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Treating Trauma After Dialectical Behavioral
Therapy
Martha Sweezy
Harvard University Medical School
Many individuals who meet criteria for borderline personality disorder have
histories of childhood trauma that may have contributed to their difficulty
regulating affect. Dialectical behavioral therapy focuses on helping these
patients to regulate emotional states and achieve behavioral control in Stage
1 so they can tolerate therapy that is focused on trauma and emotional
experiencing in a Stage 2 treatment. Although there are effective, empirically
validated treatments for posttraumatic stress disorder and its subclinical
presentation, there are also a significant number of patients who find these
treatments difficult to tolerate. The author discusses coupling dialectical
behavioral therapy, an evidence-based therapy, with internal family systems,
a therapy that is both clinically promising and compatible with dialectical
behavioral therapy, as a Stage 2 therapy for trauma patients who avoid other
modes of treatment.
Keywords: dialectical behavioral therapy, Stage 2 DBT, internal family systems, post-
traumatic stress disorder, psychic multiplicity
Dialectical behavioral therapy (DBT) teaches skills for change and
acceptance that are indexed to the impulsive and self-harming behaviors
described under the diagnosis borderline personality disorder in the
DSM–IV–R (American Psychiatric Association, 1994). Self-harm is un-
derstood in DBT as an ineffective, costly method of coping with dys-
regulated emotion; skills learned in DBT offer patients alternatives for
managing and regulating emotion as well as more effective ways of
being assertive (Linehan, 1993). The ability to tolerate strong emotion
without engaging in destructive behavior marks the success of DBT in
Stage 1 and is intended to provide a platform for the next stages of
treatment (Linehan, 1999).
Martha Sweezy, Harvard University Medical School.
Correspondence concerning this article should be addressed to Martha Sweezy, Depart-
ment of Psychiatry, Cambridge Health Alliance, Harvard University Medical School, 955
Journal of Psychotherapy Integration © 2011 American Psychological Association
2011, Vol. 21, No. 1, 90–102 1053-0479/11/$12.00 DOI: 10.1037/a0023011
90
