- What Do You Believe Dialectical Behavioral Training Programs
- Dialectical Behavioral Therapy For Children
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Dialectical behavior therapy (DBT) provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas. First, mindfulness focuses on improving an individual's ability to accept and be present in the current moment. Second, distress tolerance is geared toward increasing a person’s tolerance of negative emotion, rather than trying to escape from it. Third, emotion regulation covers strategies to manage and change intense emotions that are causing problems in a person’s life. Fourth, interpersonal effectiveness consists of techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.
Dialectical Behavior Therapy Training Dialectical Behavior Therapy (DBT) is a well-researched, comprehensive treatment for people who have intense emotions they are unable to manage in constructive ways. Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat borderline personality disorder (also known as Emotional Instability Disorder). There is evidence that DBT can be useful in treating mood disorders, suicidal ideation, and for change in behavioral patterns such as self-harm, and substance abuse. Dialectical Behavior Therapy is a research-based, cognitive-behavioral treatment originally developed by Marsha Linehan at the University of Washington, to help clients with the suicidal and self-harm behaviors often seen in Borderline Personality Disorder. DBT has since then been modified as a treatment for other complex and challenging mental disorders that involve.
When It's Used
DBT was originally developed to treat borderline personality disorder. However, research shows that DBT has also been used successfully to treat people experiencing depression, bulimia, binge-eating, bipolar disorder, post-traumatic-stress disorder, and substance abuse. DBT skills are thought to have the capability of helping those who wish to improve their ability to regulate emotions, tolerate distress and negative emotion, be mindful and present in the given moment, and communicate and interact effectively with others.
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What to Expect
DBT treatment typically consists of individual therapy sessions and DBT skills groups. Individual therapy sessions consist of one-on-one contact with a trained therapist, ensuring that all therapeutic needs are being addressed. The individual therapist will help the patient stay motivated, apply the DBT skills within daily life, and address obstacles that might arise over the course of treatment.
DBT skills group participants learn and practice skills alongside others. Members of the group are encouraged to share their experiences and provide mutual support. Groups are led by one trained therapist teaching skills and leading exercises. The group members are then assigned homework, such as practicing mindfulness exercises. Each group session lasts approximately two hours, and groups typically meet weekly for six months. Groups can be shorter or longer, depending on the needs of the group members. DBT can be delivered by therapists in many ways. For instance, some people complete the one-on-one therapy sessions without attending the weekly skills group. Others might choose the group without regular one-on-one sessions.
How It Works
DBT is a cognitive-behavioral treatment developed by Marsha Linehan, Ph.D., in the 1980s to treat people with borderline personality disorder. Those diagnosed with BPD often experience extremely intense negative emotions that are difficult to manage. These intense and seemingly uncontrollable negative emotions are often experienced when the individual is interacting with others—friends, romantic partners, family members. People with borderline often experience a great deal of conflict in their relationships.
As its name suggests, DBT is influenced by the philosophical perspective of dialectics: balancing opposites. The therapist consistently works with the individual to find ways to hold two seemingly opposite perspectives at once, promoting balance and avoiding black and white—the all-or-nothing styles of thinking. In service of this balance, DBT promotes a both-and rather than an either-or outlook. The dialectic at the heart of DBT is acceptance and change.
What to Look for in a Dialectical Behavior Therapist
DBT assumes that effective treatment, including group skills training, must pay as much attention to the behavior and experience of providers working with clients as it does to clients’ behavior and experience. Thus, treatment of the providers is an important part of any DBT program, and therapists should practice the skills themselves. They need to know basic behavior therapy techniques and DBT treatment strategies. Look for a mental health professional with specialized training and experience in DBT. The Linehan Board of Certification, a non-profit organization, has developed certification standards for clinicians. In addition, it is important to find a therapist with whom you feel comfortable working.
References
Most people have never heard the word 'dialectical' when learning of Dialectical Behavior Therapy (DBT). When I first started studying DBT in graduate school, I remember thinking, “This must be a really complicated treatment, because I don’t know what dialectical even means.”
When I start DBT therapy groups or DBT trainings, I like to start with the question, “What does dialectical mean?” I often hear, “a discussion between two people,” “a dialogue,” “the way people talk, like the word dialect,” and finally “maybe something related to two things?” The last guess is the closest. Google and Wikipedia aren’t so helpful either; each defines dialectical with other big words!
Marsha Linehan, the creator of DBT, defines dialectical as a synthesis or integration of opposites. That’s kind of confusing, right? In simpler terms, dialectical means two opposing things being true at once. But even that is still kind of confusing!
Let’s break this down.
Think about someone you care about. Now, think of a time they upset you. Here’s an example from my own life. I love my brother dearly. He’s very busy, essentially working two full time jobs right now. I’ve been trying to reach him on the phone for weeks to ask him a simple question, and either he answers and has to go within a minute or doesn’t even pick up the phone. This really irks me. I care about my brother and think he’s great, AND him being hard to reach is something I don’t like about him. This is a dialectical situation. These two, seemingly opposing facts about the way I feel about my brother, are both true at the same time.
DBT is comprised of many dialectics, two simultaneous yet opposing truths. My favorite DBT dialectic? “I’m doing the best I can AND I want to be doing better.” This can apply to many situations. On the surface, doing the best I can and I want to do better seem quite opposite. Yet, I can imagine many times both can exist right next to each other in someone’s life. Have you ever seen a parent juggling a few kids out in public, and they just won’t all listen at once, so this parent gets angry? This parent is likely doing the best they can to manage their kids, given who the parent is, who their kids are, and the situation they are in. At the same time, I can imagine that parent wishing they had more resources, or that they did not get angry as quickly. That’s the want to be doing better part of the dialectic.
Notice when describing these dialectical situations I’m using the word AND, not BUT! That’s intentional. If I wrote, “I’m doing the best I can BUT I want to be doing better,” the first part of that sentence doesn’t matter anymore. You’re left only with I want to be doing better, and that’s not a dialectical statement.
What Do You Believe Dialectical Behavioral Training Programs
DBT as a whole is centered on one main, overarching dialectic: acceptance AND change. For the treatment to work, providers and patients need to balance the two strategies, not focusing too much on either side. There are some other key dialectics as well, that I’ll be mentioning later in this DBT 101 blog series.
Do you have a favorite dialectic or dialectical situation? Let us know!
Dialectical Behavioral Therapy For Children
Andrea Barrocas Gottlieb, PhD, is the DBT Program Coordinator at Sheppard Pratt. She completed her psychology internship and postdoctoral training at McLean Hospital/Harvard Medical School in Massachusetts, where she learned to implement Dialectical Behavior Therapy (DBT) with youth and adults. She has studied and published research on nonsuicidal self-injury and mood disorders in youth. Dr. Gottlieb helps Sheppard Pratt implement DBT more widely through program development and staff training.
What Do You Believe Dialectical Behavioral Training Reliaslearning
- Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy, Personality Disorders, Depression, LGBTQ+ Mental Health Issues, Nonsuicidal self-injury, Suicidal Thoughts and Behaviors