"We, like the Mother of the World, become the compassionate presence that can hold, with tenderness, the rising and passing waves of suffering." Tara Brach, Radical Acceptance

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Dialectical behavior therapy (DBT) is a specialized form of cognitive-behavioral therapy.  It was originally developed to treat adults and adolescents demonstrat ing intense mood swings; relationship difficulties ; frantic efforts to avoid abandonment ; confused thinking; impulsive behavior ; and recurrent suicidal behaviors including suicidal ideation, intentional self-injur y, and history of multiple suicide attempts.  DBT has also demonstrated success in treating any impulsive or “out -of –control” behavioral problems including eating disorders  and addictions.  In research , DBT has been shown to reduc e the number of suicide attempts , number and length of stay of psychiatric hospitalizations, and to improve overall quality of life.

DBT considers the primary problem to be a combination of emotional vulnerability and an inability to regulate emotional responses.  Ongoing “emotion dysregulation” negatively impacts a person’s ability to function in personal relationships, to develop coping skills, to think clearly in highly stressful situations, and to hold on to a sense of self.  Problem behaviors such as substance abuse and deliberate self-harm are often found among people with intense, extremely painful emotions that are difficult to regulate.  These behaviors are thought of as providing an “escape,” but in reality they interfere with perception, wise th inking, and skillful problem solving.  The focus in DBT treatment is on accepting where a person’s at, while providing behavioral skills specifically designed to help them overcome their emotional vulnerability and to build the life they’ve always wanted.

Common mental and emotional disorders that include high levels of emotional vulnerability are :

• borderline personality disorder
• major depression
• bipolar disorders
• anxiety disorders including social anxiety, panic disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD)
• eating disorders
• addictions including alcohol, drugs, gambling and sex

Standard DBT is an outpatient treatment that consists of weekly individual therapy and weekly skills group .  DBT is provided in a team setting by   therapists who meet for weekly consultation to ensure the highest level of care.

Weekly Individual DBT Sessions

In individual DBT, the client and primary therapist begin by establishing a committed, collaborative working relationship while clearly defining the client’s treatment goals.  A comprehensive behavioral assessment is completed that includes past and current history of problematic behaviors, prior treatment experiences and life goals.  Behavioral self-monitoring is a regular part of treatment because it helps the therapist truly understand the daily struggle that many clients in DBT face.   It also helps in identifying the ineffective behavioral patterns that have developed.  Clients will often find that these patterns developed over time due to a desire to escape intensely uncomfortable emotions. The primary therapist helps the DBT client apply the group skills to better address and decrease behaviors that interfere with emotional stability, healthy and fulfilling relationships, and life goals.  In addition, the individual therapist works to anticipate and address motivational problems that often arise in the face of  behavioral change in treatment.  

Weekly DBT Skills Training

In weekly 90-minute DBT Skills Groups, the focus is on learning and mastering four skills modules which include core mindfulness skills, distress tolerance skills, emotion regulation skills, and interpersonal effectiveness skills. 

Mindfulness skills are drawn from eastern meditation practices.  They are the first skills to be taught because they emphasize and address the importance of attention control, which is a prerequisite skill for the ability to regulate emotions effectively. 

Distress tolerance skills taught in DBT are those needed to deal with crisis situations and to accept life as it is in any given moment. 

Emotion regulation skills provide group members with information about the nature of emotions, their functions, and their consequences.  Three different aspects of emotional functioning are targeted: understanding one’s own emotions, reducing emotional vulnerability, and decreasing emotional suffering. 

Interpersonal effectiveness skills help group members learn to solve interpersonal problems, handle conflict and assert opinions, wishes and preferences in ways that maintain stable relationships while maximiz ing respect for themselves within the relationship. 

By participating in a long-term skills-oriented group, group members benefit from a structured, positive peer experience that validates emotional experiences while providing concrete skills coaching and solutions to ongoing life stressors.

Between-Sessions Phone Coaching

Phone or e-mail consultation between sessions with the primary therapist is encouraged in DBT.  Calls or e-mails to the primary therapist focus on decreasing suicide crisis behaviors; increasing skillful behaviors in everyday life; and resolving interpersonal crises, alienation, or a sense of distance between the client and the therapist.  Availability of a client’s primary therapist after office hours is negotiated as part of each client’s treatment.

DBT Consultation Team

In DBT, there is a strong emphasis on a team-approach to treatment.  DBT therapists commit to obtaining weekly case consultation with colleagues within a treatment team meeting format.  The goal is to maintain adherence to DBT principles and to conduct caring, compassionate, competent and effective therapy.

Most clients who enter DBT are asked to make a year commitment to attend both individual therapy and skills training.  Adolescent clients are asked to commit for 6 months of treatment.  In 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 client’s overall functioning.