An Introduction To Dialectical Therapy

Dialectical Behavioral Therapy, or DBT, is a therapeutic treatment developed by Dr. Marsha Linehan for suicidal individuals. Since its beginnings, research continues to point to how effective it is, for treating a multiple of behavioral issues- not just suicidal thoughts. It’s one of the most effective treatment protocols out there. If you browse the self-help section of your bookstore, you’ll find a variety of DBT literature at your disposal. If you want a quick DBT overview or, if you are considering finding a certified DBT therapist, pay attention, this post is for you.

In A Nutshell

The hallmarks of DBT include behavioral science, mindfulness and dialectical philosophy. So, DBT is behavior focused: it emphasizes behavioral skills or the introduction of new habits into daily routines. DBT recognizes mindfulness and the importance of being present to the moment. Unlike solution-based treatment models, which can emphasize goal-setting and future planning, DBT addresses the urges, emotions and difficulties of the present moment. Lastly, dialectical philosophy holds that the “extremes” or the “yin” and the “yang” are unavoidable: good cannot exist without bad, pain cannot exist without joy, courage cannot exist without fear, etc. Most dialectical therapists will endorse this way of seeing reality. The progression of dialectical behavioral therapy includes accepting both, and thereby taking a more balanced stance towards everything: the good, the bad, and the ugly. The dialectical therapist would then argue this is a holistic or more integrated way of coping with reality.

Who Benefits?

Frankly, I think all of us can benefit from DBT- whether diagnosed, undiagnosed, old, young, seeking therapy or not-DBT is a profound and powerful treatment. DBT is known to be most effective with individuals who struggle to cope with strong emotion. You might read the phrase: “emotional regulation” when learning about DBT. If someone regulates emotions effectively he/she is able to take things in stride and is not consumed, for example, by difficult emotions like self-hatred or despair. Unmanageable and “large” emotions like these often take on the form of impulsive or compulsive behavior like substance use or disordered eating behavior (bingeing, purging restricting). If you, or someone you love has been diagnosed with an eating disorder, substance use disorder or a personality disorder DBT may be a step in the right direction. If you haven’t been officially diagnosed but sense you may benefit from DBT ask yourself: Do you find yourself addicted to life’s “high’s” and unable to cope with the “low’s?” if the answer is even a vague yes, look into a therapist who provides DBT.

The Stages

Full-fledged DBT treatment involves four stages, most dedicated clients move through all four stages, others may only complete a few. In the first stage, the DBT therapist focuses on addressing the problematic behavior, i.e. the reason you came into therapy.

  1. Stage one is arguably intensive and can take a long time to address the area of concern and the emotions that go with it. Clients will learn how to tolerate or experience difficult emotions without “running” to the behaviors that masked them.
  2. In stage two clients explore with their DBT therapist some of their early-life experiences that may have contributed to their behaviors. Childhood trauma, emotional neglect and abandonment are widespread and it affects everyone differently. In this stage, clients explore how these issues may have affected them.
  3. Stage Three pulls together the skills, practice and insights clients have learned and helps develop an overall sense of self-respect and connection to the world.
  4. Lastly, Stage four, focuses on any sense of incompleteness and explores any spiritual beliefs that the client believes may round out his/her identity.

If DBT sounds like it would strike a chord with you, ask your therapist if they have knowledge of the treatment. As I mentioned earlier, some therapists are DBT certified, others simply incorporate DBT skills and intervention into more general treatment plans. Whether or not you pursue a certified DBT therapist may be a matter of how much depth and expertise you seek.

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