; the idea of meeting many at the same time was making my stomach turn. Finally, I saw the psychologist I had spoken to about the program, and she motioned to an open door.
There were still five minutes till the meeting started, but there were already several people seated around the table. A former bassist for a metal band, a young Asian college student hiding in her parka hood, a woman on the phone arguing with her father’s caretaker in Spanish, a Black man in a suit and tie pulling his workbook out of a shiny leather briefcase. “A slice of New York City life,” I remember thinking.
DBT was developed by Dr. Marsha M. Linehan specifically as a treatment for BPD. It doesn’t “cure” BPD, but it has been shown to lessen its symptoms. One study found that 77% of people no longer met the diagnosis criteria of BPD after a year of DBT treatment.
DBT programs are made up of two weekly meetings—a 2.5 hour group session, and a one-on-one session with a therapist—over the span of a year, and a lot of homework. In my program, the group meetings were divided into three parts, each about 45 minutes: skills training, roleplay, and a discussion of how we applied skills learned the past week.
The 400+ page spiral-bound DBT Skills Training Handouts and Worksheets was both Bible and journal for the group. Within were the teachings of Dr. Linehan and our worksheets (the weekly homework).
That first group meeting was dizzying. I had skimmed through the workbook, but that didn’t prepare me for the avalanche of acronyms. FAST, GIVE, PLEASE, swirled around the table like alphabet soup. Slowly, I learned to associate skillsets and social strategies with acronyms. There was a mindfulness lesson, a discussion of our homework, and then a final exercise.
The people were searingly honest, opening up their lives on a level I had never experienced in a group setting. I vowed to try to let my guard down to make my life better.
But at first, I answered the homework lessons with only positive results, only sharing when I applied the previous week’s lesson and had found success. This wasn’t because every lesson worked perfectly every time. Far from it. I’d certainly tried out DBT tools and been met with failure. But admitting that failure seemed unproductive. When we discussed lessons I’d struggled with, I remained silent.
After a couple of weeks of only reporting my wins, the metal bassist asked me as we walked out of group therapy, “Does the training ever fail you? I mean, you try it and it doesn’t work? Because it’s about 50/50 for me.” I realized that this was true for most of the group; members shared defeats about as often as they shared victories. I became aware then that to help myself and the members of my group, I had to share when DBT methods didn’t work for me, as well as when they did.
That’s when I realized then that I was actually learning more from my fellow group members when they recounted failed attempts to utilize DBT methods than when success stories were recounted.
When DBT tools didn’t work for a member, the group would discuss alternative ways to attack the circumstance; it felt like we were fighting to save one of our own. When someone became increasingly upset at their siblings’ indifference toward helping with her father’s care, we came together to find coping strategies, such as paced breathing and mindfulness tips. When someone admitted using drugs again to deal with their pain, we offered stronger options. Always with empathy. I saw their failures and successes reflected in my own life. When I started bringing my own failings to class, I became stronger.
Group therapy was a constant game of musical chairs. People joined and left every week. Absences were common. Lack of childcare, inability to get away from work, even jail time were common reasons for missed sessions. But no matter who was there, I left every session feeling stronger, more capable of dealing with the world.
Most people graduate this DBT program in a year. On my 52nd session, I said goodbye to a group of people who had become my comrades in a mental health foxhole, at least for two and a half hours every week. I appreciated the psychologist who led the program and my two therapists, but was surprised to find I had learned the most from my group therapy cohort.
We had become a family, albeit one that continually adds and drops members, and one with too many prodigal sons and daughters to count. We shared our failings and our fears. Our victories big and small. Our hopes and dreams. For some of us, it was the only family we had. We had traded phone numbers and texted when we faced daily struggles. We cheered when someone overcame obstacles. I teared up as I hugged everyone goodbye.
I still read Marsha M. Linehan’s books and refer to my spiral-bound dialectical behavioral therapy Bible when I need to. Most of the DBT training has become second nature, I even remember most of the acronyms and am happy to share the tips with others. Though my borderline personality disorder will never be “cured,” the tools I learned in that hospital meeting room have allowed me to live a life that isn’t defined by it.
May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. Mental Health Clinician, 6(2), 62–67. https://doi.org/10.9740/mhc.2016.03.62
Munsey, C. (2020). Schema-focused therapy appears effective for BPD treatment. Retrieved November 18, 2020, from https://www.apa.org website: https://www.apa.org/monitor/mar07/schema
Choi-Kain, L. W., Finch, E. F., Masland, S. R., Jenkins, J. A., & Unruh, B. T. (2017). What Works in the Treatment of Borderline Personality Disorder. Current Behavioral Neuroscience Reports, 4(1), 21–30. https://doi.org/10.1007/s40473-017-0103-z
Stiglmayr C, Stecher-mohr J, Wagner T, et al. Effectiveness of dialectic behavioral therapy in routine outpatient care: the Berlin Borderline Study. Borderline Personal Disord Emot Dysregul. 2014;1:20. doi:10.1186/2051-6673-1-20