What is DBT?

15 Aug

Dialectical Behaviour Therapy is a four-module therapy that Dr Marsha Linehan developed some 30 years ago to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD), and is now recognised as the gold standard psychological treatment for this population.

It is an evolution of Cognitive Behaviour Therapy (CBT), which is the most widely recognised, and used, psychological therapy. However, Linehan found that it didn’t work on its own for people with BPD.

Dr Linehan’s genius was to recognise the necessity of combining the seemingly contradictory - or dialectical - notions of acceptance and change; that in order to be able to…

… build a life worth living, we all need to accept ourselves and the need to change ourselves.

She taught clients the behavioural methods of CBT to effect change, while drawing on the Eastern traditions of mindfulness and acceptance to learn how to tolerate distress that cannot be avoided or fixed, in this moment. She named this synthesis of two opposing methods Dialectical Behaviour Therapy.

Research has shown that DBT is effective in treating a wide range of other disorders such as substance dependence, anxiety, depression, post-traumatic stress disorder (PTSD), and eating disorders.

The skills are so effective that they are now being taught in some schools in the US and are used in corporate coaching programs.

DBT works because it assumes that many of the problems people are experiencing are due to skills deficits and by teaching people to use effective coping skills, particularly strategies for expressing, experiencing, and regulating intense emotions, they can go on to live rich, full and meaningful lives.

The skills are divided into four modules which are taught over a six-month period and then can be repeated, adding up to a year of therapy. Some organisations will only offer skills training, or a reduced curriculum to fit the group skills training into 12 weeks. We prefer to offer the full curriculum.

The DBT Skills Modules are:

Mindfulness: the practice of being fully aware and present in this one moment
Distress Tolerance: how to tolerate pain in difficult situations, not change it
Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
Emotion Regulation: how to change emotions that you want to change

As DBT therapists, we use the skills in our own lives, every day.

The skill I use every single day is Mindfulness, not only as a meditation practice, but to know what I am feeling, why I might be feeling it and how that is impacting on how effective I am, at any given moment.

Validation was the skill that impressed me the most when I first came across DBT. Years before I undertook DBT training, I started using it with a friend that I had always had a fractious relationship with and was amazed to discover that while I may not have agreed with the content of what she was saying, if I could validate how strongly she felt about it, or that it was a concern for her, we could always find common ground. Mindfulness is a vital first step of validation, as you have to be mindful of your state and others, in order to validate effectively.

Then, thanks to becoming a Family Connections leader, I learnt DEARMAN - an acronym that adds up to the skill of how to ask for what you want, effectively. It’s a process that takes time to teach, and in my experience, once people learn it, they use it all the time.

Radical Acceptance, the skill of recognising reality and that it cannot be changed in this moment, is the fourth of my top four skills.

I teach all my clients, whether they are doing DBT or not, these four skills.

Why group therapy AND individual therapy?

This is the gold standard way of delivering DBT.

The 2-hour groups are primarily to teach the DBT skills but they also offer opportunities for support, connection, feedback and multiple examples of group participants trying and applying the skills in their own lives.

Individual therapy sessions are a chance to explore what cannot be shared in the group and for a deeper exploration of the individual’s experience.

We offer three courses in DBT:
Healthy Relationships Now (Mindfulness & Orientation plus Interpersonal Effectiveness, 7 weeks)
Befriending Your Emotions (Mindfulness & Orientation plus Emotion Regulation, 9 weeks)
Crisis Surfing (Mindfulness & Orientation plus Distress Tolerance, 8 weeks)

To our knowledge we are the only private practitioners in WA offering the DBT modules in full. Private hospital DBT programs in Perth are abbreviated and don’t always offer individual therapy in coordination with the skills group, as per DBT best practice.

For timing and intake of our current course please click on the Courses & Events tab.

So what is “dialectics”?

Often people suffer because they experience extreme emotions, thoughts and behaviours. For example, “If you don’t love me, then you hate me”, or “I’m either out all the time, or I crash and don’t come out of my room for a week,” or “I really loved him, then he didn’t return my call straight away and now I hate him!”. In psych-speak we call this being polarised, or black-and-white thinking. In a family, people may take polarised positions such as one parent being the inflexible disciplinarian and the other being the indulgent appeaser. Dialectics recognises that there is both a kernel of truth in either end of the scale and there is a middle way that encompasses both truths.

In DBT, a key dialect is the truth that clients need to both accept themselves just as they are, and they need to change, and therapists need to offer clients total acceptance and a pathway towards change. We also accept that everyone is doing the best they can and we can all do better.

Dialectics reminds us that:

1. The universe is filled with opposing sides/opposing forces.

There is always more than one way to see a situation, and more than one way to solve a problem.

Try: letting go of extremes, change from “either/or” to “both/and” ways of describing a situation.

2. Everything and every person is connected in some way.

The waves and the ocean are one.

Try: looking for similarities among people instead of differences and treating others as you would like to be treated.

3. Change is the only constant.

Meaning and truth evolve over time. Each moment is new; reality itself changes with each moment.

Try: radical acceptance of change, and embracing it.

4. Change is transactional.

What we do influences our environment and other people in it.

The environment and other people influence us.

Try: paying attention to your effect on others and how they affect you.

extracted from DBT Skills Training Manual, Marsha M. Linehan

Why DBT will change your life

When we are skilful at recognising and managing our own emotions and needs, we avoid unnecessary suffering, even when pain is unavoidable. We can move from reacting to responding when faced with difficult emotions or events and we can validate ourselves and others which lessens pain and fosters deeper connections.

These are skills that we all need, whether we have a mental health challenge or not, which is why we are passionate about offering DBT.