What is Dialectical Behavior Therapy?

Dialectical behavior therapy is evidence-based psychotherapy used to treat various mental health conditions, including mood disorders, suicidal ideation, and more.

In this article, we’re taking a closer look at a common question we hear from people – what is dialectical behavior therapy?

What is Dialectical Behavior Therapy?

Dialectical Behavioral Therapy (DBT) is a form of cognitive behavioral therapy designed to assist a person to adjust to life the way it is while simultaneously finding ways to make it better. The root word, dialectic, refers to finding truth through examining and challenging perceptions of reality, often through assimilating opposite ideas.

While that concept may sound esoteric, the application of DBT is very down-to-earth and easy to integrate into daily life.

Originally developed for treating the needs of suicidal clients and those diagnosed with Borderline Personality Disorder, DBT has since been recognized as an effective treatment for multiple mental health disorders.

Those suffering from anxiety, trauma, depression, and ADHD can all benefit from learning to apply the techniques encompassed within the therapy. The overall focus of DBT is on developing the skills necessary for living a more fulfilling and effective life, which is something that all people can aspire to.

So, what is dialectical behavior therapy?

Background of Dialectical Behavioral Therapy

The concept of Dialectical Behavioral Therapy was developed, during the 1970s, by Dr. Marsha Linehan. Dr. Linehan was doing work with clients who were suicidal.

She found that neither the cerebral approach of behavioral therapies nor the emotional approach of humanistic therapies was working to relieve the inner turmoil of this vulnerable population. The solution, she found, was an approach that addressed both the dysfunctional behaviors and the emotional dysregulation which plagued her clients.

Dr. Linehan found that a fluid technique of moving back and forth between the focus of behaviorism and humanism produced the lasting change people sought. Thus, the concept of DBT was born.

Core Attributes of Dialectical Behavioral Therapy

Central to the mechanism behind DBT is the concept that a person can simultaneously bear responsibility – and no responsibility – for the life circumstances that have developed up to this point.

Historically, people with mental health disorders have been blamed for their conditions, and all of the responsibility for change has been placed on their shoulders. This burden of blame tends to be counterproductive when making positive changes.

People who feel guilt for their perceived inadequacies can have difficulty finding the inspiration to do better. Similarly, blaming others for our problems does little to improve our circumstances.

To alleviate this hindrance of blame in personal growth, DBT therapy develops a foundation where a person can begin to separate the things that can be controlled and those that cannot.

The process of distinguishing the difference is known as Radical Acceptance. With Radical Acceptance, we learn to accept ourselves and our lives for how they are. We also recognize the areas of our lives that we have the ability to change for the better.

The development of healthy personal boundaries is ongoing work within DBT treatment. Human beings are social creatures, meaning we rely on our connections with others to survive.

For those with mental health disorders, it is often the case that the healthy lines between self and others have been blurred.

Establishing social boundaries that protect ourselves from becoming overly vulnerable while also practicing discretion regarding whom we allow into our intimate circle creates the conditions for establishing and nurturing healthy relationships.

Another attribute of DBT which distinguishes it from other forms of therapy is the concept of a Wise Mind.

As previously noted, the clients that Dr. Linehan worked with had difficulty accepting rational information without reacting emotionally. Human beings are both rational and emotional creatures, so the need to balance these two motivators became apparent.

Rather than seeking to deny or prefer one attribute over the other, a person with Wise Mind learns to accept both the rational and the emotional as reality. Then, the task is to decide on a balanced approach to the situation.

To accomplish these mental and emotional states of self-compassion, acceptance of reality, and application of wisdom, the practice of mindfulness is central to DBT.

While the definitions of what mindfulness consists of can vary, it is generally considered an adaptation of Eastern meditation practices. Rather than it requiring that practitioners seclude themselves and maintain a contortionist pose, however, mindfulness is practiced on the fly.

It is essentially a state of self-awareness that consists of acknowledging and accepting our thoughts and feelings as they come without feeling the need to act on them. This state of mindfulness provides the space necessary for making decisions that come from a place of balance.

Structure of Dialectical Behavioral Therapy

Due to the extensive training involved with restructuring perspectives to adopt DBT interventions, the therapy is intense. Participants are typically signed on for a year of treatment or longer. Sessions involve group therapy, individual therapy, peer meetings, and phone coaching.

There is also a heavy dose of homework, by which a person will learn to apply the skills learned during sessions to real-world scenarios.

An initial interview for acceptance into a DBT program will assess a person’s level of commitment to the process. An individual unwilling to commit a significant portion of time and energy to therapy and homework is not likely to continue with the program or reap the benefits.

Once accepted into the cohort, a safety contract is established. With this contract, the participant agrees to put aside any actions of self-harm or suicidal intent while in the program.

Official DBT is only delivered by those who have undergone the specific training and certification developed and approved by Dr. Linehan herself.

Due to the practical and effective approaches within the model, however, many clinicians employ pieces of DBT treatment when interacting with clients outside the official program.

Clinicians who use techniques recognized as a proprietary part of DBT treatment can preface the adoption by identifying that they are teaching DBT-like skills to their clients.