Client and clinician experiences of dialectical behaviour therapy : a discourse analysis : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, New Zealand

Abstract

Dialectical Behaviour Therapy (DBT) is recommended as the treatment of choice for people with borderline personality disorder (BPD) in New Zealand. This research presents four studies examining the experience of DBT. Discourse analysis was used to examine 27 clinical journal articles with the aim of identifying discourses about BPD and DBT likely to be read by practising clinicians. A second study examined interview data from five practising DBT clinicians in a New Zealand District Health Board (DHB). The third study looked at interview data from five clients, who were undertaking the DBT programme at the same DHB. A fourth study used three case studies to discuss client changes in mindfulness and quality of life, as they participated in DBT. The discourses associated with BPD were of BPD as an illness, as a stigmatising label with connotations of a difficult client group, as a means of ‘making sense’ of the clients’ experience, and as emotion dysregulation and a skills deficit. DBT was constructed as providing skills which enabled clients (and clinicians) to manage distress in their lives. Clients described themselves as changing in a fundamental way, and assuming new identities, which was a frightening (albeit positive) process. DBT was constructed as well researched and theory based, and as a coherent whole which was also divisible into functional elements. Clients and clinicians were found to utilise different discourses to position themselves and to validate their behaviour in various situations. DBT was constructed as helpful within all the studies, and was promoted as a worthwhile therapy by all participants.