Dialectical behavior therapy (DBT) is a specialized form of cognitive-behavioral therapy that was developed by a psychologist named Marsha Linehan, Ph.D. in the 1980s. While she was doing graduate work at Stony Brook University, she realized that a strictly behavioral approach to therapy did not work with certain clients because they feared and struggled with change. When she switched to a purely acceptance-based approach, she realized that this did not work either because clients were unhappy with their lives and needed to take steps toward improving them.
From this experience, Dr. Linehan decided to create a therapy that drew from several different schools of thought including cognitive behavioral therapy, which emphasized changing thoughts and behaviors, and Eastern meditational practices, which emphasized a mindful, acceptance-based approach. Delicately balancing this dialectic of acceptance and change then became the basis of Dialectical Behavior Therapy.
The biosocial theory of borderline personality disorder, which forms the basis of DBT, states that many of the problems we experience stem from our emotional vulnerability and difficulty in regulating our intense emotional responses. When you have a biological make-up that leads you to struggle with your emotions, you can develop difficulties in many areas of your life including behaviors (e.g., suicide attempts, acting impulsively, additions, self-injury, eating disorders), thoughts (e.g., suicidal thoughts, cognitive distortions, confusion), relationships (e.g., enmeshed, co-dependent, or abusive relationships; fears of abandonment; avoidance), and feelings about yourself (e.g., feeling empty, self-hating). These problems can 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 include:
- Borderline personality disorder
- Major depression
- Bipolar disorders
- Anxiety disorders, including social anxiety, panic disorder, and obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
- Eating disorders
- Addictions including alcohol, drugs, gambling and sex
DBT includes clear, easy-to-remember skills that target all of the life areas that are affected by unmanageable emotions (described under the “Weekly Skills Group Therapy” section below). DBT therapists can help you to apply these skills so that you can decrease your emotional suffering and develop a “life worth living.” Our therapists will also relate to you in an accepting, validating manner and help you to maintain motivation to move forward.
Research that has been done on DBT has consistently demonstrated that DBT is an effective treatment for many disorders of emotion dysregulation. DBT has been shown to reduce the number of suicide attempts, reduce the number and length of stay of psychiatric hospitalizations, and to improve overall quality of life. Our personal experience working with clients using a DBT approach corresponds with these findings.
The following sections describe the different components of DBT: individual therapy, skills groups, between-session coaching, and consultation.
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 that you have with your mood, problematic behaviors and thinking patterns, interpersonal issues, and 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 session 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, review the skills homework from the previous week, and discuss 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: 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. It also emphasizes 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 emotions. This module offers many suggestions for different actions you could 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 skillshelp people learn to avoid black and white thinking (a thinking style associated with being overly emotional) and to instead seek 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 Group 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.
Psychological evaluations are not a core component of DBT treatment but they are sometimes suggested to clarify symptoms and diagnoses so that your therapist can target your issues more effectively in treatment. Certain types of psychological testing can be conducted at Suffolk DBT but other more extensive evaluations may require a referral to an outside specialist.