My psychiatrist has suggested several times that I find a practitioner of Dialectical Behavior Therapy (DBT). I was vaguely familiar with what DBT was, and knew that it was originally developed to help people with Borderline Personality Disorder (BPD). I’ll talk about how I don’t like the name “personality disorder” in a later post. I wanted to learn more about this form of therapy, so I did some research.
I learned that though DBT was originally created to help those with BPD, it has also since been proven to help in treating other disorders, such as depression, post-traumatic stress disorder (PTSD), and eating disorders. Dialectical, means integration of opposites – the practitioner accepts who the client is while acknowledging the need for change. DBT is a combination of cognitive behavioral therapy (CBT) and Buddhist practices (such as mindfulness). To learn more about CBT, read my post about it here.
I noticed a trend of lists of four items in DBT, as you will see below.
There are four components to DBT: DBT skills training, DBT individual therapy, DBT phone coaching, and DBT therapist consulting.
- DBT skills training is run like a class. A group meets weekly for two and a half hours, for 24 weeks. This is often repeated for one year.
- DBT individual therapy runs concurrently with the DBT skills training. This helps clients with motivation, and in applying skills, on an individual basis.
- DBT phone coaching provides in the moment coaching to clients, allowing them to call their therapist between sessions, during a difficult moment.
- DBT therapist consultation team provides the therapist with support from other DBT practitioners. This is an important part of DBT, because the types of clients who benefit from DBT can be very draining on a practitioner, and can cause burn-out fairly quickly if the therapist does not engage in self-care and group support.
DBT has four main goals, and prioritizes them as follows:
- Life threatening behaviors – DBT first addresses suicidal and self-injurious behaviors, which include self-harm (such as cutting), as well as dangerous levels of substance use.
- Therapy-interfering behaviors are addressed next. These behaviors can be on the part of either the practitioner or the client and include behaviors such as being late to appointment, or frequently canceling appointments.
- Quality of life behaviors are the third goal which is prioritized. This addresses any other behavior that affects the quality of life for the client.
- The last goal is skills acquisition – which means to replace ineffective behaviors with new skillful behaviors to help achieve goals.
The stages of DBT are also in four parts.
- In the first stage, the client is miserable and their harmful behavior is out of control (e.g. suicide attempts, drugs, or self-harm).
- In the second stage, the client is living a life of quiet desperation.
- The third stage is when the client learns to live. They can now define life goals, build self-respect, and find peace and happiness.
- The fourth stage is needed by some people – and it involves finding a deeper meaning through a spiritual existence.
This is a very basic summary of DBT, and if you want to learn more, I recommend the sources listed below.