An Introduction to DBT
Dialectical Behavioral Therapy might sound like a mouthful, but the reality is actually pretty simple. DBT is an extension of Cognitive Behavioral Therapy that teaches skills for mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation. DBT basically lists a selection of skills to use either habitually or during particularly emotional times, which the consumer memorizes.
Mindfulness forms the basis of the practice, serving as a way to slow down a rushing mind to focus on external realities and what is happening in the present moment.
The “dialectical” part in the name refers to the therapy’s emphasis on reconciling extremes and proving to consumers that two seemingly incompatible things can be true at the same time. My favorite dialectical statement is the tattoo-worthy “I am doing my best and I can do better,” but other great ones include “I can accept the moment and also change my circumstances” and “I am independent and I also want help.”
While it was designed for people with Borderline Personality Disorder, DBT is great for anyone with extreme emotions, black-and white thinking, or problems with impulsivity– and that is many of us.
I’m a big fan of DBT because the more I learn and apply the skills, the more in control I feel. Instead of feeling helpless to the whims of my own messed-up brain or the people around me, I have the skills and abilities to calm myself down out of crises and deal effectively with interpersonal interactions.
The Creation of DBT
DBT’s creator, Marsha M. Linehan, is a personal hero of mine. She developed DBT after her own struggles with BPD, which at the time (before the 1980 creation of the BPD diagnosis) was pegged as schizophrenia and treated with electroshock therapy.
After a period of hospitalization in her late teens, she got a psychology degree and went on to work with suicidal patients in Buffalo, New York. This experience helped her formulate an evidence-based program to help those whose behavior seems out of control.
Unfortunately, many of the people who could benefit from DBT have never heard of it. It’s not a particularly common course of action for consumers that haven’t been diagnosed with BPD and done inpatient treatment. Why is that?
Why DBT is Under-Utilized
Here are some reasons that DBT is often passed over as an option for treatment:
The unfortunate stigma against Borderline Personality Disorder. Both anecdotal evidence and hard data show that mental health professionals take issue with people with a BPD diagnosis and might believe them to be untreatable or, at the very least, particularly difficult. A whole other post could be written about BPD stigma, but for now let it suffice to say that professionals are hesitant to suggest a treatment normally reserved for these mental health untouchables.
The inaccessibility of training programs. DBT education for professionals is rare, often lasting multiple days and requiring travel. My counselor, for example, has been convinced to jump on the DBT train, but because she hasn’t done the sporadically-available program, she can’t use it professionally.
The group format. DBT is traditionally administered in a classroom-like group setting, in which skills are explained and practiced, and then homework is assigned. Usually, the only people who have time for these sorts of classes are on a break from work and/or school.
The classroom may (or may not) be the best environment for learning DBT skills, but professionals and consumers also have the option of applying DBT concepts outside of these programs. My own study of DBT has been independent, and while I believe I might have an easier time remembering the skills after a dedicated class, I have nonetheless made great strides.
It’s a relatively new type of therapy. DBT was only created in the 1980s, meaning that many of the professionals who are practicing now might have missed out on its slow introduction to the mainstream.
If you’re interested in DBT, stay tuned for more posts on applying the skills in your own life!