Client Experience of Receiving Adapted Dialectical Behaviour Therapy (DBT) and its Perceived Role in the Process of Change

Research into Dialectical Behaviour Therapy (DBT) has been dominated by the neo positivist paradigm providing clinical practice with a sufficiently robust evidence base for DBT as an intervention, reporting positive outcomes with regards to reducing symptoms of Borderline Personality Disorder (BPD). However, in recent years, DBT has been adapted and replicated to different client groups, offering potential for new research into transdiagnostic applications and adapted versions of DBT to different settings.
Recent literature concludes that there is less practice-based evidence on the process of change in DBT, and which components are useful. The client voice is lacking in the literature, which would provide services with evidence and unique insights into how the therapy works and for whom.
This study aims to address these questions, by asking the clients how they experience DBT and its perceived role in the process of change. Furthermore, the study focusses on client experience in a private hospital setting with a transdiagnostic group of an adapted 12 week DBT programme.
Interpretative Phenomenological Analysis (IPA) was applied as the methodology, incorporating descriptive, linguistic and conceptual elements in analysis of semi-structured interviews. The sample consists of five participants whom had completed a 12 week DBT programme at a private hospital.
Three master themes were identified, namely ‘Pre DBT: Crisis & Desperation’; ‘In-session: Belonging’; and ‘The Real World: Living’. Each master theme was characterised by 4 sub-themes, illustrating the journey of the participants and the perceived process of change. All themes were conceptualised by the overarching theme ‘The private setting: Heterotopia’, giving voice to the role of the context of the private psychiatric setting.
The research findings illustrate that this version of DBT was a helpful and positive experience for participants, where outcomes included being able to build a life worth living, feel hope and joy, build DBT skills into a lifestyle, connect with a sense of spirituality and develop reflective practice. The implications for service delivery and for Counselling Psychology are discussed, along with ideas for future research.