Dialectical behavioral therapy (DBT) is a type of psychotherapy with roots in cognitive-behavioral therapy, but tailored specifically for individuals who experience intense emotions. DBT involves working with a therapist for individual talk therapy, and in specific “skills groups.”
Psychologist Dr. Marsha Linehan developed DBT in the 1980s for individuals with borderline personality disorder (BPD). Since then, mental health providers have used it for others who struggle with emotional regulation, such as those with post-traumatic stress disorder (PTSD) or addiction.
What does dialectical mean?
The “dialectical” in DBT comes from the philosophical idea of dialectics, which involves looking at and resolving contradictory or opposing viewpoints. Ideally, dialectics form a comprehensive, balanced point of view or attitude. It involves one idea (the thesis), an opposing idea (the antithesis), and a resolution that integrates the two (the synthesis).
Dialectical thinking recognizes that real life is dynamic and full of changes, tensions, and often contradictory or opposing concepts. The term is used in DBT because this type of therapy helps individuals consider and reconcile potentially conflicting elements of their feelings, behaviors, or experiences.
This approach can help resolve black-and-white, rigid thinking that is characteristic of BPD and emotional struggles. It can also help individuals address or resolve internal conflicts, become more flexible, accept ambiguity, and become more open to alternative points of view.
What does a DBT session look like?
The frequency, length, and exact agenda for each DBT session will vary. In general, however, a DBT session may involve:
- Checking in on the client’s current condition and setting an agenda for the session
- Reviewing previous discussions and challenges, or any “homework” the client may have had
- Discussing current challenges, engaging in problem-solving, targeting undesirable behaviors, identifying triggers, or developing coping strategies
- Identifying skills to be practiced and reviewing them in the session, such as mindfulness or role-playing
- Providing encouragement and support for the client
- Assigning additional homework for the client
- Summarizing the session, generating feedback from both client and therapist, and setting goals for the next session
Each session of DBT should involve, to some degree, dialectical strategies. This may involve recognizing and validating different perspectives or feelings, reconciling ideas that may seem opposed, and creating a more nonjudgmental attitude toward oneself and other people.
A DBT session may also include:
- Practicing mindfulness to help a client become more aware of his or her thoughts, emotions, and sensations without judgment, to foster self-awareness
- Increasing distress tolerance without turning to impulsive or harmful behaviors, helping the client learn to manage difficult emotions or crises
- Learning emotional regulation, becoming more effective at understanding and managing emotions and becoming less overwhelmed by them
- Building healthier relationships and communication through skills like negotiation and setting boundaries
Are DBT outcomes good?
Does DBT deliver? Research suggests that it does, for adolescents and adults. This includes reduced self-harm behaviors and better emotional regulation. One study found that even brief treatments based on DBT can reduce symptoms and improve functioning. It may be cost-effective among individuals who self-harm.
Interested in providing DBT? For existing therapists, there are a variety of training and certification options. The DBT-Linehan Board of Certification has information on the certification process.
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