Dialectical Behavior Therapy (DBT) is a comprehensive multi diagnostic, modularized behavioral intervention designed to treat individuals with severe mental disorders and out-of-control cognitive, emotional and behavioral patterns.
It has been commonly viewed as a treatment for individuals meeting criteria for Borderline Personality Disorder (BPD) with chronic and high-risk suicidality, substance dependence or other disorders. However, over the years, data has emerged demonstrating that DBT is also effective for a wide range of other disorders and problems, most of which are associated with difficulties regulating emotions and associated cognitive and behavioral patterns.
As the name implies, dialectical philosophy is a critical underpinning of DBT. Dialectics is a method of logic that identifies the contradictions (antithesis) in a person’s position (thesis) and overcomes them by finding the synthesis. Additionally, in DBT a client cannot be understood in isolation from his or her environment and the transactions that occur.
Rather, the therapist emphasizes the transaction between the person and their environment both in the development and maintenance of any disorders. It is also assumed that there are multiple causes as opposed to a single factor affecting the client. And, DBT uses a framework that balances the treatment strategies of acceptance and change – the central dialectical tension in DBT. Therapists work to enhance the capability (skills) of their client as well as to develop the motivation to change.
Maintaining that balance between acceptance and change with clients is crucial for both keeping a client in treatment and ensuring they are making progress towards their goals of creating a life worth living.
DBT Serves 5 Functions of Treatment:
- Improve and maintain a client’s motivation to change and be engaged with treatment.
- Enhance an individual’s capability by increasing skillful behavior.
- Ensure generalization of change occurring through treatment.
- Enhance the motivation of therapists to deliver effective treatment.
- Assist the individual in restructuring or changing his or her environment such that it supports and maintains progress and advancement towards goals.
Why a Certified DBT Clinician Matters
What to expect in DBT treatment
We hope that understanding what to expect from DBT will help you be an informed consumer. While not all treatment delivery will include every element listed below depending on the Stage of treatment needed, what follows is a description of the modes of evidence-based DBT delivery for clients in need of the most intensive form of DBT to begin with.
Individual DBT Therapy
In individual DBT therapy, you work one-on-one with your DBT provider to identify what your life worth living looks like. This vision will help develop your goals for treatment, set treatment targets for how to get there and support you in working on applying new skills and strategies and work on goals and targets and how to apply new skills and strategies.
Individual DBT therapy sessions are organized by a target hierarchy:
Life Threatening Behaviors (LTB): Suicidal or non-suicidal self-injurious behaviors or other behaviors that could be life threatening (including urges and thoughts).
Therapy Interfering Behaviors (TIB): Behaviors that get in the way of doing the therapy, i.e., arriving late, cancelling appointments, not completing homework, etc. or other behaviors that could interfere with the therapy process. (Therapy interfering behaviors of the therapist are included in this target.)
Quality of Life (QOL): Target behaviors that are barriers to developing and maintaining a quality of life that facilitates building and sustaining a “life worth living”.
DBT therapists will apply a variety of strategies within individual sessions to facilitate progress toward your goals, including using a DBT diary card (a way of tracking what you are working on and the progress you are making), learning and using DBT skills and doing Behavioral Chain Analysis (BCA), a way of discovering what maintains a behavior you know is a problem but just seem to keep repeating.
The BCA helps uncover vulnerabilities and factors that lead up to the problem behavior and helps you “break the links” in the chain. Once again you will be learning new skills to replace your old behaviors.
Skills Training
(Core Mindfulness, Emotion Regulation, Interpersonal Effectiveness, Distress Tolerance, and Walking the Middle Path)
Skills training is typically delivered in a group format that meets one time per week for a minimum of 2 hours (The suggested time is 1 hour for mindfulness/homework review and 1 hour for content).
Skills training sessions have four sections:
- A beginning ritual,
- Review of homework practice since last session,
- Presentation of new material,
- Closing “wind down.”
DBT Phone Coaching
Phone coaching is a service offered by the primary individual therapist or a therapist on the DBT team. It allows clients to contact their therapist by phone between therapy sessions. After-hours phone coaching is an important aspect of DBT because it helps clients apply the skills they have learned in therapy to real-life situations as they are happening. Phone coaching aims to help clients apply the skills they are learning to their daily lives with support.
Phone coaching provides support and guidance on how to use coping skills during a difficult time. It is not a crisis intervention service; therefore clients are encouraged to call before a crisis occurs. The goal is to use skills to prevent a crisis rather than to manage it.
The purpose of phone coaching is almost always on how the client can effectively use skills.
Consultation Team for Therapists
DBT therapists participate in weekly team meetings to discuss their delivery of DBT treatment to their clients. The main objective of these meetings is to help each therapist adhere to the treatment manual and deliver DBT with fidelity. It is therapy for the therapist.