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