Dialectical Behavioral Therapy
Dialectical Behavioral Therapy (DBT) is an intensive outpatient treatment program with its foundations in cognitive behavioral therapy. It is designed to help people with histories of chronic suicide attempts, suicidal ideation, urges to self-harm and patterns of self-harming behaviors. The goal of treatment is to guide and support people in mastering the skills and attitudes to build a “life worth living.”– founder Marsha Linehan, 1992.
DBT assumes that all behaviors are choices and these choices have the function of solving problems in our lives. Sometimes the way we work to solve our problems is helpful. Other times, our choices can actually make things worse. Sometimes in solving one problem, we create another. Our choices can lead to misery, and perhaps, a life we might think is not worth living.
For most of us, the way we solve our problems today has a lot to do with ‘what worked’ at another time in life. As our situations and responsibilities change, we can find that what once worked isn’t really helpful anymore.
In DBT, we believe that we all are doing the best we can and have done the best we could to this point, AND, with a new day and new information, we can do better.
Because DBT is a ‘problem solving’ focused treatment, it is designed to teach and support new ways of responding to the issues of life: ways that are more helpful, ways that may actually solve the problems.
Individuals who may benefit from DBT include adolescents 14 years of age through high school and adults who (1) may have been diagnosed with Borderline Personality Disorder or (2) are experiencing some of the following:
- Chronic suicidal thoughts
- Multiple suicidal attempts
- Self-mutilation such as cutting, burning, piercing for the experience of the piercing
- Disordered eating; weight and body image issues
- Serial problematic relationships
- Alcohol and other drug use (after a period of sobriety)
- Isolation and chronic feeling of emptiness
- Emotional and behavioral distress related to issues of chronic pain
DBT may also be a benefit for individuals whose treatment to this point (individual outpatient therapy, psychiatric hospitalizations, residential treatment programs, substance abuse treatment, etc.) has not been as effective as desired.
DBT is an inclusive program of treatment made up of:
DBT Skills Group
- Clients are expected to attend each weekly meeting of the 24 week DBT Skills Group (20 for Adolescents).
- The Adolescent Skills Group requires a parent or guardian to participate as well.
- Most clients complete two courses of the 24 week skills group over one year of intensive treatment.
- Each week, new skills are learned in a classroom setting and then practiced throughout the week as home based assignments.
Clients are expected to attend individual therapy at least bi-monthly, with a DBT primary therapist who is a member of the Pine Rest DBT treatment team.
- The purpose of DBT individual therapy is to learn to apply the skills learned to the client’s specific situation.
- The therapist is considered the “primary provider” for the client and coordinates care across the treatment team.
- Clients are expected to call the 24/7 DBT coaching line for skills coaching before engaging in any self-harm behavior, for support in problem solving and to celebrate effective choices.
- The primary therapist is expected to authorize any decision to seek psychiatric hospitalization.
In DBT, the client and the therapist will make agreements and work hard to keep these agreements. This forms the foundation of your therapy relationship. When people stay true to their agreements, over time, their experience of their lives gets better.
The DBT client agrees to:
- Enter and stay in treatment for the agreed upon time.
- Come to all therapy sessions (even when you don’t feel like it!)
- Stay alive. You can’t be in treatment if you aren’t alive…..and there are many things that could put you at risk of not being alive. You will work with your therapist to identify these things.
- Work on the issues that might get in the way of the therapy being effective…maybe some of the same things that have made it hard to stay in treatment in the past.
- Go to DBT Skills Training meetings.
- Be responsible for payment of your treatment.
Your therapist will agree to:
- Make every reasonable effort to be effective in delivering DBT treatment
- Act ethically
- Be available (within the agreed upon boundaries)
- Respect you
- Keep confidentiality (except in emergency situations – will be discussed)
- Seek consultation from the treatment team and other resources when necessary
“I feel like I have more control over where I place my attention. I’ve been able to stand up for myself, let the negative things go and hold on to the positive things in my life.”
“The most positive changes I’ve noticed in my life since beginning DBT have been decreased impulsive behaviors and increased control over my attention/focus and emotions. I used to think that it wasn’t possible to control my emotions. I let them control me.”
“In my own experience, looking back, I have had a lot of therapy. DBT is the one that has made the difference for a happier, stable life. It works.”
“Where do I begin? I am a whole new person. I have learned to accept things as they are (more often than not). It sure does make life a whole lot easier. I have learned so many skills to handle life when things are very unstable or emotional or stressful. I have learned how and when to ask for what I need. I have learned to ask for help and that it is okay to ask.”
“I feel more in control of my life instead of life just happening to me. I have learned ways to change my experience of life by using DBT skills such as Distress Tolerance, Mindfulness, willingness and acceptance, and emotional experiencing. I believe that life isn’t as likely to get out of control or that I’m just going to have to be sad because I can choose thoughts and actions that positively affect my life.”
“If you work hard and work the program, your quality of life will improve. It works!”