Development of an Inpatient Cognitive-Behavioral Treatment Program for Borderline Personality Disorder

This article describes an inpatient treatment program for borderline personality disorder. The program has evolved from a purely psychodynamic to a more cognitive-behavioral treatment approach. It emphasizes dialectical behavior therapy (DBT—Linehan, 1987a, 1987b, 1993a, 1993b), which we believe more effectively operationalizes treatment interventions. DBT is the only treatment approach shown in a randomized clinical trial to decrease parasuicidal behavior in patients with borderline personality disorder, and the use of DBT in an inpatient setting has not been previously described. Inpatient DBT immerses borderline patients in a culture of support for their attempts to skillfully solve problems with emotion regulation and related dysfunctions. Data are presented that suggest that this approach is associated with decreased rates of parasuicide on the inpatient unit.