Background

Individuals with Borderline Personality Disorder (BPD) and Complex Post-Traumatic Stress Disorder (C-PTSD) often face significant challenges in treatment due to the severity and complexity of their symptoms. Dialectical Behavior Therapy for PTSD (DBT-PTSD) is a phase-based, multicomponent psychotherapy developed to address the needs of this population. While its efficacy has been demonstrated in clinical trials, little is known about how patients and clinicians experience this treatment.

Methods

This qualitative study explored the perspectives of six patients and five clinicians involved in DBT-PTSD at a university-affiliated mental health institute. Data were collected through individual interviews and focus groups at multiple time points and were analyzed inductively using Reflexive Thematic Analysis.

Results

Five themes were generated, including trauma-focused exposure as a main mechanism of change, the role of the therapeutic alliance in supporting engagement and treatment outcomes, the demanding nature of trauma-focused exposure, the tension between fidelity and flexibility within the protocol, and the influence of individual resources on patients’ experiences with at-home assignments.