Differential Therapeutic Responses to DBT Skills Training and Validation: A Case Study

Abstract

There is some debate in clinical circles about whether therapy should be oriented more to the client’s subjective emotional needs or to the client’s need for therapeutic direction and problem solving. Although not a true dichotomy, clinicians often orient more strongly to one of the aforementioned strategies or the other. Dialectical behavior therapy (DBT) offers a framework to practice both strategies, as it emphasizes both validation and skills training. It is hypothesized that either the validation, as an example of meeting client’s subjective emotional needs, or the skills training accounts for more of the therapeutic change in individuals with borderline personality disorder (BPD). This hypothesis is explored through the case of Teresa, a borderline client who received therapy that aligned with the principles of DBT. She seemed to respond most favorably to basic empathic connection and a subjective sense of being understood. Contrastingly, she tended to recoil from skills-focused interventions. Based on these results, limitations and implications for future research are proposed.