What is Dialectical Behavior Therapy?
I often get asked, “What exactly is Dialectical Behavior Therapy?”, and it can be tough to answer briefly because the therapy incorporates various treatment philosophies and leans into the idea that nothing is truly straightforward. If I were to give you a straightforward and quick answer, Dialectical Behavior Therapy focuses on the relationship between your thoughts, emotions, and behaviors so that you can live in the moment skillfully and create a life worth living. However, I don’t feel like this description truly captures the magic of DBT. For a more detailed understanding, keep reading:
Dialectical Behavior Therapy was invented by Marsha Linehan in the late 1980’s as a modified form of Cognitive Behavioral Therapy (CBT) specifically to treat people with Borderline Personality Disorder (BPD) and chronically suicidal individuals. DBT is one of the most highly researched therapy treatments and has been proven to be effective for BPD and suicidality, as well as depression, anxiety, self-harm, PTSD symptoms, substance use, and binge eating.
What does “Dialectical” mean? DBT relies heavily on the philosophical concept of dialectics, which is the idea of taking two seemingly contradictory or opposite ideas, and creating a deeper truth by combining or forming a synthesis of them. The core dialectic in DBT is acceptance and change - at any given time we must be practicing acceptance while also working towards change. Our brain tends to process the world in black and white, or with categories of labels, but sometimes that black and white thinking can get in the way of understanding the truth. Dialectical thinking is about observing extremes or strong positions we take that causes conflict within ourselves or relationships, and finding a deeper truth in the midst of that conflict.
What does Dialectical Behavior Therapy look like? Dialectical Behavior Therapy has a structured treatment model that was developed and has been researched heavily. Many DBT therapists practice what would be considered “DBT-informed” treatment, which is therapy that utilizes certain components of DBT treatment, but doesn’t follow the model to a ‘T’. Often times, DBT-informed treatment is simply individual therapy that borrows some of the structure and treatment philosophies of DBT, which can still be very helpful for most. However, for people who struggle with Borderline Personality Disorder, persistent suicidality, or treatment-resistant mood disorders, a full DBT-adherent program may be a better fit. An outpatient DBT-adherent program consists of 4 key components:
Individual Therapy: DBT includes individual therapy sessions that are often more structured than your typical therapy session. An individual session will start with a review of your diary card (think of it like a worksheet that takes an emotional snapshot of your week), and then an in-depth look at specific moments in the past week where you felt emotionally distress or engaged in behaviors you’re trying to change, known as “target behaviors”. You and your therapist will work together to figure out what target behaviors are priority, typically focusing first on life-threatening and treatment-threatening behaviors. As you and your therapist explore these events in (sometimes excruciating) detail, you and your therapist will explore what coping skills may help you react to these situations in line with your goals and values.
Group Skills Training: Group skills training is a weekly therapy group typically lasting around 2 hours, The focus of group is to learn skills and how to apply them in all life situations. Group includes a skills homework review and check-in with all group members, and then a lesson and discussion on a DBT skill from one of the core skills areas. Often DBT has four skills areas:
Mindfulness Skills - learning how to stay focused in the present moment without judgment.
Distress Tolerance Skills - learning how to tolerate the most painful or distressing moments of life without responding in a way that creates even more pain.
Emotion Regulation Skills - learning how to shape your emotions day-to-day to feel more balanced as you go through life.
Interpersonal Effectiveness Skills - learning how to respond to the people in your life effectively and to help others respond to you effectively.
Phone Coaching: In DBT treatment, you have (nearly) 24/7 access to your therapist. With phone coaching, you can request a 10-15 minute call with your therapist when you’re struggling with intense emotions or dangerous urges with the expectation that your therapist will talk to you within a couple hours (depending on the therapist). The goal here is to help you learn how to apply skills in any situation, which can be difficult to do if you don’t have support in the moment.
Consultation: An effective DBT therapist will be in weekly team consultation to get support from other therapists, because DBT understands no therapist is perfect, and it’s important that your therapist is getting an opportunity to enhance their skills just like a DBT client is doing in treatment. Consultation is a required part of DBT treatment so you know that your therapist is following the DBT model effectively and getting any support they may need in order to give you the best support you need.
In our society, especially in the mental health field, we often prioritize feeling good and finding our happiness. And while it is important to feel happy and good, DBT recognizes it’s unhealthy to expect that at all times. Life can be incredibly painful at times, but we can utilize our skills to keep that pain from turning into suffering. DBT borrows from Zen mindfulness meditation, loving-kindness, and feminist & relational theory. and pairs it with traditional Cognitive Behavioral Therapy and other behavioral interventions. One of my favorite parts of DBT is that it focuses heavily on the therapeutic relationship - something research shows is one of the biggest indicators of treatment success. DBT prescribes that the therapeutic relationship should not be antagonistic or adversarial, but instead one of genuine connection and allyship to help you reach your goals.
Do any parts of Dialectical Behavior Therapy feel like what you’re looking for in therapy? Have you tried other therapies and felt like you weren’t making the changes you wanted? Are you looking to build a life and relationships that feels meaningful to you? Contact me for a free 15-minute consultation so we can talk about how DBT can meet your needs:
