Learn more about dialectical behavior therapy

Dialectical behavior therapy seems to be one of those polarizing therapies that you’ve either happened to hear about or really like. In fact, I know a number of people (both clinicians and those who have undergone Dialectical Behavior Therapy) who joke about how Marcia Linehan has a cult-leader-like reputation in some circles (I’m taking a leap; Marcia is the founder of DBT).

I must confess that I have been on both ends of this spectrum. I first encountered DBT during my clinical training and have now had the opportunity to participate in numerous DBT programs in a variety of settings. I have to say it is one of my favorite treatments. I would like to take this opportunity to explain why DBT is so great and how it can help you.

Origins of dialectical behavior therapy

Let’s start from the beginning. What is DBT? Dialectical behavior therapy was developed in the late 1980s by Dr. Marsha Linehan. Marsha has one of the most incredible stories of a patient advocating for her patients’ needs that I know of, and she is widely respected for that (among many other admirable attributes).

Marcia herself struggled with emotional dysregulation and thoughts of self-harm as a young woman. In her memoir she says: build a life worth living How she spent two years in an inpatient psychiatric ward in the early 1960s. She explains that going through traumatic “treatment” as we currently know it usually worsens rather than helps someone’s mental health.

What Marcia discovered was that the therapies in use at the time did not sufficiently focus on her emotional experience, much less treat it effectively. After being discharged from the hospital, she earned a doctorate in psychology and devoted herself to developing treatments. The result of all her research and efforts was the development of Dialectical Behavioral Therapy (DBT).

“Dialectic” is the core of DBT

The appeal of DBT lies in its ability to integrate opposites. Have you ever felt that two seemingly opposite things are true at the same time? For example, do you want independence, but also deep connection and intimacy? Or do you want to change something, but are afraid to make that change happen?

These are examples of “dialectics,” a central concept in DBT. The term “dialectic” comes from reconciling two opposing ideas. When two seemingly fundamentally contradictory concepts are both true at the same time. Curling your head may be a little difficult at first. (You can read more about dialectics here. )

At the heart of DBT is the dialectic of acceptance and change. DBT teaches people to accept themselves and their experiences as they are without judgment, while aiming for positive change. This dual focus helps individuals balance what they have now without losing sight of what they want for the future. This ultimate goal is, in Marsha’s words, “to build a life worth living.”

DBT’s four core modules

The way we explore the central themes of acceptance and change is through four core modules:

1. Mindfulness: This module, the foundation of DBT, teaches people to stay present and engage fully in the present moment. By promoting self-awareness and openness to current experience, mindfulness increases emotional regulation and the ability to work toward life goals (read more about the benefits of mindfulness here!).
2. Pain tolerance: Life can be stressful, but distress tolerance skills teach individuals how to cope with painful situations without resorting to unhelpful coping behaviors. This module includes strategies such as radical acceptance and self-soothing techniques.
3. Regulation of emotions: Understanding and managing intense emotions is the key to a stable life. This module provides tools to identify and understand emotions, increase positive experiences, and reduce vulnerability to painful emotions such as sadness and anxiety.
4. Interpersonal effectiveness: Building and maintaining healthy relationships is a big part of living a happy and meaningful life. In this module, individuals will learn how to proactively communicate their needs, set boundaries, and manage conflict constructively.

Each module builds on the other to provide individuals with skills designed to improve emotional resilience, reduce impulsivity, and foster more satisfying interpersonal relationships.

What can DBT help? Can it help me?

DBT combines cognitive-behavioral techniques and mindfulness strategies to treat not only borderline personality disorder (which is what most people associate with this treatment); Various other conditions. These include people struggling with self-harm or suicide concerns, drug or alcohol problems, eating difficulties, anxiety, trauma (including complex trauma), dissociation, depression, as well as emotional regulation and intense emotions more generally. There is also recent research exploring how DBT can help with emotional management aspects of neurodivergent disorders such as ADHD and autism (e.g. this research).

If you’re wondering whether DBT skills will work for you, ask yourself the following questions:

• Are you struggling with intense and painful emotions that make you feel overwhelmed or scared?
• Or do you sometimes experience wild mood swings without knowing why?
• When you feel yourself in crisis, do you have the urge to do something that you later regret? For example, do you emotionally eat, drink, or engage in other unhelpful coping behaviors?
• Do you find it difficult to maintain stable and satisfying relationships because you have difficulty communicating or setting boundaries?
• Are you afraid of being alone with yourself because you have difficulty thinking your thoughts alone? Are you often self-critical?

If you answered yes to any of the questions above, you may find it helpful to learn just a few specific DBT skills.

Wait, isn’t DBT a hospital thing? Can I see a psychologist at a private DBT clinic?

DBT can be delivered in several formats. In its original form, DBT includes weekly group therapy to learn skills, weekly individual sessions to apply those skills, and a so-called “coaching line” where people can call for help throughout the week as needed. This is usually referred to as comprehensive DBT and is often performed by hospitals or other community-based specialized facilities. Comprehensive DBT is ideal for people who suffer from very severe pain or safety concerns, or who would benefit from receiving support at least once a week.

However, many psychologists are trained to provide DBT in private practice. This may include combining skills instruction plus How to apply them at the same time. This allows you to proceed more efficiently. It also allows for personalization, which can be helpful. Some practicing psychologists may also team up with group programs run elsewhere to form part of the comprehensive program described above. Not everyone is suitable for doing DBT with a private psychologist, but many people benefit greatly from doing so.

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If you are unsure whether DBT in private practice is right for you, you can contact our reception team to discuss this. They can listen to your needs and provide guidance on what is best for you. If you want to learn more about a specific DBT skill, listen to: clever podcastor read our blog on self-soothing and acceptance.

If you want to learn more about other types of therapy, try our blogs on Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Internal Family Systems (IFS) Therapy, Acceptance and Commitment Therapy, and Couples Therapy.