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Use of Dialectical Behavior Therapy in Borderline Personality Disorder: A View From Residency

Received August 17, 2005; revised August 21, 2006; accepted September 21, 2006. Drs. Dunlop, Ninan, and Bradley are affiliated with Emory University School of Medicine, Atlanta, Georgia. Address correspondence to Dr. Dunlop, 1841 Clifton Road, Wesley Woods Health Center, 4th Floor, Atlanta, GA 30329; bdunlop{at}emory.edu (e-mail).

OBJECTIVE: The authors describe the use of dialectical behavior therapy (DBT) in treating borderline personality disorder during psychiatry residency, and assess the status of DBT education within psychiatry residencies in the United States. METHOD: The authors present a patient with borderline personality disorder treated by a resident using DBT, along with perspectives from the resident’s supervisors. Additionally, self-report surveys inquiring about the attitudes and experiences of residency directors and PGY-4 residents regarding DBT were sent to program directors with available e-mail addresses on FREIDA online. RESULTS: The DBT method employed by the resident had to be modified to fit the constraints of a residency program. The patient in therapy had a tumultuous course, ultimately resulting in the discontinuation of treatment. Survey results suggested an underemphasis on the education and use of DBT during residency, though the strength of this conclusion is limited by the small proportion of surveys returned. CONCLUSIONS: Achieving the efficacy of DBT-based treatment of borderline personality disorder reported in the literature in the setting of a residency program is challenging. Greater exposure to DBT during residency may increase residents’ skills in using the technique and the likelihood that they will use it after residency.

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