Background

People with psychiatric problems, despite efforts in recent decades still experience vulnerability. Patients with borderline personality disorder (BPD), where self-harm is common, often live in difficult and complex social relationships because of their illness. Additional knowledge and studies about mental illness, self-harm, dialectical behaviour therapy (DBT) and the therapeutic alliance are needed.

Purpose and Method

This study aims to examine how staff perceive and describe: DBT as a treatment method; the therapeutic alliance and the importance it has for treatment. The study utilises a qualitative approach with a qualitative content analysis method and presents earlier research on DBT and the therapeutic alliance. The empirical material consists of focus group interviews comprising three DBT - teams. The theoretical framework is based on attachment theory which addresses the dynamics of close relationships and how we act in them.

Results

Results show that DBT - teams describe patients with self-harm as vulnerable. Here, self-harm represents a way to reduce aggression and make life bearable. DBT is produced as a collaboration between therapist and patient, giving patients the opportunity for a new secure attachment to achieve self-respect and a meaningful life. The teams assess DBT as successful and effective. The therapeutic alliance is seen as an emotional and social interaction and is considered the most important tool in the treatment.

Conclusions

Patients who self-harm and have emotional difficulties may indicate insecure and lack of attachments. Through DBT, trust and confidence are trained and developed to enhance attachment patterns and move the process forward. New aspects emerge such as the significant role of relatives and the team and the importance of feeling hope in both the patient and the therapist. Furthermore, the health professional’s knowledge of the BPD diagnosis affects the care and the treatment of the patients and thus the patients’ possibility to live better lives. In a broader discussion of health determinants, health care, early intervention, cooperation and long-term measures are assessed to be important factors for promoting health and good living conditions for the patients.