What is DBT?
Dialectical Behavior Therapy (DBT) is a treatment developed by Marsha Linehan. The first research studies found DBT to be effective for treating individuals diagnosed with Borderline personality disorder who were chronically suicidal and had experienced repeated hospitalizations. Over time, DBT was also found to be effective to treat other symptoms related to difficulty in regulating emotional reactions.
What does Dialectical Mean?
“Dialectical” means a synthesis or integration of opposites. Black and white thinking can keep you stuck. In reality, that extremes that appear to be contradictory and mutually exclusive often both exist at the same time. When thinking dialectically, you work to see the world from this new perspective. An example of a dialectic would be feeling desperate for love and connection but at the same time feeling fearful of relationships and unable to trust.
The primary dialectic within DBT is between the seemingly opposite strategies of acceptance and change. DBT therapists accept clients as they are while also acknowledging that they need to change in order to reach their goals. When you are thinking in black and white, all or nothing terms, this causes a great deal of pain. Accepting both sides of your experience can be difficult but brings with it a sense of freedom and compassion. A DBT oriented therapist can model this ability to stay in the middle, to accept seemingly contradictory experiences and to find this “wise mind” perspective for yourself.
What is DBT Treatment?
Although ideas and strategies based in DBT can be integrated into any psychotherapy, if you have struggled with severe suicidal ideation or repeated hospitalizations, seeking a full protocol DBT treatment with all components may make sense. The components of a traditional DBT treatment include:
- Individual therapy in DBT is usually weekly. The focus is on your individual goals and struggles. You have the freedom to talk about the issues that are most relevant to you in the moment. At the same time the structure of DBT treatment targets (for example life-threatening behaviors or behaviors that might interfere with your ability to succeed in treatment must be addressed first) make your sessions are as productive as possible. Recovery from BPD can be a long and difficult road, but having a strong relationship with your individual therapist help maintain your motivation and sense of connection.
- Skills training groups are another component of DBT. A patient must have an individual therapist in order to participate in a group. The group is run like a classroom. The leader presents material on new skills each week, and the group members practice the skills with homework between sessions. Even patients who don’t normally like “group therapy” often enjoy this approach because the classroom setting focuses the sharing on skills and progress (not overwhelming emotions or processing of past trauma). Despite the emotional ups and downs you may experience from week to week, there can be a great sense of accomplishment knowing that you are consistently building skills for making your situation better. The skills groups were in part developed because with only individual therapy sometimes the sessions would get bogged down by crises or negative experience. Allowing weekly proactive skill building helps hold down the other side of the dialectic, things can feel very bad but they are also getting better. There is room for both sides in this treatment each week.
- Skill coaching phone calls are an important part of DBT. Clients can call their individual therapist for coaching about the use of skills in the moment. We would rather address hard emotions and find a way to cope effectively than to have to pick up the pieces of ineffective coping after the fact. Of course, dialectics even comes into play here. The therapist is available to you between sessions, but she is not always and absolutely available. Accepting that the DBT therapist is human and has limits of her own, and discussing your needs and her availability openly helps to reduce any sense of fear that patients sometimes have that they have “bad boundaries” for wanting to reach out. You also know that if the therapist does not return your call it is not because the therapist is “mad” or resentful. The discussion in open, both parties know what to expect and the process is collaborative.
- The DBT therapist consultation team is a treatment component that patient does not participate in. This is an acknowledgement that each DBT oriented therapist must get consultation to support her in providing the best care possible. Therapists are responsible for checking their own emotional reactions and for working think dialectically so that we can maintain motivation and competence as DBT therapists.
How is DBT different than CBT?
Traditional Cognitive Behavior Therapy (CBT) is the foundation for the DBT approach. But in working with people diagnosed with BPD, Linehan found that traditional CBT was too focused on change. Clients felt invalidated and had difficulty staying in treatment and getting what they needed. So by adding the concepts of dialectics, acceptance, and validation, she was able to make DBT more effective for this group.
I hope this overview has helped you better understand DBT. If you would like to talk more about your situation and what therapy approach might be best for you, please call me at 404-668-9893.
