Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy (DBT), developed by Marsha Linehan, Ph.D., A.B.P.P., is a principle driven evidence based comprehensive cognitive-behavioral treatment. Although the strongest evidence exists for DBT as a treatment for people with Borderline Personality Disorder (BPD), DBT has been found to be effective for a wide variety of mental health conditions including Substance Use Disorder, depression, Bipolar Disorder, Cluster B Personality Disorders, Post-Traumatic Stress Disorder (PTSD), eating disorders, transdiagnostic emotion dysregulation, Attention-Deficit/Hyperactivity Disorder (ADHD), suicidal and self-harming adolescents, and pre-adolescent children with severe emotional and behavioral dysregulation.
Borderline Personality Disorder is a diagnosis that includes dysregulation of several areas: emotions, interpersonal, self, behaviors and cognition. Clients receiving DBT services may struggle with suicidal thoughts or behaviors, self-injurious thoughts or behaviors, impulsive behaviors that may be self-damaging (i.e., alcohol/drug use, binge eating, restricting food, purging, gambling, reckless driving, sexual behaviors), dissociating, anger issues, identity issues, a sense of emptiness, fears of abandonment, relationship problems and mood issues. It is common for individuals in DBT to also struggle with depression, anxiety, chemical dependency/abuse, and/or trauma related issues.
The goal of DBT is to create “a life worth living.” Clients work on identifying goals for what “a life worth living” would look like for them. Other goals include decreasing suicidal thoughts and behavior, decreasing self-injurious urges and behavior, reducing impulsivity, decreasing clinical symptoms such as depression, anxiety and anger, reducing frequency and duration of psychiatric hospitalizations, improving interpersonal effectiveness, increasing coping skills and increasing overall functioning.
Skills trainers and individual therapists encourage clients to consider a dialectical approach which includes balancing acceptance and change in the therapeutic process.
DBT includes core assumptions about treatment, clients and therapists with a focus on a non-judgmental stance.
DBT TREATMENT STAGES
DBT is divided into four stages of treatment. Stages are defined by the severity of the client’s behaviors and each stage has specific areas of focus and goals.
STAGE 1: The goal of Stage 1 is for the client to address behaviors that feel out of control and achieve behavioral control.
STAGE 2: The goal of Stage 2 is for the client to move from a state of quiet desperation to one of full emotional experiencing.
STAGE 3: Focuses on defining life goals, building self-respect, and finding peace and happiness. The goal is for the client to lead a life of ordinary happiness and unhappiness.
STAGE 4: This stage is for those clients who want to work on finding a deeper meaning, a sense of connectedness of a greater whole. In this stage, the goal of treatment is for the client to move from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom.
TREATMENT DELIVERY
There are four primary modes of treatment delivery:
SKILLS GROUP
DBT skills training group is generally part of STAGE 1 and focuses on enhancing clients’ capabilities by teaching them behavioral skills. DBT clients attend a skills group weekly for about a year (some clients attend longer). Skills group is similar to taking a class and homework is assigned weekly. Clients learn and practice skills from four modules:
MINDFULNESS: Focuses on quality of attention and awareness.
DISTRESS TOLERANCE: Focuses on getting through a time of distress/crisis without doing anything to make the situation worse.
INTERPERSONAL EFFECTIVENESS: Focuses on initiating/maintaining/repairing relationships, effectively making requests and setting boundaries and increasing/maintaining self-respect.
EMOTION REGULATION: Focuses on decreasing emotional sensitivity/intensity, preventing unwanted emotions from starting and stopping or reducing unwanted emotions once they start.
INDIVIDUAL PSYCHOTHERAPY
In individual therapy, the therapist helps the client identify and work toward “life worth living” goals. DBT individual therapy is focused on enhancing client motivation and helping clients to apply skills to specific challenges and events in their lives. The therapist helps the client identify and address life-threatening behaviors, therapy interfering behaviors and quality of life interfering behaviors. Another area of focus is skills acquisition. Clients keep a diary card to monitor symptoms, behaviors and skills. The therapist and client use chain analyses and missing links (to address behaviors) and solution analyses (to identify skills that could be helpful in specific situations). Most clients continue with individual psychotherapy following the completion of skills group. Some clients choose to stay in individual psychotherapy through STAGE 4.
BETWEEN SESSION COACHING CALLS
The individual therapist is available for coaching calls outside of the session to help the client problem-solve barriers and generalize skills.
DBT CONSULTATION
Both skills trainers and individual therapists attend a weekly consultation meeting to gain support and consultation from their colleagues. The consultation team is designed to help therapists stay motivated and competent so they can provide the best treatment possible.
The DBT program at MCP is certified by the Minnesota Department of Human Services (DHS). MCP adheres to the DBT model created by Marsha Linehan, Ph.D., A.B.P.P.
Many of the clinicians who offer DBT services at MCP have been intensively trained through Behavioral Tech, LLC, an organization dedicated to teaching DBT following Dr. Marsha Linehan’s model.
The DBT services provided at MCP include:
Most types of insurance are accepted, as is private pay. Please contact your insurance company to determine your level of coverage.
For more information, to make a referral, or to request an assessment for our DBT program, contact us at 651-644-4100.
“You may encounter many defeats, but you must not be defeated.”