What DBT Is
DBT stands for Dialectical Behavior Therapy. DBT was developed by Marsha Linehan in the 1980s specifically to treat Borderline Personality Disorder, a mental disorder that is diagnosed in people who struggle to regulate their emotions, behaviors, sense of self, relational behaviors and cognitions. DBT is considered TNAU, that is, Therapy Not As Usual. It focuses on the relationship between the therapist and the client working together to create change where needed and to develop acceptance where needed.
It is not a therapy for the faint of heart—either as a therapist and as a client! We go where angels fear to tread, using a non-judgmental and behavioral approach to target those behaviors that are life threatening or negatively impact a person’s quality of life.
DBT is a lot of work and commitment! And, the effects can be transforming and lifesaving. It begins with a pre-treatment phase that is at least four sessions and can be up to eight or more as the therapist and client go through a process of assessment, rapport building, orientation to what DBT entails and making sure that DBT is the right therapy at the right time for the individual.
When a person is in DBT, they will have a group session and an individual session every week, with homework. The homework will entail practicing the skills learned in group in their daily lives and completing a daily diary tracking card. The skills group is more like a class than a process group, teaching new skills each session that are then practiced in the client’s daily life.
The group teaches four modules, or sets of skills: Mindfulness, Interpersonal Effectiveness, Emotion Regulation (my fav) and Distress Tolerance. Who needs a diagnosis of any kind in order to benefit from skills like these?!
The therapist participates in our weekly DBT consultation group that has been meeting for over 20 years. The DBT consultation group meets to support the therapist and to help our therapists provide quality therapy adherent to the DBT model.
Dr Linehan has shared her own experience as a teenager with life threatening behaviors and being institutionalized for 2 years. At the age of 18, she made a vow that “I would get out of hell and that once I got out of hell, I would go back to hell and get other people out.” To say she has carried out this vow is an understatement.
Linehan has transformed a terribly stigmatized mental illness that was considered by many to be untreatable, to one a person can recover from OR be able to live with and build a life worth living. While she developed DBT specifically to treat BPD, empirical evidence supports that DBT treatment helps those who struggle with dysregulation and need to develop more effective coping skills.
Prior to Marsha’s work, there was limited understanding of BPD and very limited effective treatments for this mental disorder that entails great pain and suffering to those who have the diagnosis, and for those who love them.
What DBT is not
While the majority of our clients who receive DBT have experienced trauma, DBT is not a treatment for trauma. However, it can be an excellent and very needed preparation to ready an individual for doing trauma work.
Trauma work is a courageous and intense process that may not be as effective if one cannot tolerate the great pain of reprocessing traumatic experiencing with the goal of recovering from it.
Many of the coping skills survivors of trauma developed and used to survive their trauma do not help them recover from it unfortunately. Avoidance, such as numbing out, not talking about traumatic memories and dissociation are examples of survival responses that helped a person survive trauma but then become blocks to recovery once a person is out of the traumatic situation. The skills that were once adaptive become maladaptive. DBT helps a person develop skills to replace these responses with more effective ones.
