What Is Dialectical Behavior Therapy (DBT)?

Dialectical Behavior Therapy

What is Dialectical Behavior Therapy?

Learn the basics of a growing trend in mental health.

Potential clients often inquire if I provide Dialectical Behavior Therapy, (DBT).  The next question is generally whether I believe DBT was recommended because this might indicate they have Borderline Personality Disorder.  

Dialectical Behavior Therapy was originally developed to work with clients with personality disorders, but it's usage has since changed due to the simplicity and effectiveness with treating a wide range of mental health conditions.  DBT has become increasing popular with therapists nationwide and is often the preferred modality of treatment. While Dialectical Behavior Therapy sounds complicated (and can be presented as such), DBT is simple to understand and use in treatment.   

And, no, having DBT recommended to you does not mean you have Borderline Personality Disorder.

 
Dialectical behavior therapy is a type of cognitive behavioral therapy. The primary goals of DBT is to teach individuals emotion regulation, distress tolerance and how to improve relationships.  While DBT was initially designed to work with a specific group of clients (Borderline Personality Disorder), it has proven to be effective in therapy with patients with other conditions such as depression, anxiety and challenges in relationships.  Many mental health professionals integrate DBT into their treatment plans while others use it as their preferred method of treatment.  


DBT Basics
Dialectics is based upon the concept that “everything is composed of opposites and that change occurs when one opposing force is stronger than the other”.  In simpler terms, when we commit to learning new desired behaviors, generally the opposite thought, feeling or action of previously used responses, we can improve our relationships and quality of life.

 
The fundamentals of Dialectical Behavior Therapy include:

  • Cognitive Behavioral Therapy
  • Validation
  • Dialectics

Cognitive Behavioral therapy includes the following primary strategies to change behavior:

  • Skills Training includes learning new skills, completing homework assignments and role playing new ways of interacting with others.
  • Exposure Therapy requires patients to acknowledge feelings, thoughts or situations which were once feared and avoided.
  • Cognitive Therapy teaches us how to recognize patterns of negative thoughts (Cognitive Distortions).  These negative thoughts are replaced with positive thoughts that reflect reality more accurately.
  • Contingency Management helps clients understand how mal-adaptive behaviors can be unconsciously learned and might have been rewarded in the past. These insights encourage patients to modify their behavior in a positive way.

Validation-

Many patients feel invalidated or defensive when changing patterns of thinking or behavior is suggested.  Because previous behaviors often served a purpose of protecting oneself in earlier life, the suggestion of change can create distress or resistance.  To manage feelings of invalidation, therapists will validate that actions used previously “make sense” considering the patient's previous experiences. Therapists will also demonstrate how the previously used actions are now ineffective in their current lives or relationships.


Dialectics is used by therapists to demonstrate that while opposites exist, they are still interconnected.  The patient and therapist work together to resolve the contradiction of encouraging self-acceptance while also promoting change. 


Like most techniques or treatment modalities offered in the field of mental health, clinicians may use Dialectical Behavior therapy in their work when it best fits their client’s needs. Many therapists naturally utilize the fundamentals of DBT in every session: validation, recognition of faulty thinking, suggestions for improved ways of responding/behaving.  Clients may be unaware that they have been practicing the basics of DBT in their sessions unnoticed.

Dialectical Behavior Therapy is closely related to the concepts and strategies used by Cognitive Behavioral Therapists.  DBT combines sensible concepts for every therapist and client: it seems logical that it would be utilized by most therapists on a regular basis in session.

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