What is DBT?
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 clearly articulates the functions of treatment that it addresses. They are:
1. to enhance an individual's capability by increasing skillful behavior,
2. to improve and maintain a client's motivation to change and be engaged with treatment,
3. to ensure generalization of change occurring through treatment,
4. to enhance the motivation of therapists to deliver effective treatment, and
5. to assist the individual in restructuring or changing his or her environment such that it supports and maintains progress and advancement towards goals.
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 elements of evidence-based DBT delivery for clients in need of the most intensive form of DBT to begin with.
There are four things that comprehensive DBT includes.
1. Individual Therapy (where you work one-on-one with your DBT therapist to identify and work on your goals and targets and how to apply new skills and strategies.)
DBT individual therapy sessions are organized by a target hierarchy. The first focus is to assess and problem-solve any suicidal or non-suicidal self-injurious behaviors (including urges, fantasies and thoughts). The second target is to address any behaviors that get in the way of actually doing the therapy – like arriving late, cancelling appointments or other “therapy interfering behaviors”. (Therapy interfering behaviors of the therapist are included in this target.) The third target of individual therapy is to problem-solve 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 your goals, including 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 (a way of discovering what maintains a behavior you know is a problem but just seem to keep repeating. It helps uncover the chain of controlling variables 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 use instead of your old behaviors).
2. Skills Training (Core Mindfulness, Emotion Regulation, Interpersonal Effectiveness and Distress Tolerance)
Skills training is typically delivered in a group format that meets one time per week for approximately 2.5 hours. Skills training is organized in two segments - review of homework practice from the preceding week and teaching of skills.
3. Phone Coaching - where you will have access to your DBT therapist for assistance in your day-to-day life when you need help in applying the skills when they really matter and may be hard to do. It is NOT therapy over the phone. It is coaching of skills in the moment.
4. Consultation Team for therapists –
DBT therapists attend weekly DBT consultation team meetings in order to consult with one another about their delivery of DBT with their clients. The focus of the meeting is to help each therapist deliver DBT with fidelity to the treatment manual.