Assertive Community Treatment and the Shift Towards Dialectical Behavior Therapy: As Valuable for Practitioners as for the Clients?

Abstract

Not until recently have individuals with severe and persistent mental illnesses sought treatment outside the traditional means of inpatient wards and psychiatric hospitals. Fortunately, the expanse of resources now available encompasses a more comprehensive, client-centered approach, emphasizing community-based treatment and outpatient services, many of which originally formed in response to the growing lack of effective treatment for commonly misunderstood illnesses such as schizophrenia. Presently, the need for such locally based agencies as Assertive Community Treatment, evolving in the late 1960's (Stein & Test, 1985), is increasingly great, yet the population of those who undergo outpatient psychiatric services may be changing. Borderline Personality Disorder, having only recently received recognition among the list of chronic mental illnesses, affects an estimated six million individuals living in the United States. An additional thirty million are significantly affected by the lives of these persons (BPD Central), making it a growing concern for mental health professionals in their continuous efforts to effectively treat the disorder. While numerous studies review current treatment methods in the hopes that they reveal clients' perceptions, feelings, and experiences related to the management of their illness, rarely are the therapists themselves the center of question, specifically in regards to a particular therapy or treatment method designed to serve clients with BPD. Yet due to the increasing number of individuals diagnosed with BPD, the need to examine the context through which practitioners implement a particular treatment must also be understood. In light of the growing availability of community-based mental health, our study focused specifically on ACT outpatient services, seeking to identify and highlight the differences in treatment approaches concerning the recently integrated Dialectical Behavior Therapy (DBT) (Linehan, 1993), as compared with other therapies issued to treat clients with BPD.