Dialectical Behavior Therapy

Borderline Personality Disorder, Insecure Attachment, and The Role of Dialectical Behavior Therapy

Dialectical Behavior Therapy or “DBT” therapy was created by psychologist, Dr. Marsha Linehan. She initially created this therapy for individuals with chronic suicidality and Borderline Personality Disorder (BPD). (If you would like to read more about BPD and it’s DSM 5 criteria, Dr. Robert Friedel has an informative blog post on his site, “Borderline dbt_blogPersonality Disorder Demystified”.) Currently, DBT is shown to be an effective treatment option for a myriad of psychological disorders.


Individuals who show insecure attachments in childhood or during the teen years are at a higher risk for developing BPD as a late teen or young adult. There are three types of insecure attachment: ambivalent, avoidant, and disorganized.

Ambivalent or anxious attachments are shown to be an indicator for BPD development. In 2004, Harvard Doctors Agrawal, Gunderson, Holmes, and Lyons-Ruth reviewed 13 empirical studies that looked at the type of attachments found in individuals with BPD characteristics. Their article, “Attachment Studies with Borderline Patients: A Review” states that “every study concludes that there is a strong association between BPD and insecure attachment. The types of attachment found to be most characteristic of BPD subjects are unresolved, preoccupied, and fearful.”

Ambivalent attachments are formed when a caregiver vacillates between nurturing, attuned and responsive caregiving to their child’s cries for help or assistance, and yet at other times the caregiver is intrusive, insensitive or emotionally unavailable. This inconsistent care causes a child to become insecure and confused, and they attempt to get predictability and their needs met through clingy behavior. As a parent, you might recognize this with your child’s “push-pull” behaviors as these kids tend to emotionally or physically push others away only to desperately pull them close again.

In my practice, I specialize in treating trauma; and children, teens, and young adults who have been in the foster care system, lived in an orphanage and have experienced the loss therapist.childof birth parents and/or siblings. As a result, a portion of my patients tend to have a working pattern in relationships that reflects an anxious/preoccupied attachment style.


In my over 25 years practice as a psychotherapist, I have learned several types of therapy to assist kids, teens, and adults. I truly believe in the power of Eye Movement Desensitization and Reprocessing (EMDR) and it’s ability to facilitate adaptive information processing from past traumas. At the same time, I think there often is a missing link without a cognitive behavior based therapy like DBT.

In general, DBT skills teach people to manage their emotions and emotional crises (without making them worse), and ways to get along better with others. DBT has four modules or sets of skills: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. In each of these four modules, exist numerous hands-on tools for kids, teens, and adults to use to create a wise, well balanced life. Readers can learn more about the four modules of DBT in my recent blog post, ‘DBT Skills: A Life In Balance.’

DBT skills offer those with an anxious attachment style tools to manage their worries and fears in relationships. A few examples of pertinent DBT skills include: mindfulness, starself-soothing, half-smiling, exploring and knowing emotions, surfing the wave, TAPS, and THINK. These skills and many more are discussed in my book, DBT Therapeutic Activity Ideas for Working with Teens, which is being released February 21, 2018 on Amazon and the publishers website, Jessica Kingsley Publishers.

The good news is attachment styles are not written in stone; individuals are adaptable and can change. Growth comes out of being in secure relationship with others, healing past trauma, and practicing DBT skills that balance self-acceptance and constructive change.


Carol Lozier earned a Masters in Clinical Social Work from Florida State University in 1989. Ms. Lozier is a licensed therapist in Kentucky, and has been in private practice since 1998. Ms. Lozier specializes in trauma; and adopted and foster children, teens, and adults. Ms. Lozier is also the author of three books for adoptive and foster children and families. Learn more about Ms. Lozier and her books at http://www.carollozierlcsw.com.





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