working with clients, I primarily use a Cognitive Behavioral Therapy (CBT) and
Dialectical Behavior Therapy (DBT) approach. In my experience, many of my
clients are much more familiar with CBT than DBT. To help familiarize others
with this relatively new therapy (DBT was born from CBT in the late 1970s), I’ve
created a weeklong DBT Spotlight Blog Series. So, for day one, let’s start with
What is Dialectical Behavior Therapy (DBT)?
Developed by Dr. Marsha Linehan at the University of Washington, DBT was originally developed to treat interpersonal chaos, intense emotional swings, impulsiveness, confusion about the self (identity), and suicidal behavior associated with Borderline Personality Disorder. DBT has since been applied to a range of problems relating to emotion disregulation, including substance use problems, eating disordered behavior, and anger-related problems.
DBT is based on the idea of “dialectics,” which is the thought that two things that appear as opposites can both be real and true at the same time and can be synthesized.
What this looks like in practice:
Dialectics takes a situation that people would like to make black and white, and, rather than making it gray, it creates something more along the lines of a yin and yang symbol.
One of the core dialectics often referred to in DBT is that of “Acceptance and Change,” which can be described as weighing out various points of view in any situation and constantly working on balancing an effort to change with accepting situations as they are.
With my clients, I work from a place of “acceptance and change.” I believe that my clients are doing the best they can and that their life would be more fulfilling if they made some changes. Both of these things are equally real and true.
Behavior therapy is based on the study of how behaviors are learned. For the most part, it is a "doing" therapy that focuses on the present rather than a “talking” therapy that focuses on the past.
What this looks like in practice:
DBT works to replace ineffective ways of coping by learning new, skillful ways of coping. This is accomplished, in part, by focusing on specific, measurable goals that can realistically be attained.
Take for instance this example: You are feeling stressed by the amount of tasks you must complete for school or work, so you avoid doing the tasks to help relieve that stress. From a DBT approach we would understand or accept why you are feeling stressed – the fact is that you likely have many tasks to balance right now and you are doing your best to balance all of them at once. However, the way that you are attempting to balance them (by avoiding certain tasks) is not effective and this must change. Avoiding certain tasks only results in you feeling more stressed when you are trying to complete the tasks at the last minute or when you don’t complete them at all and suffer the consequences (e.g., your teacher or boss is upset with you, etc.). In behavioral-based therapies like DBT, you would work with your therapist to create a plan of specific, measurable, and attainable goals so that you could complete tasks in a timely manner while experiencing the least amount of stress possible.
With a background in psychology, I find it important to use approaches in my clinical work that are empirically backed. Research supports that DBT is as effective or more effective than other psychotherapies when treating a range of problems related to emotion disregulation, including substance use problems, eating disordered behavior, and anger-related problems. Click here to view a summary of DBT data to date.
Continue to check back this week for more on DBT. Next up in the DBT Spotlight Blog Series will be the basis of DBT - the Bio-Social Theory.