Dialectical Behavior Therapy (DBT for short) is a comprehensive treatment approach for people whose emotions create major problems in their lives (and perhaps in the lives of people around them). These emotions may be expressed in a destructive way (as in angry outbursts and even violence, or depression and immobility), or avoided by behaviors such as suicide attempts, substance abuse, eating disorders, or impulsive actions.
DBT clients are taught more skillful ways to regulate their emotions, deal with the distressing situations in their lives, and improve relationships with the people around them. These skills are taught in caring treatment relationships that appreciate the clients’ strengths, acknowledge their emotional sensitivity, and offer powerful, pragmatic methods for creating a “life worth living”.
Components of DBT
Ideally DBT includes individual therapy, a skills training group and skills coaching by phone between sessions. In many cases it is helpful for clients to receive psychiatric medication, but this is not always necessary. DBT therapists should belong to a consultation team.
DBT skills training groups are more like classes than traditional therapy groups. The goal is to teach DBT skills in an efficient and effective manner, using examples and problems from the clients’ and therapists’ lives to illustrate the principles involved. For a discussion of the skills themselves, see “Skills for a life worth living”. In some cases, it can be appropriate to teach the skills as part of the individual therapy, or in individual skills training in addition to working with another therapist.
The primary job of the DBT individual therapist is to help clients get better control over the behaviors that are destroying their lives (or even threatening to end their lives). Beginning with an acceptance of clients exactly as they, the therapist helps them to find the resources, the motivation, and the skills to move towards the life goals they want to achieve. This process takes place within a relationship that is real, warm and validating of what is positive within clients’ lives and personalities.
Phone skills coaching is usually performed by the individual therapist, but in some cases skills group trainers will take up the task if the client does not have a DBT-trained individual therapist. Clients can call when in emotional crisis for suggestions about skills to employ that will help them deal with the crisis without reverting to behaviors that make things worse.
A Different Kind of Therapeutic Relationship
Due to the intensity of the difficulties experienced by the people for whom DBT was designed, the manner of a DBT therapist is rather different from the reserved, traditional stance that clients may have previously experienced (or seen parodied on television). DBT therapists are generally more available to their clients in between sessions, more candid about their reactions to client behaviors, and likely to tell anecdotes from their own lives illustrative of the skills they are trying to teach clients.
My clients have my cell phone number in order to be able to reach me when they need help. I am comfortable responding to questions about my own life, or what I think clients should do about their problems.
How to choose a DBT Therapist
As awareness has grown about the clinical data showing that DBT is the most effective approach to treating clients who meet criteria for Borderline Personality Disorder, many clinicians have begun to receive training in how to do it. This is quite a positive development, and introducing elements of DBT (particularly the use of DBT skills training) into other therapeutic approaches should be helpful. That said, however, delivering DBT individual therapy in the research proven manner is actually pretty complex and requires substantial specialized training that many therapists who say they do DBT have not had. For a useful set of guidelines from the mental health advocacy group TARA entitled “How to Choose a DBT therapist”, click here. For a description of my training in DBT, see “About Michael Baugh”.