What is Dialectical Behavior Therapy (DBT)?

Editors of Marsha Linehan’s foundational book Cognitive-Behavioral Treatment for Borderline Personality Disorder (essentially the DBT Bible for DBT therapists) asked the same question and suggested she refrain from using the term in the text’s title.

Dialectics acknowledges two opposing forces and attempts to find synergy between the two.

Acceptance and change are the two opposing forces identified in DBT and it’s your job, with the help of your therapist, to establish synergy that works for you.

In order to effectively help participants, the DBT model and therapists operate under these assumptions:

1. Participants are doing the best they can.

2. Participants want to improve.

3. Participants need to do better, try harder, and be more motivated to change.

4. Participants may not have caused all their problems, but they have to solve them anyway.

5. The lives of suicidal, dysregulated, and “borderline” individuals are often unbearable as they are currently being lived.

6. Participants must learn new behaviors in all relevant contexts.

7. Participants cannot fail in therapy.

8. Therapists need support.

(Linehan, 1993)

Comprehensive DBT consists of the “Core 4” modes: individual therapy, skills training, phone coaching, and therapist consultation.

Each mode targets a specific function. Read more about the identified function in the respective sections below.

Individual therapy within DBT helps participants implement and reinforce DBT skills, stay on track, and process the messier bits of life.

Two functions have been identified for individual therapy: enhancing motivation and using case management to structure the environment.

As a participant in DBT, you will receive additional support in the way of DBT skills training.

DBT Skills modules include mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. These skills have been found to be beneficial to participants in their efforts to build more fulfilling lives. They’re also practical and useful AF.

The function of DBT skills training is to help enhance your current capabilities, using what you already know and building on from there.

At this time I am not offering a skills group, but I can help you find one locally. However, I include skills training as part of individual therapy.

You are encouraged and able to make contact with your DBT therapist outside of “normal” business hours to receive brief phone coaching. This usually occurs in times of crisis or exasperation.

It’s hard to use skills in the heat of the moment and pausing to contact your therapist may be the boost you need. The function of in-the-moment phone coaching aims at helping you apply skills and get through everyday situations without making them worse.

All DBT therapists should regularly meet with a DBT consultation team to discuss clinical issues and should not be practiced in isolation.

DBT helps create change for participants and for therapists, so it can be heavy work and therapists need their own support during the process. The function of this mode helps therapists adhere to the DBT model and reduce burnout.

I meet with a local DBT team and consult with a handful of trusted colleagues on a regular basis. It’s a wonderful thing.

Family therapy is not listed in the “Core 4” elements of comprehensive DBT, but as a family therapist I find it necessary to include.

Family members and/or partners may find it incredibly useful to learn DBT along with you. And you may find it helpful to have their support in a new way.

Additionally, emotionally focused family therapy or emotionally focused couples therapy may be a fitting conjunctive service to comprehensive DBT.