Dialectical behavior therapy (DBT) is a specialized cognitive-behavioral therapy that combines individual therapy with skills group training sessions to help people manage emotions and navigate life’s difficulties.
DBT was developed on Long Island when in the 1980s by Dr. Marsha Lineman, who was doing graduate work at Stony Brook, realized that a strictly behavioral approach to therapy did not work with certain clients who feared and struggled with change. But when she switched to a purely acceptance-based approach, she realized that this did not work either because clients were unhappy and needed to take steps towards improving their lives.
Dr. Linehan decided to create a therapy that drew from several different schools of thought including cognitive behavioral therapy, which emphasizes changing thoughts and behaviors, and Eastern meditational practices, which emphasizes a mindful, acceptance-based approach. Delicately balancing this dialectic of acceptance and change became the basis of Dialectical Behavior Therapy.
DBT is often used to treat borderline personality disorder and the theory which forms the basis of this treatment states that many of the problems we experience stem from our emotional vulnerability and difficulty in regulating our intense emotional responses. If your biological makeup leads you to struggle with your emotions, you can develop difficulties in many areas of your life. Some of these difficulties may be manifested in behaviors such as suicide attempts, acting impulsively, addictions, self-harm such as cutting and eating disorders. Sometimes you struggle with your thoughts, for example, suicidal thoughts, cognitive distortions and confusion. You may also find yourself struggling with feelings of emptiness or self-hatred or you may have difficulties in your relationships, such as being involved in enmeshed, co-dependent, abusive or avoidance relationships, or having fears of abandonment. These problems can also be made worse when your emotions are invalidated, discounted, shamed, or criticized by others.
Psychological disorders in which people suffer from high levels of emotional vulnerability, leading to them seeking DBT include:
Borderline Personality Disorder (BPD)
Anxiety disorders, including social anxiety, panic disorder, and obsessive-compulsive disorder (OCD)
Post-traumatic stress disorder (PTSD)
Addictions including alcohol, drugs, gambling, and sex
DBT includes clear, easy-to-remember skills that you’ll learn in weekly skills group therapy sessions. The skills target all of the life areas that are affected by unmanageable emotions and a DBT therapist can help you apply these skills so that you can decrease your emotional suffering and make life more meaningful. Our therapists will also relate to you in an accepting, validating manner and help you to maintain motivation to move forward.
Research on DBT has consistently demonstrated that it is an effective treatment for many disorders of emotion dysregulation, which is the inability to control an emotional response. DBT has been shown to reduce the number of suicide attempts, reduce the number and length of psychiatric hospitalizations, and to improve the overall quality of life. Our personal experience working with clients using a DBT approach corresponds with these findings.
There are different components of DBT including: individual therapy sessions, skills group training sessions and between-session phone coaching. We examine each component below:
Weekly Individual DBT Sessions
In Individual DBT therapy, you will work toward establishing a committed, collaborative working relationship with your therapist. You will have opportunities to discuss things such as struggles you have with your mood, problematic behaviors and thinking patterns, interpersonal issues, the impact of traumatic events from your past and your goals for the future.
You will be encouraged to fill out a weekly “Diary Card,” which is an easy-to-use self-monitoring chart on which you will take note of the urges, behaviors, emotions, and skills that are part of your life each day. These are discussed in sessions with your therapist so you can gain a better understanding of them, identify your patterns, and develop more effective ways of increasing skillful behaviors and decreasing unskillful ones. Your individual therapist will also work with you to anticipate and deal with times when you may struggle in motivating yourself to make important changes in your life.
Weekly DBT Skills Training
Skills groups usually start out with a mindfulness practice, followed by a review of the skills homework from the previous week, and discussion of a new skill that can be tried out over the course of the following week. Members also get the benefit of having a positive structured peer experience in which they can feel less alone with their problems, get encouragement and support, and receive feedback from others about how to apply skills to their own life stressors.
Members are encouraged to learn and master the five DBT skills modules outlined below: core mindfulness skills, distress tolerance skills, emotion regulation skills, interpersonal effectiveness skills, and middle path skills.
Mindfulness skills, which are drawn from Eastern meditation practices, emphasize the importance of being in the moment, observing, and focusing attention, which in turn can help you to regulate emotions and impulses effectively. These skills also emphasize increased awareness of yourself and your environment, which helps to improve self-monitoring, maintain a sense of reality, see things more clearly, and make effective decisions.
Distress tolerance skills are tools to cope with crisis situations and high levels of stress and emotion. This module offers many suggestions for different actions you can take and different ways you can think about your situation so that you can deal with it more effectively.
Emotion regulation skills are designed to give you the ability to better identify, validate, and express your emotions. This module provides information about the nature of emotions, their functions, and their consequences. You will also learn how to better understand your emotions, reduce your emotional vulnerability, and decrease your emotional suffering.
Interpersonal effectiveness skills can help you to improve your relationships with others. You will learn techniques for solving interpersonal problems; managing conflict; setting effective boundaries; assertively expressing your needs, opinions, and preferences; keeping good relationships, and maintaining self-respect.
Middle path skills help people learn to avoid black and white thinking, a thinking style associated with being overly emotional and to change that thinking with a more reasonable middle ground, a thinking style associated with calmness, peace, and wise decision-making.
We currently offer the following groups:
Adolescent skills groups – weekly
Adult skills groups – weekly
Multi-family groups – weekly
Between-Sessions Phone Coaching
Although you will be learning skills in the context of your individual and skills group therapy treatment, communicating with your therapist between sessions can help you learn how to apply skills in real life situations when you are feeling stuck. Phone, text, or email consultation between sessions with the primary therapist is encouraged in DBT to help with this skills generalization. The availability of your primary therapist after office hours can be negotiated as part of your treatment.
DBT Consultation Team
All of our Suffolk DBT clinicians meet together on a weekly basis to discuss our clients in a treatment team meeting format. We are able to receive feedback from each other that allows us to provide you with the best treatment possible. Our goal is to maintain adherence to DBT principles and to offer caring, compassionate, competent and effective therapy to all of our clients.
Most clients who enter DBT are asked to make a one-year commitment to attend both individual therapy and skills group training. Adolescent clients are asked to commit for 6 months of treatment. In the one year of treatment for adults or 6 months for adolescents, hard work from both the client and the therapist is likely to result in significant improvement in clients overall functioning.
A blog my boss said. “I want you to write a blog on DBT skills”. I’ve never written a blog before. Will people like it? What will I even write about? Where will I find the time? There is no way I can do this. I’m already counseling my patients as a second job, have supervision group, team consultation, and am going to be starting a class soon. All that with my personal life responsibilities. It’s impossible…
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“DBT doesn’t feel like therapy; therapy is boring and it is hard for it to be helpful to those who are unsure of their ability to get better. DBT shows you it is possible to get better, and feels more like life coaching than being psychoanalyzed.”
“I used to think I can live with how I was but DBT showed me a better me.”
“If it was not for DBT, I honestly don’t know where I would be in life today.”
“Often we don’t see our problems as problems, but it took DBT to help me see my problems and make me want to change for the better.”
“DBT did not change who I was, but instead it helped me become who I want to be.”
“DBT works if you work at it. Believe me, the outcome is worth it.”