What is Dialectical Behavior Therapy?

A Bit of an Intro to DBT

DBT stands for Dialectical Behavior Therapy, and I like to explain that this is a therapy, it’s a behavior therapy, which means we’re going to target behaviors in order to affect how you’re feeling, and the nuance that DBT adds over other behavior therapies is the idea of dialectics. Dialectics is a type of philosophy with a few different components to it, and the important part about it to remember is that there are always multiple truths. There is always more than one way to look at something, in this world. Of course, Hashem is one, Hashem echad. And He created this world with the word “bereishis”, with the letter “beis”, this world is only multiples. This is important because it helps us to see the grays rather than getting stuck in the black and white.

Our most important dialectic in DBT is acceptance and change. Behavior therapy prior to DBT was completely change focused and when Marsha Linehan, PhD, began offering her treatment to women with chronic suicidality, she found that they pushed back, saying “hey, you are not understanding how hard my life is, and you’re expecting me to just change.” She then switched to a Rogerian approach focused on acceptance and validation, only to receive further pushback, “my life is a disaster, I need you to stop validating me and actually help me fix it.” This led her to adding a dialectical approach that balances both acceptance and change strategies across treatment.

So, the skills we cover in treatment are balanced by acceptance and change skills. Our acceptance skills are mindfulness and distress tolerance. Our change skills are emotion regulation and interpersonal effectiveness. For the adolescent adaptation, we add the walking the middle path skills which are about learning to manage family conflict. While many people think of DBT as a treatment about skills, skills are really only part of a nuanced and complex treatment model. There are 4 modes of comprehensive DBT: (1) individual DBT, (2) DBT skills group, (3) phone coaching, and (4) consultation team for the therapist. Without all 4 modes, it’s not full DBT. Skills alone can be a helpful adjunct to treatment for some people, and for people struggling with borderline personality disorder, full DBT is recommended.