WHAT IS DIALECTICAL BEHAVIOR THERAPY?
DBT is a method of cognitive behavioral therapy that treats people with Borderline Personality Disorder (BPD) developed by Marsha Linehan, PhD. at the University of Washington. In DBT, behavioral change is balanced by acceptance, compassion and validation.
STRATEGIES BALANCING ACCEPTANCE and CHANGE FORM THE “Dialectic” IN DBT
Dr. Linehan studied women who met criteria for BPD – angry women, suicidal women, and drug abusing women. She found that these clients felt that their ability to change was being over-estimated while the degree of their suffering was being underestimated. She formulated strategies to help them tolerate their pain while working towards making a “life worth living”. They were taught various skills that helped them to tolerate their distress without resorting to self-destructive behaviors.
"DBT IS A LIFE ENHANCEMENT PROGRAM, NOT A SUICIDE PREVENTION PROGRAM." LINEHAN
DBT is the only psychosocial outpatient treatment for BPD that has evidence from randomly controlled clinical trials demonstrating its success.
CHARACTERISTICS OF DBT
DBT is Supportive: It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life.
DBT is Cognitive: DBT helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” & helps people to learn different ways of thinking that will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion.
DBT is Collaborative: It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.
EXPLANATION OF DBT TERMS
Behavior Therapy: The aim of “Behavior Therapy” is to help people try new ways of thinking, feeling, speaking, coping and doing things. Rather than focusing on the past, it looks at the present situation. It does not depend on the insightful discussions characteristic of psychotherapy to solve problems, although this can be valuable in its own right. It focuses on a person’s views and beliefs about their life, not on their personality traits. It aims to replace maladaptive methods of coping with more effective ways of achieving specific changes and goals, it helps a person to get what they want or need while helping them develop control of their life.
Dialectics: DBT is based on the idea that opposites can coexist and be integrated. Thinking dialectically means recognizing that both points of view in any situation are valid and means constantly working on balancing change and acceptance.
HOW IS DBT PRACTICED?
DBT is generally practiced as an outpatient treatment. Researched DBT with data to support its use includes:
1. Once weekly individual psychotherapy.
2. Two hour weekly psychoeducation skills groups.
3. Consultation meeting for therapists.
4. Therapist available for phone coaching.
WHY IS IT IMPORTANT TO SEE A TRAINED DBT THERAPIST?
DBT may be the most hopeful and helpful of any new therapy available for people with BPD. Many people with BPD have problems trusting others, have “failed in treatment” or have been dropped by former therapists. When DBT is not done as designed, the results may not be the same, causing the person with BPD to lose hope and trust and then be reluctant to ever try DBT again. If DBT is not practiced according to the research model that produces effective change but is practiced “my way” by a therapist without adequate training, it probably won’t produce the same kind of results as the research programs. Outcomes from this kind of DBT will not justify additional DBT training or new DBT programs in the community. Currently. Dr. Linehan is working on a way to certify therapists who practice DBT so that people can determine if a therapist is truly qualified to practice DBT.
HOW TO KNOW IF A THERAPIST DOES DBT?
These are the questions you should ask:
•Have you completed a 10 day intensive DBT training ?
•Are you a member of a DBT consultation team ?
•Have you been supervised by an expert DBT therapist?
•Are you familiar with the main sets of DBT strategies (cognitive behavioral therapy, validation, dialectics)
•Do you teach skills, practice behavior analysis, review diary cards,?
•Do you do phone coaching?
•How many clients have you treated using DBT?
The answer to these questions should be yes. You have a right to check on the therapist’s credentials; to know if the therapist is licensed in his/her state; to know the extent and nature of the therapist’s education and training; the extent of the therapist’s experience in treating clients with similar problems; the therapist’s arrangements for coverage or emergency contacts.