6 Things You Can Expect From Dialectical Behavior Therapy (DBT)

DBT is becoming more commonly available.  With its spread, more people are referred to DBT therapists and groups and are considering entering DBT treatment.  But what is it?  If you enter treatment, what you can expect?  How will your therapist respond to you?  What will be the focus of the treatment?

There are three primary treatment activities in DBT.  These are individual therapy, group skills training and coaching in crisis situations.  Individual therapy and the skills training group usually meet each week, while coaching in crisis occurs as necessary.  Each of these 3 activities has specific goals and structure, which are usually explained to you at the beginning of treatment.  Regardless of whether it’s individual, group or a crisis, DBT treatment is comprised of the following 6 characteristics.

  1. DBT is supportive.  The treatment providers support you in your attempts to decrease problem behaviors, such as self-destructive behaviors, substance use and aggression.  They help you recognize positive strengths and attributes and encourage you to develop and use these.
  2. DBT is behavioral.  The skills group and therapy sessions focus on teaching you to analyze problem behavior patterns and to replace destructive behavior with healthy and effective behavior.
  3. DBT is cognitive.  The therapy and group focus on changing beliefs, expectations, and assumptions that are no longer effective or helpful.  The therapist will help you notice and challenge all or nothing thinking and tendencies to be over judgmental.
  4. DBT is skill oriented.  Structured skill training is designed to teach new skills and enhance capabilities.
  5. DBT balances acceptance and change.  The treatment is focused on both accepting you and the difficulties of your current situation as well as helping you to make changes.  It has specific strategies designed to increase your ability to accept and tolerate painful feelings, your current life situation, and yourself.  It will also expect you to learn new skills, try different ways of behaving and interacting with others and be committed to making changes.
  6. DBT requires a collaborative relationship.  In DBT it is important that you and your therapist function as a team to achieve goals.  It is essential that all team members (i.e. you, therapist, groups therapist, psychiatrist etc.) work on their communication and collaboration to make progress.

7 Replies to “6 Things You Can Expect From Dialectical Behavior Therapy (DBT)”

  1. Despite the widespread secular publicity of DBT in places like Time magazine & Forbes, DBT remains unavailable to many due to costs. Therapists are not ignorant of the treatment, they just don’t have the funds to access the training. No one is talking about costs. This most valuable, efffective treatment is labor inensive (with both individual and group therapists) and costly (the training & more importantly the need for ongoing supervision…reading Linehan’s manual or taking her expensive 2-3 day course, is not the same as training that is re-inforced with good supervision). I was exposed to DBT training/supervision for a year as part of our residency program (I asked to join the classes)however when the supervisor left, we lost the training. We could not afford to replace him. Many clinics such as mine, simply cannot affort this modality. I’m half way through the poignant, well written book, “Buddha and the Borderline: a memoir” and even there the author had to wait weeks for a DBT group. I’m sure her state insurance paid for it but even in environments where there are trained, seasoned DBT therapists, waiting lists abound. Until DBT is made more fiscally available, such as in the dispersing of large scale federal or state training grants in trauma communities, like my own, East New York-Brownsville, most of us will just have to rely on the resources we have. Patti O’Kane NP

  2. If only this “dream”-based theory were so. By “dream,” I don’t mean what goes on between one’s ears while in REM-4. Sure, there are some good things to be said for DBT, like it’s a less-expensive way to treat the mass of seething psyches than more expensive therapies. But, it’s a neat way, on the part of DBT therapists, to side step a client’s real issues. “Just follow the formula we gave you. What do you mean it doesn’t work? You haven’t tried hard enough. Another suicide attempt? How can you let me down so?” From someone who has been there–there being a cold bath in the Salish Sea in mid-November where the Linehan acolytes hold forth.

  3. It doesn’t sound very deep to me. I don’t have a problem in understanding how others might feel, which is a suggested deficiency that DBT seeks to address and I don’t think that behaviour change is going to do the trick. Maybe this works for some people, but if a person is already very self-aware it’s not going to make a lot of difference. Some kinds of trauma go a lot deeper than our thoughts.

  4. WOW–I’m amazed at these comments as a 56-year-old who has the dx of bipolar 1 who shares the traits of borderline so who knows & at this point who cares? I’ve been in therapy & on various meds since 15-years-old when I had my 1st suicide attempt (last one 4 yrs. ago). My mother was dxed as schizo affective & did finally complete her suicide when I was 15 after many attempts & hospitalizations & you can’t imagine what life was like (she threatened to kill us children also).

    I sought out DBT after hearing about it in my DBSA support group from a fellow w/treatment-resistant depression. He said it was the only thing that helped him. My bipolar meds were helping but I was still having these over-reactions to things–extreme sensitivity…

    Acting in a very overly dramatic & immature way (“running away from home”; threatening divorce; attempting suicide, etc.)

    After 3 mos. of DBT & individual therapy w/the DBT therapist my meds provider was amazed at the difference. I was no longer “out of control.” If I felt sad & started to cry I no longer continued to cry for an extended period of
    time & could not seem to stop myself. Now I could cry for 5 min. or so & “pull myself together.” I no longer sank deeper & deeper into the hole of depression. I couldn’t do that before.

    I’ve been able to get off an anti psychotic medication I’ve been on for 15 yrs. that has caused me to gain 50 lbs. & now have metabolic syndrome & am lowering my dosages of other meds (Lamictal) in the hopes of getting off it completely. Have been able to get off Trazodone…

    My DBT may be different from what you all experienced. Mine was more like a class. We had a manual & homework to do every day. It was intensive & hard, concentrated work. But utilizing the skills showed me that even at my advanced age & with so many years of so many problems I got relief after about 3 mos. It was amazing & gave me hope. I was no longer suicidal after 3 mos. of DBT.

    Of course, I took the proverbial 3 steps forward & 2 steps back & got discouraged when I seemed to not be handling things well, but I learned about “vulnerability factors” & “giving myself credit” & distress tolerance & mindfulness & I tell you, I was such a mess that I needed a paper bag over my head & ear plugs as I was getting triggered by EVERYTHING but I still had my thoughts which were triggering me & how could I stop those?

    That’s what led to the suicide attempts. So if I could get relief from DBT, boy, I bet anyone who has a good therapist, well-trained & a soft, caring soul can get relief.

    I have been in the DBT group 2 years or so (& in individual therapy) & I really would like to continue forever. I learn so much every week.

    But I’m a pathetic 56-year-old bipolar babe so my “insights” might not count for much.

  5. Another thing is that w/a DBT-trained therapist you have individual therapy where you do go into all the deeper stuff. The DBT group is not for processing stuff. It is a skills learning group. You do the processing w/the therapist on an individual basis so no, it is not “deep”, as that is not the purpose. It is a “class’, a “training session.” The purpose of the DBT group is to teach the skills, to practice the skills, to talk about our homework (we have a manual as a textbook) as to how we did or did not use the skills well & how we could improve after analyzing the situation if we didn’t have a successful situation & giving ourselves credit for at least attempting to use the skills in some small way as before the DBT group we were tossed to & fro by our emotions & seemed to have no control.

    And part of the DBT-trained therapist thing is that they are on-call 24-hrs. a day by phone so maybe that is why there are not so many therapists willing to be certified as that is a great commitment, isn’t it? My therapist was willing to answer my calls 24 hrs. a day & I did test her on it when I was going through a hard time.

  6. I am about 4 weeks into my DBT journey and I feel worse than before. I am very turned off by the acceptance and tolerance ideas. I have always said that if I were to take the idea of well that’s the way life is, then I would kill myself. I am not interested in living a life that I don’t like.

    Does anyone have any suggestions other than DBT for me?

    1. I’m sorry you are struggling so much with DBT. It might be helpful to use the word acknowledge, rather than accept. Changing your life is a big part of DBT. You can think of it as you need to acknowledge circumstances as they are now, in order to make effective and lasting change.

      If DBT isn’t for you, there is a new treatment that is gaining in popularity and has empirical support (research) called Mentalization that you might look into.

Leave a Reply

Your email address will not be published. Required fields are marked *