Dialectical Behavior Therapy
What is Dialectical Behavior Therapy?
Dialectical Behavior Therapy (DBT) is a multifaceted treatment that was developed by Marsha Linehan throughout the 80's and early 90's. Treatment aims to equips individuals with skills to manage intense emotions and navigate challenging relationships. DBT has been shown effective for a number of problems, including Borderline Personality Disorder, Depression, Eating Disorders, Substance Dependence, and Post Traumatic Stress Disorder. DBT can be used with children or adults; however, the approach to each slightly differs.
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The "dialectical" part of the treatment refers to the concept that seemingly opposite or contradictory concepts can exist at the same time. For example, you may feel exhausted in the morning, not want to go to work and still have to go to work. Another example of a dialectic is that DBT therapists accept people for who they are and at the same time understand that they need to make a change in life in order to improve it. This is one of the main dialectics a DBT therapist helps balance during treatment - providing an atmosphere of acceptance while also helping a person move toward change. Treatment aims to help instill a new perspective through balancing dialectics in life and finding a "middle path" between opposites. DBT does this through individual therapy, DBT Skills Group, therapist consultation team, and Skills Coaching.
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DBT is a comprehensive approach. Each element works together to equip you to manage the challenges in life. Below is a breakdown of its key elements:
Individual Therapy
Group Skills
This is the core component where you work one-on-one with a therapist trained in DBT. They provide support, monitor progress, and help you apply learned skills to real-life situations. The therapist validates your experiences while also guiding you towards positive behavioral changes. This creates a safe space to explore difficult emotions and develop a sense of self-worth.
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Individual therapy sessions are structured so that you receive the maximum benefit from treatment. For example, each session starts off with reviewing what's called a diary card (a way to track emotions throughout the week) and setting an agenda. The agenda helps overcome the tendency to discuss only the "crisis of the week" so that you make progress toward your goals (this doesn't mean you won't talk about difficult situations that came up during the week).
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A core aspect of individual therapy is the therapist's validation of your emotions and experiences. This creates a foundation of trust and safety and is essential for exploring difficult feelings and vulnerabilities. The therapist acts as a guide, not a judge. DBT also emphasizes developing healthy coping mechanisms. The therapist collaboratively sets treatment goals and helps you identify and replace unhelpful behaviors with the skills learned in group training.
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Individual DBT aims to provide a safe space to discuss thoughts of suicide, urges to self-harm, or overwhelming emotions. A DBT therapist will develop an individualized crisis plan with you, outlining steps to take when you feel dangerously overwhelmed.
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These sessions are designed to help you change how you view different situations, master your coping skills, and gain valuable insights into how and why difficulties arise.
DBT skills are primarily learned in a group setting. Think of skills group like taking a class about managing difficult life experiences. Group has a set schedule and dedicated "open" periods where new group members can join. This helps group remain stable, predictable, and help foster connection with each other.
Group meetings are structured in the following way: Opening greeting followed by a brief mindfulness practice (which is different every week), review of homework from last week, discussion of the skill(s) of the week, and closes with the assignment of homework for next week. Depending on the skills leader, group may be anywhere from 90 - 120 minutes long (usually the 120 minute group has a 20 min break). DBT skills leaders are considered as a part of the group and will share their experiences using skills and complete the same homework assignment as participants do.
Skills group is broken down into four core learning modules:
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Orientation & Mindfulness: Mindfulness is about focusing your attention on the present moment without judgement. It helps to reduce emotional suffering and increase a feeling of being connected to life in a fulfilling way. This module is 2 weeks long, repeats between modules, and serves as an open period for new group participants to join.
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Distress Tolerance: This module focuses on developing strategies to cope with emotional crises without resorting to self-destructive behaviors. It also includes "Reality Acceptance" which focuses on living with painful situations that we cannot change in a way that allows a person to live life to the fullest degree possible, despite limitations.
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Interpersonal Effectiveness: These skills focus on improving the interactions we have with others. You will learn how to express your needs and get them fulfilled more often, set boundaries, learn ways to find new relationships, strengthen old ones, and end toxic or destructive relationships, and prioritize your self-respect when managing difficult interpersonal situations.
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Emotion Regulation: The focus of this module is to better understand the core function of emotions, how to identify emotions and emotion urges, understand how emotions build upon one another, reduce vulnerability to undesired emotions, and learn coping skills that help you overcome intense emotion-based urges. This module also focuses on ways to improve self-care, improve sleep, and learn what values you have and how you can live into them.
Consultation Team
Skills Coaching
DBT therapy is very intense, both for the patient and therapist. DBT Consultation Team a confidential, weekly meeting that your DBT therapist attends. The consultation team ensures that the treatment you receive adheres to the core principles of DBT. This helps maintain consistency and maximize the effectiveness of DBT therapy.
Additionally, the team provides support and guidance to the therapist working with you. Therapists can receive feedback on treatment strategies they use and address any challenges that may arise during therapy. This allows for the sharing of best practices and ensures a consistent approach across different therapists. If your therapist is not in a consultation team, they are not providing adherent DBT!
Coaching sessions offer additional support in between individual therapy sessions. Once you are ready for coaching (as discussed during individual therapy) you may contact your therapist by phone to receive guidance on applying DBT skills to manage a challenging situation you're currently facing.
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Coaching reinforces skill application in real-time and helps bridge the gap between therapy sessions. They offer immediate support and guidance when you're facing a situation that you are struggling to apply skills during. The therapist can help you de-escalate a situation, identify triggers, and apply learned coping skills. All in a call that is less than 15 minutes!
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Using DBT skills in the "real world" is the only way that meaningful change can occur. Coaching reinforces learning and applying skills and helps you build confidence in using the skills effectively.
Use the contact form below to reach out if you have any questions about DBT therapy, if you are looking to start individual therapy, or if you are interested in joining a DBT skills group.