DBT Assumptions

dbt assumptionsEvery therapy operates with a certain set of basic assumptions.  These are sets of hypothesis', facts or statements that are taken for granted.  They are not always articulated, but they are acted upon as rules and guidelines for treatment.

DBT is no different.  It too operates with a certain set of assumptions.  In DBT, however, the assumptions are clearly articulated.

About Clients

  1. People are doing the best that they can.
  2. People want to improve
  3. People must learn new behaviors both in therapy and in the context of their day-to-day life.
  4. People cannot fail in DBT
  5. People may not have caused all of their problems, but they have to solve them anyway.
  6. People need to do better, try harder and be more motivated to change.
  7. The lives of people who are suicidal are unbearable as they are currently being lived.

About Treatment

  1. The most caring thing a therapist or treatment provider can do is help people change in ways that bring them closer to their own ultimate goals.
  2. Clarity, precision and compassion are of the utmost importance.
  3. The treatment relationship is a real relationship between equals.
  4. Principles of behavior are universal, affecting clinicians no less than clients.
  5. Treatment providers need support
  6. Treatment providers can fail.

What do you think of these assumptions?  Are any of them contradictions?  Can these assumptions still be true, despite contradiction?  Do these assumptions fit with your experience of therapy.

Write your thoughts and comments in the comment section below.

9 Replies to “DBT Assumptions”

  1. From my understanding it is the therapist who fails in DBT, not the therapy and you do have the choice of changing therapists.

    Yes people can fail in DBT and they do. People drop out of DBT all the time and these people are not added to the statistics that boast overwhelming success.

    Chances are it is a very successful type of therapy and certainly sounds very well-rounded but, like everything else in life, it is not infallible.

    Beware of any therapy that says people or the therapy cannot fail.

    1. Thank you for your comment. I wanted to clarify my understanding of the intention behind the assumption “people cannot fail in DBT.” I believe the intention is to emphasize that it is not the person that has failed, but the treatment or the treatment provider. Too often the people who are receiving help are blamed when treatment doesn’t work for them. This basis of this assumption is that we should not blame people if a treatment is not working for them (people cannot fail in DBT), but should look to find something that does work for them (DBT can fail people).

  2. In developing brain-based coping skills for kids, our motto is using a “no fault” approach — something quite akin to DBT. When kids learn “there’s nothing wrong with me when I get upset or stressed”, they are amazed to learn that their brain controls how they feel, think and act. As an emotional health educator directly working with over 700 pre-teens, it’s obvious that “No child should suffer from the misbelief that they DESERVE the pain they feel inside!” We’ve had nearly 90,000 pre-teens, teens plus many more of their parents, counselors and teachers visit our Coping Skills for Kids free and open access “virtual classroom” in less than 3 years. We need more emotional health education (promoting self-management strategies) so kids and the adults who care from them use a “no fault” approach at home and in schools. As I often say to adult audiences, “Blaming others for how we feel only keeps us from developing healthy coping skills.”

  3. How is it that the therapist can fail in DBT, but the client can’t?

    It makes sense as a sort of motivational slogan, but it’s difficult to see how it could be descriptive of reality.

    Unless the client is the person in a burning building, and the therapist is the firefighter. But if that’s the case, how does that fit with the client empowerment paradigm?

  4. Clients can fail when the other assumptions are not met, such as all clients try. You can’t change without trying to change and using what you are learning. Correctly implementing DBT means that you are unlikely to fail rather than all people will not fail.

  5. In DBT, the assumption is that it is the therapist who is responsible for failures – the therapist didn’t do what that client needed in order to succeed.

    I wish that more therapists took that responsibility seriously, although I know how hard that is and what a burden it can be to the therapist. As a therapist myself, I am weary of putting everything I have into trying to help people who reject everything I do. Which emphasizes the importance of therapists needing support. I wish that all modalities and settings would recognize that one too.

    I draw from DBT to the extent that I can, both personally and professionally, but have not had the opportunity to get either live training in DBT or DBT therapy for myself. I do all that I can. I have failed out of therapy 8 times, but I completed my master’s degree with nearly a 4.0. That counts against me in therapy too. But I no longer have insurance, so no help for me.

  6. I know my daughter’s therapist failed her miserably. Now they recommend a restrictive “boarding school.”

    DBT is a great therapy – – I recognize that. But, the attitude that the “therapist do not fail the client” is ridiculous. How many other
    DBT-ers out there were recommended to be placed in a restrictive boarding school?

    Also, does anyone have any good DBT therapist in the NYC areas?

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