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Understanding Dialectical Behavior Therapy

psychologyDialectical Behavior Therapy (DBT) is a specific type of Cognitive Behavioral Therapy that was originally developed to be used in the treatment of people with severe issues regarding self-identity and suicidality. DBT became the preferred method of treatment for borderline personality disorder, a severe personality disorder that is notoriously difficult to treat. As DBT progressed and developed, it became useful in the treatment of a number of other issues, including substance use disorders.

Brief Background of DBT

It is nearly impossible to have any type of discussion about DBT without mentioning Dr. Marsha M. Linehan, the developer of the technique. According to Dr Linehan’s website, the basics of DBT embrace the notions that:

  • DBT has its roots in both science and philosophy.
  • The nature of reality and truth is constantly evolving
  • DBT assumes that everything is connected to everything else, that the one constant and inevitable nature of reality is change, and that opposite points of view can be integrated to form a closer approximation of truth.

The term dialectic is used to describe the synthesis of opposite points of view, opposite states, or opposite paradigms. DBT was originally developed in an effort to work with individuals who were actively suicidal. These people wanted to kill themselves because they believed they did not have the skills to deal with the types of problems that made their lives unmanageable. In treatment, it was difficult to get these patients to change their behavior because they would either shut down emotionally and not participate in treatment or just drop out of therapy. In many instances, the patients would become aggressive toward the therapist in these situations. On the other hand, therapists who tried to get these clients to accept their feelings as opposed to changing them were accused of being uncaring and insensitive. The result again was patients dropping out of therapy or just becoming detached. Similar reactions are seen in individuals who are diagnosed with borderline personality disorder, which is why the disorder had and continues to have a reputation as being extremely difficult to treat in therapy. Dr. Linehan developed the principles of DBT as an attempt deal with these issues by uniting these opposite modes of action of changing one’s behavior and accepting the harsh realities of living in the world.

DBT Basics

The overall goals of DBT are based around three major processes:

  1. By being person-oriented, DBT works with the individual in therapy to identify the person’s strengths as well as the issues the person has. The basis for change is formed on using the individual’s strengths to assist them in addressing the reasons that they are in the treatment.
  2. Because DBT is a form of Cognitive Behavioral Therapy, it uses cognitive behavioral principles. These principles are based on the identification of certain belief systems, attitudes, and assumptions that individuals harbor towards themselves, the world, and future potentials. DBT helps individuals identify and target irrational beliefs and attitudes, and then change them so they are more in line with reality and functional.
  3. The basic mechanism of change in DBT is the therapeutic alliance, which is the bond between the therapist and the client to work together and address the situations that brought the client into treatment. The therapeutic alliance is universally recognized as a crucial component in the success of any form of therapy.

DBT uses a collaborative approach that includes the therapist, the client, and the client’s support group/system. Therapists who are trained in DBT concentrate on:

  • Developing the motivation the client needs to improve and change
  • Teaching skills and behaviors to the client to assist in the change
  • Focusing on the capacity of change in the client
  • Making sure the therapy is structured toward both change and learning in the real world; this is accomplished by practicing new skills in session and then having the client apply them in real-world situations
  • Structuring the environment when possible to assist with change or with accepting things that cannot be changed

Therapists also work on their own motivation and confidence with continued training in DBT that is provided by a number of national and local DBT organizations.

Major Components of DBT

DBT utilizes a number of different approaches and components. According to the book Doing Dialectical Behavioral Therapy, at its basic level, DBT is typically delivered by four interacting methods:

  1. DBT utilizes individual therapy sessions that are typically held once a week. The sessions include the client and the DBT therapist. These sessions are where the bulk of the work in DBT occurs, and they are focused on the motivation to change, developing new skills, identifying irrational patterns of thinking and behaving, changing irrational patterns, and learning to accept certain aspects of reality that one cannot change. Individual therapy continues for the duration of the treatment.
  2. Focused group therapy sessions are essentially skills training groups where individuals in treatment who have similar problems or issues meet with a group leader or qualified therapists who teach specific skills or supply information that the individuals need to accept things about the world or to implement certain changes in their environment. These groups are structured and typically designed in a psychoeducational format. The format typically lasts 20-24 weeks and then repeats itself. Individuals are expected to attend weekly group sessions and work on the issues presented in them.
  3. Phone coaching is designed to provide clients with access to immediate support if they encounter situations in their daily lives that they need assistance to address. This option may or may not be available depending on the therapist and clinic involved, but it is designed to be used in DBT. Clients can call their therapist, or another trained online therapist or coach, and receive advice when they need it.
  4. Consultation teams are designed to keep therapists upgraded on new techniques, sharpen existing skills, and instill motivation for therapists to remain confident in DBT techniques. These team meetings consist of lectures, new skills training, case presentations, and so forth. They meet regularly in order to ensure that therapists are at the highest level of competence.

DBT also incorporates a number of other techniques from different paradigms, including mindfulness training, emotional regulation, and behaviorism. They can be used in conjunction with psychiatric medication treatment and other forms of intervention.

Who Is Qualified to Perform DBT?

Who is qualified?
DBT is a highly specialized form of therapy. It requires very intense and specific training as well as supervision initially when one is learning the techniques. Only licensed mental healthcare professionals, such as psychologists, counselors, therapists, social workers, and so forth, qualify to be formally trained in DBT.

DBT cannot be learned from reading an article or a couple books. DBT cannot be administered by someone who is not formally trained in therapy or counseling.

What Is DBT Best Suited For?

Effectiveness of MedicationsAs mentioned above, DBT was originally developed to assist in the treatment of suicidal individuals and those diagnosed with borderline personality disorder. However, given the breath of its potential applications, it is also used in the treatment of a number of other issues, including substance use disorders, other personality disorders, major depression, and eating disorders. DBT has also been demonstrated to have some uses in the treatment of post-traumatic stress disorder; adjustment issues and treatment compliance for people who have bipolar disorder; anxiety disorders; addressing issues in couples therapy; addressing issues with adolescents who have behavioral problems; and for regulating emotions associated with any particular psychiatric/psychological disorder. Because it is a type of treatment that emphasizes both learning to change and learning to accept things that cannot be changed, as well as utilizing cognitive behavioral principles, it has a broad spectrum of application.