TrueCare therapist and counselors provide DBT at all levels of care.

Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment developed by Marsha Linehan PhD, ABPP. It emphasizes individual psychotherapy and group skills training classes to help people learn and use new skills and strategies to develop a life that they experience as worth living. DBT skills include mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

The goal of DBT is to help clients build a life that they experience as worth living. In DBT, the client and the therapist work together to set goals that are meaningful to the client. Often this means they work on ways to decrease harmful behaviors and replace them with effective, life-enhancing behaviors.

DBT has five components that work together to make up a standard DBT program. This is different than many other psychotherapies that consist of just one mode or aspect of treatment (such as individual therapy). Each component or mode of treatment is intended to meet a specific function.

Function = Objective or aim of DBT | Mode = Therapy component that supports each objective.

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Figure 1

Enhance Capabilities with DBT Skills Training

DBT skills training focuses on enhancing clients’ capabilities by teaching them behavioral skills. Skills training is frequently taught in groups. The group is run like a class where the group leaders teach the skills and assign homework. The homework helps clients practice using the skills in their everyday lives.

Groups meet on a weekly basis for approximately 2.5 hours, and it takes 24 weeks to get through the full skills curriculum, which is often repeated to create a 1-year program. Briefer schedules that teach only a subset of the skills have also been developed for particular populations and settings.

    There are four modules in skills training:

    • Mindfulness: the practice of being fully aware and present in this one moment
    • Distress Tolerance: how to tolerate pain in difficult situations, not change it
    • Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
    • Emotion Regulation: how to change emotions that you want to change

    Enhance Motivation with Individual Therapy

    DBT individual therapy is focused on enhancing client motivation and helping clients to apply the skills to specific challenges and events in their lives. In the standard DBT model, individual therapy takes place once a week for as long as the client is in therapy, and it runs concurrently with DBT skills training.

    Ensure Generalization with Coaching

    DBT uses telephone coaching and other in vivo coaching to provide in-the-moment support. The goal is to coach clients on how to use their DBT skills to effectively cope with difficult situations that arise in their everyday lives. Clients can call their individual therapist between sessions to receive coaching at the times when they need help the most.

    Structure the Environment with Case Management

    Case management strategies help the client manage his or her own life, such as their physical and social environments. The therapist applies the same dialectical, validation, and problem-solving strategies in order to teach the client to be his or her own case manager. This lets the therapist consult to the patient about what to do, and the therapist will only intervene on the client’s behalf when absolutely necessary.

    Support Therapists with the DBT Consultation Team

    The DBT consultation team is focused on the people who provide DBT, including individual therapists, skills training group leaders, case managers, and others who help treat the client or patient. The consultation team is intended to support DBT providers in their work; it’s almost like therapy for the therapist. The consultation team is designed to help therapists stay motivated and competent so they can provide the best treatment possible. This is especially important when they are treating people with severe, complex, difficult-to-treat disorders so the team can help one another manage burnout and share their knowledge.

    Problematic behaviors evolve as a way to cope with a situation or attempt to solve a problem. While these behaviors might provide temporary relief or a short-term solution, they often are not effective in the long-term. DBT assumes that clients are doing the best they can, and they need to learn new behaviors in all relevant contexts. DBT helps enhance a client’s capabilities by teaching behavioral skills in areas like mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These skills help people develop effective ways to navigate situations that arise in everyday life or manage specific challenges.

    How is DBT different than Cognitive Behavioral Therapy?

    DBT is a modification of standard cognitive behavioral treatment. When first developing DBT, Dr. Linehan and her team of therapists used standard CBT techniques, such as skills training, homework assignments, behavioral rating scales, and behavioral analysis in addressing clients’ problems. While these worked for some people, others were put off by the constant focus on change.

    Clients felt the degree of their suffering was being underestimated, and that their therapists were overestimating how helpful they were being to their clients. As a result, clients dropped out of treatment, became very frustrated, shut down, or all three. Linehan’s research team, which videotaped all their sessions with clients, began to notice new strategies that helped clients tolerate their pain and worked to make a “life worth living.” As acceptance strategies were added to the change strategies, clients felt their therapists understood them much better. They stayed in treatment instead of dropping out, felt better about their relationships with their therapists, and improved faster.

    The balance between acceptance and change strategies in therapy formed the fundamental “dialectic” that resulted in the treatment’s name.

    "Dialectic" means 'weighing and integrating contradictory facts or ideas with a view to resolving apparent contradictions.' In DBT, therapists and clients work hard to balance change with acceptance, two seemingly contradictory forces or strategies. Likewise, in life outside therapy, people struggle to have balanced actions, feelings, and thoughts. We work to integrate both passionate feelings and logical thoughts. We put effort into meeting our own needs and wants while meeting the needs and wants of others who are important to us. We struggle to have the right mix of work and play.

    In DBT, there are treatment strategies that are specifically dialectical.

    These strategies help both the therapist and the client get "unstuck" from extreme positions or from emphasizing too much change or too much acceptance. These strategies keep the therapy in balance, moving back and forth between acceptance and change in a way that helps the client reach his or her ultimate goals as quickly as possible.