Finding Balance
Dialectical Behavioral Therapy (DBT)
Dialectical Behavior Therapy (DBT) is a comprehensive, evidence-based cognitive-behavioral treatment originally developed to treat chronically suicidal individuals diagnosed with Borderline Personality Disorder (BPD). It is now recognized for its effectiveness in treating a wide range of disorders characterized by difficulties in regulating emotions. DBT emphasizes the core dialectic (tension) between acceptance of one's current state and the necessary changerequired to build a life worth living.
Who Created DBT?
DBT was created by American psychologist Dr. Marsha M. Linehan in the late 1980s. Dr. Linehan developed DBT out of her attempts to adapt traditional Cognitive Behavior Therapy (CBT) to the unique and intense needs of her severely struggling clients. She recognized that a focus solely on change often made clients feel criticized or invalidated. Therefore, she integrated Eastern mindfulness and radical acceptance practices to create a therapy that balances validation with skill-building (Linehan, 1993a).
Perspectives in DBT
The Therapist's Perspective
The DBT therapist adopts a dialectical perspective, meaning they consistently seek the synthesis of two seemingly opposing ideas:
Acceptance: The therapist radically accepts the client as they are, recognizing that their dysfunctional behaviors are the best coping mechanisms they have developed up to this point, and that their feelings are valid.
Change: At the same time, the therapist pushes for committed action and skills practice, viewing change as necessary to reduce suffering and achieve life goals.
The therapist maintains a non-judgmental stance and views the client as doing the best they can and needing to try harder (Linehan, 1993b). They function as a coach and consultant, providing specific skills training, while also being available for "in-the-moment" skills coaching outside of session times.
The Client's Perspective
The client shifts from viewing themselves as deeply flawed or incapable of managing their emotions to understanding that they have a skills deficit in the area of emotional regulation.
Key shifts for the client include:
Accepting Responsibility: Learning that while they may not have caused their problems, they are responsible for solving them by learning and applying new skills.
Committing to Treatment: DBT requires a high degree of commitment, often including signing a contract to reduce life-threatening behaviors and attending all four modes of treatment.
Using a Diary Card: The client meticulously tracks their target behaviors, emotions, and skills use daily, which provides accountability and structure for the therapy sessions.
What to Expect in DBT
DBT conducted by a formally trained clinician can be a highly structured and rigorous treatment program that typically includes four main components:
Individual Therapy (Weekly): The core one-on-one session uses a behavioral chain analysis of recent problematic behaviors (like self-harm or suicide attempts). The therapist works to identify the chain of events, thoughts, and feelings that led to the behavior, and then helps the client determine where a specific DBT skill could have been used differently.
Skills Training Group (Weekly): This is taught in a classroom-like setting and focuses on teaching the four primary skills modules:
Mindfulness: Learning to observe and describe experiences in the present moment without judgment.
Distress Tolerance: Learning how to survive crises without making things worse (e.g., TIPP skills, Distracting).
Emotion Regulation: Learning to understand, name, and change unwanted emotions.
Interpersonal Effectiveness: Learning how to ask for what you need, say no, and maintain self-respect in relationships (Linehan, 2014).
Phone Coaching (In-the-Moment): Brief, structured calls between sessions to help the client generalize the skills to their everyday life. This is used only to coach the client on using a skill to prevent a catastrophic behavior, not for processing emotional material.
Consultation Team (For Therapists): The DBT therapists meet weekly to support each other, maintain fidelity to the model, and ensure they are not burning out—a crucial component for working with clients who struggle with intense emotion.
How DBT Can Help a Person
DBT is exceptionally effective because it targets the core issues of pervasive emotional dysregulation, which often underlies complex psychological problems. It helps a person by:
Decreasing Extreme Behaviors: It directly targets and successfully reduces high-risk behaviors like suicidal ideation, self-harm, and substance abuse.
Improving Emotional Control: Clients learn to tolerate distress and manage intense emotional responses (e.g., chronic anger or panic) without resorting to harmful coping methods.
Strengthening Relationships: Through Interpersonal Effectiveness skills, clients learn how to communicate their needs effectively, set boundaries, and build healthier relationships.
Creating a "Life Worth Living": The ultimate goal is to move the client out of "hell" and into a state of ordinary suffering that is necessary for pursuing personally meaningful goals and values.
Common Uses and Applications (DSM-5 Disorders and Life Problems)
DBT is considered the gold-standard treatment for:
Borderline Personality Disorder (BPD)
Chronic Suicidal Ideation and Self-Harm
Its success in treating emotional dysregulation has led to its effective use in many other areas:
Post-Traumatic Stress Disorder (PTSD)
Substance Use Disorders (especially when co-occurring with BPD)
Binge Eating Disorder and Bulimia Nervosa
Difficulties with Anger Management and Impulse Control
Life Problems characterized by frequent relationship chaos or persistent emotional instability.
References
Linehan, M. M. (1993a). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
Linehan, M. M. (1993b). Skills training manual for treating borderline personality disorder. Guilford Press.
Linehan, M. M. (2014). DBT skills training manual (2nd ed.). Guilford Press.
Ready to Find Balance and Build a Life Worth Living?
If you are struggling with intense emotions, chronic distress, or difficulties in relationships, the structured, skill-based approach of DBT can help you find stability.
Connect with a therapist that utilizes DBT principles and begin learning the life-changing skills of mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.
*Please note that no one our team is formally DBT trained or certified through The Linehan Institute.
