Dialectical behavior therapy (DBT) is guided by a number of core assumptions about the nature of human behavior and about the process of treatment. Over the next few weeks, I will describe each in turn. One that is high on my list right now, however, is the treatment assumption that clients cannot fail DBT. People often struggle in the beginning with this concept. They say things to me like “but they weren’t motivated enough” or “they weren’t attending regularly” or “they are too difficult to treat”.
Our job as researchers and clinicians IS to motivate the client, IS to develop treatments that will work for the people will treat. We may not have the treatment right now AND that isn’t the patients fault. Imagine for a moment if I were an oncologist who thought this way about my patients who were not responding adequately to chemotherapy or radiation. If I thought it was the patient’s fault, that they weren’t motivated enough, not trying hard enough, etc it would make me quite judgmental and it would stop me from pursuing more research. It would, in fact de-motivate me to find new ways to help my patients. Cancer research is driven by the search to do better for our patients. We don’t blame the patients, we look to science to help us find new approaches.
So why on earth is there still such a prevalent view that there is something “wrong” with the individuals who don’t respond adequately to psychological treatment? This type of thinking must change.
I, for one, love that Marsha Linehan added this treatment assumption to DBT. It keeps me in a non-judgmental state of mind. It drives me to think outside the box. It motivates the type of research I do. Our patients do not fail therapy but the therapy can fail the patient (more on this in the next post).