Is DBT a non-negotiable?

[Before you can make things better, you have to stop making them worse...]

No children with my uBPDw, married <1 year, met 2 years ago. My wife has unraveled significantly over the course of the last year and I’m struggling with the decision to stick with her or not. She started DBT a little over 4 months ago but in the last 5 weeks she stopped going to the skills/tools class and is just going to the talk therapy sessions. She had lots of excuses for it, but it comes down to a choice and prioritizing. She has said that those classes trigger the most shame because they seem pathetic. It also comes down to very specific actions—you’re either trying the tools in a spiral or not. She can’t avoid the ambiguity as well with that. Since I found out I’m having a harder time justifying all of the effort I’m putting in. I’m validating and validating, communicating with the SET-UP method, keeping clear, compassionate boundaries, getting therapy… Carrying the weight of this dilemma (compassion vs self-preservation) is brutal, and it’s harder still when she is avoiding treatment and accountability. She’s still very resistant to structured treatment or groups of any kind. She even suggested dropping the frequency of DBT to once every other week. It makes her pleas for me to be patient and insistence that she’s trying everything ring hollow.

Does anyone with experience have any insight as to how important DBT is? I know that if she’s not ready to face it, merely attending won’t help much. But are her hopes for practical things like a job and social circle being the catalyst for change realistic? Or is it just stalling/deflecting? I can hang with her if she’s on the pat past the point of surrender, but I don’t know that I can stay when it’s just enabling avoidance and costing me more than I can afford, financially, emotionally, creatively…

[Zosima]

No children with my uBPDw, married <1 year, met 2 years ago. My wife has unraveled significantly over the course of the last year and I’m struggling with the decision to stick with her or not. She started DBT a little over 4 months ago but in the last 5 weeks she stopped going to the skills/tools class and is just going to the talk therapy sessions. She had lots of excuses for it, but it comes down to a choice and prioritizing. She has said that those classes trigger the most shame because they seem pathetic. It also comes down to very specific actions—you’re either trying the tools in a spiral or not. She can’t avoid the ambiguity as well with that. Since I found out I’m having a harder time justifying all of the effort I’m putting in. I’m validating and validating, communicating with the SET-UP method, keeping clear, compassionate boundaries, getting therapy… Carrying the weight of this dilemma (compassion vs self-preservation) is brutal, and it’s harder still when she is avoiding treatment and accountability. She’s still very resistant to structured treatment or groups of any kind. She even suggested dropping the frequency of DBT to once every other week. It makes her pleas for me to be patient and insistence that she’s trying everything ring hollow.

Does anyone with experience have any insight as to how important DBT is? I know that if she’s not ready to face it, merely attending won’t help much. But are her hopes for practical things like a job and social circle being the catalyst for change realistic? Or is it just stalling/deflecting? I can hang with her if she’s on the pat past the point of surrender, but I don’t know that I can stay when it’s just enabling avoidance and costing me more than I can afford, financially, emotionally, creatively…

[Notwendy]

Does anyone with experience have any insight as to how important DBT is? I know that if she’s not ready to face it, merely attending won’t help much. But are her hopes for practical things like a job and social circle being the catalyst for change realistic? Or is it just stalling/deflecting? I can hang with her if she’s on the pat past the point of surrender, but I don’t know that I can stay when it’s just enabling avoidance and costing me more than I can afford, financially, emotionally, creatively…

I think each person has to decide on their own deal breakers- what is non negotiable for you. This is your relationship to decide on. If your decision is based on what the other person is doing- that may change, vary, and be confusing.

In the case of therapy for BPD (and for anyone in therapy)- the person needs to be self motivated to do the work. Doing it, going through the motions to meet someone else's deal breaker or expectation is not self motivation. It's also not a fast process. Change takes time. DBT is considered a main therapy for BPD but for any therapy to be effective, the person needs to be willing to work with it.

So rather than focus on DBT as a non negotiable, consider what are your non-negotiables in this relationship in order for you to want to remain in it. At the moment, being recently married without children- the decision to stay or leave is less complicated. Emotionally it's not easy regardless.

Base these on you, not the "you must be in therapy in order for me to stay in this marriage". Her looking at work, or making friends as a catalyst for change- these are external things that neither of you have control over. When she gets a job, when she makes friends- these are not based on your feelings and boundaries.

It is possible for someone to pull it together quickly when motivated, out of fear of losing you. But this isn't long term change. One suggestion is to stop negotiating her staying in therapy with her. This is between her and the therapist. If she's negotiating with you, coming up with reasons to not go to therapy in discussions with you- you aren't the one to make her go. If she wants to stop- she has that choice. But you also have the choice of deciding what you will do if she does. One response might be "honey, I care about you and would like to see you get help,  but whether or not you want to continue therapy- this is between you and the therapist. It's your choice to make".

Look instead at what your non negotiables- a discussion with yourself, not your wife. Don't discuss them with her as they'd sound like threats or ultimatums.

One of yours might be "I need to see her make her own commitment to working with therapy and some kind of progress over the next 6 months" and then reassess. If she's quit therapy and has made no changes- then you can see that too.

Or, you've decided enough is enough at any point, or that you want to have a longer interval to decide. It's actually up to you.

[CC43]

Hi there,

I agree with NotWendy that change is hard, and for change to stick, the motivation should usually come from within.  A constructive internal dialogue for your wife might look like, I'm really unhappy . . . I love my partner and want us to be happy together, but for that to happen, I need to be in a good place first. . . I should give therapy a try because nothing else has seemed to work very well for me, and it's up to me to do this for myself, because I'm worth it, I just need some extra support and tools right now.  BPD is treatable if I have the right attitude, and DBT has a good treatment track record, provided that I give it a chance, and therapy should be my priority right now.

However, the BPD internal dialogue often centers around a victim narrative, which means that she thinks that others are the cause of all her problems.  As a victim, she doesn't need to change, but other people do.  She might agree to "go along with" therapy for a short time, but just to get some sort of concession out of you, and not because she's committed to the process, because her core belief is that she's a victim, and others are perpetrators.  The sad part about this narrative is that she feels helpless, stuck and very unhappy.  After reading these boards, it seems that many BPD sufferers have to "hit bottom" before they are ready to change.  And hitting bottom is not pretty--these boards will have tales of complete alienation from family, substance abuse, couch surfing, evictions and encounters with police. 

[kells76]

To focus on a detail:

Does anyone with experience have any insight as to how important DBT is?

While DBT is one effective modality for BPD, there are others, as well. McLean Hospital's website discusses a couple of other treatments:

McLean’s expert treatment focuses on these proven care models. Our BPD care utilizes dialectical behavior therapy, mentalization-based treatment, transference-focused psychotherapy, and other therapies.

Dialectical behavior therapy (DBT) is the gold standard treatment for BPD. DBT emphasizes the development of four skill sets. These are mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.
Mentalization-based treatment (MBT) helps patients stabilize their sense of self, with the goal of improving interpersonal and relationship skills and reducing self-destructive behaviors.
Transference-focused psychotherapy (TFP) focuses on a patient’s contradictory sense of identity. This is associated with problems with interpersonal relationships, self-esteem, and mood regulation.
In addition to therapies that address BPD, group and individual therapy cover a broad range of topics. These can include mindfulness, interpersonal effectiveness, distress tolerance, emotion regulation, and family issues.

They also have a brief discussion of GPM (General Psychiatric Management) as another option.

So, I would maybe not frame the question as "DBT or nothing", as like Notwendy highlighted,

In the case of therapy for BPD (and for anyone in therapy)- the person needs to be self motivated to do the work. Doing it, going through the motions to meet someone else's deal breaker or expectation is not self motivation. It's also not a fast process. Change takes time. DBT is considered a main therapy for BPD but for any therapy to be effective, the person needs to be willing to work with it.

it's less about "how can I make her stick with DBT specifically" and more about "I want for her to be engaged with and trusting a competent therapist, of her own volition".

I'm curious if you've looked into DBT clinic guidelines and client rules? Here is an example -- might have some helpful insights about what's realistic to expect, as you are deciding what you are OK with in your life and relationship:

https://www.lenapevf.org/wp-content/uploads/2020/06/DBT-FAQs.pdf

[CC43]

Sorry, I didn't mean to end my reply on a dour note.

Anyway, I've found that with the BPD and NPD in my life, progress doesn't happen in a straight line; rather there have been some baby steps forward and some setbacks, too.  I find that it has been helpful to think in terms of being "on track."  In other words, the direction of movement is more important than speed.  At first, positive change can be slow, but I looked for baby steps in the right direction.  An initial sign of staying on track would be to set and KEEP therapy appointments (i.e. not skipping therapy or dropping out of programs).  Another baby step might be improving one or two daily habits (like observing regular bedtimes, making the bed in the morning, eating at mealtimes, getting exercise, tending to plants or pets, etc.).  Then a baby step might be refraining from meltdowns/lashings out/self-harm, leading to a period of relative stabilization.  After stabilization, another baby step might involve the social sphere, like making a friend or engaging in a social endeavor from time to time.  Then I've seen some baby steps in the academic/professional sphere, like taking an online class or training program, or starting an easy part-time job.  I guess my point is to allow her to tackle one or two small changes at a time.  In the case of the BPD person in my life, once she made a few small changes, she built up her self-confidence and positive momentum, and bigger changes came seemingly quickly after that.  Now, I'm not saying she's conquered BPD completely; she still has high emotional reactivity and negative thinking patterns.  Sometimes temporary "derailments" happen, but the key is that they have been temporary.  I think she realizes now how to counteract those derailments before she spirals out of control into a pit of despair, because she doesn't want to go back there.  Sometimes we remind her, don't ruminate on past grievances, you did that miserable victim routine for years, and that has nothing to do with your life NOW, right?  Today, she's better able to reflect, rely on her DBT tools/strategies and get back "on track" much faster.  Does that make any sense?

That's a long-winded way of saying, thinking in terms of being "on track" might help you in your decisioning.  In other words, BOTH of you should be working towards a happier relationship, not just you.  That likely involves therapy in the short term, but it could take some time to find a therapist your wife trusts, and therapy might not last forever.  I like how NotWendy put it:  I need to she her commit to therapy and make some progress, and then in X months I'll reassess . . .

All my best to you.