What is DBT?

Dialectical Behavior Therapy (DBT) is a comprehensive treatment approach for people who have intense emotions they are unable to manage in constructive ways. This results in impulsive or emotion-based actions that cause pain and problems in their lives and the lives of those who love them. These emotions may be expressed in a destructive ways or avoided as in raging, self harm, depression, being emotionally paralyzed, suicide attempts/self harm, substance abuse, shopping too much, gambling, or eating disorders. Fear or denial of emotions in these ways leads to additional anxiety and depression, which leads to more avoidance and/or destructive behavior to create a cycle of deeper and deeper suffering.

DBT offers a way out of the suffering with skillful, effective ways to regulate emotions, deal with the painful situations, and improve relationships with the people around them. These skills are taught in caring treatment relationships that recognize the clients' strengths, understand their emotional sensitivity, and offer practical and powerful ways to build a functional life.

Components of DBT
DBT includes individual therapy, skills training group, skills coaching by phone between sessions and a treatment team concept.
DBT skills training groups are more like classes than traditional therapy groups. The goal is to teach DBT skills in an efficient and effective manner, using examples and problems taken from the present. Skills are taught in the areas of Mindfulness, Distress Tolerance, Interpersonal Effectiveness and Emotion Regulation.

The primary job of the DBT individual therapist is to help clients stop behaviors that are destroying their lives or that are dangerous to their life. Therapists offer acceptance and understanding to each client just as they are and them works to help them learn ways to build their lives in the ways they wish. All goals are only the goals of the client. The relationship with the therapist is supportive, honest, and validating of what is positive and also direct about destructive patterns.

Phone skills coaching is the responsibility of the individual therapist. If someone is experiencing a difficult situation and feel urges to act in destructive ways but have not acted, they are encouraged to call for help in using the skills to act in constructive ways. Skills coaching is obviously not helpful if destructive behavior has already occurred.

If someone is suffering from trauma, this is addressed in Stage II DBT.

Therapeutic Relationship
The manner of a DBT therapist is rather different from the traditional “blank slate” model that clients may have previously experienced (or seen parodied on television). DBT therapists are more candid about their reactions to client behaviors and likely to tell anecdotes from their own lives to assist in teaching skills and modeling coping behavior.

How to choose a DBT Therapist
As awareness has grown about the clinical data showing that DBT is the most effective approach to treating clients who meet criteria for Borderline Personality Disorder, many clinicians have begun to receive training in how to do it. This is a positive development, and introducing elements of DBT (particularly the use of DBT skills training) into other therapeutic approaches should be helpful. That said, however, delivering DBT individual therapy in the research proven manner is complex and requires substantial specialized training that many therapists who say they do DBT have not had. For a useful set of guidelines from the mental health advocacy group TARA entitled “How to Choose a DBT therapist”.

For therapists who have been intensively trained in DBT, see the website www.behavioraltech.org.