I want help for my problems, but I don’t want to feel judged for them.

I didn’t ask to have these mental health struggles. Why do people make me feel like they’re my fault?

I’m tired of people treating me like if I just tried harder, my mental health issues would go away.

If you’ve ever had thoughts like these before, then you understand what inspired Marsha Linehan to create Dialectical Behavior Therapy, known as DBT, in the late 80s.

While DBT has some similarities to CBT, which was discussed in “What is Client Centered Therapy”, it also has some points of departure that make it unique.

Q: What’s the difference between this and other kinds of therapies?

A: The most helpful way to understand the core principle of DBT is to unpack what the name actually means, sooooo…. time to dust out our knowledge of Greek roots! The prefix “di-“ gives us an idea that this therapy has to do with two of something occurring at the same time. In the case of DBT, those two things are acceptance and change. In other words, this therapy tries to put equal emphasis on accepting one’s self and on attempting to make positive changes. These two things might sound like they contradict each other, but one of the core ideas of DBT is that they don’t have to, that clients can learn how to change their behavior without feeling like their behavior makes them a fundamentally wrong or bad person.

Toward this end, DBT incorporates elements of CBT, such as helping patients to identify unhelpful, inaccurate thought processes (i.e. “No one will ever love me because I can’t get my emotions under control) and learn what triggers these thought processes in themselves and how they can start combating them. At the same time, though, DBT encourages thought patterns such as “distress tolerance,” as Psych Central explains. The emphasis here is on learning to bear with emotional pain rather than always deflecting it or trying to alleviate it.

Q: How do I know if I would benefit from DBT?

A: This is a particularly good question for DBT because DBT is generally not applied to as wide a spectrum of mental health issues as many other kinds of therapy.

Marsha Linehan originally developed DBT for clients with Borderline Personality Disorder. Since then, researchers have tried it with other kinds of mental health issues and have gotten positive results, but it’s still not really thought of as a kind of therapy that’s well-suited for just any client.

One of the major emphases in DBT is on the regulation of emotions. Practitioners of it take the view that some people (particularly people with BPD) “are born with a biologically hard-wired temperament or disposition toward emotion vulnerability,” according to Alexander L. Chapman, Ph.D. Champman says this means having “a relatively low threshold for responding to emotional stimuli, intense emotional responses, and difficulty returning to a baseline level of emotional arousal.” Therefore, one of the goals of DBT is to help clients learn how to regulate their intense emotional responses and reverse some of the psychological damage that may have been done by caregivers who treated such high emotions with neglect or punishment in the clients’ childhoods.

If this description of emotions doesn’t sound like it applies to you very much, then DBT might not be the therapy that would be most helpful for you. But for a list of kinds of mental health issues that DBT has been shown to work well with, take a look at the Linehan Institute’s FAQ page.

Q: What would happen in a typical session if I was being treated with DBT?

A: While many other types of therapy feature individual sessions with just a possibility or option of group sessions, DBT includes group sessions as a standard, necessary component.

Chapman writes, “The standard DBT treatment package consists of weekly individual therapy sessions (approximately 1 hour), a weekly group skills training session (approximately 1.5–2.5 hours), and a therapist consultation team meeting (approximately 1–2 hours).”

Like CBT, these sessions might involve “homework” of some nature, such as keeping a journal of what events were triggers for high emotional responses. The individual sessions take any self-injurious or suicidal thoughts/behaviors as their first priority but also involve working on any evident PTSD or general self-image issues that could use improvement. The group sessions include skills training in, as Psych Central explains, one of four different modules: “interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness.”

Q: What are the limitations or weaknesses of DBT?

A: Goodtherapy.org provides a helpful list of limitations that come along with DBT, most of which have to do with the fact that it’s a relatively young method, having just started in the 80s.

• Some critics say that more research needs to be done with larger sample sizes before DBT can be fully and completely trusted and legitimated.
• DBT takes quite a lot of training for therapists to be able to practice. Obviously, this isn’t a bad thing in itself – most clients would love to know that their therapist underwent extensive training! – but it does mean that a DBT-practicing therapist might be harder to find than some other kinds of therapists.
• Some critics say that post-treatment follow-up on trials of DBT should be more extensive and should check in with clients for a longer time after therapy to ensure that they’re still showing the improvements they showed during and shortly after the therapy.

As with all the other kinds of therapies discussed in this mini-series, remember that the most helpful thing you can do for yourself if you’re considering one of them is to talk to several therapists who practice it one-on-one to try to get a sense of whether or not it would be right for you.

Next up in the types of therapies mini-series: ACT, Acceptance and Commitment Therapy. Check back in to find out what it’s all about!

We hope this article helps demystify why therapy costs “so much” as you’re searching for support.  If you like what we have said and what we stand for, then please accept our invitation to schedule a free 20-minute Clarity Consult.  You can also reach us at (305) 501-0133.   We will gladly address your concerns, and point you in the right direction if we’re not a good fit for each other.