What Is Dialectical Behavior Therapy?

DBT is an evidence-based, comprehensive system of therapy created by Dr. Marsha Linehan, psychologist and researcher at the University of Washington. DBT aims to effectively treat people suffering from complex, chronic, emotional, and behavioral problems. DBT was originally developed to treat people meeting criteria for Borderline Personality Disorder; however, DBT is also proven to be highly effective in treating people suffering from life-threatening and quality-of-life-threatening behaviors including suicidality, self-harm, impulsive self-destructive behaviors, chaotic and volatile interpersonal relationships, anxiety and panic disorders, mood disorders, substance abuse problems, eating disorders, anger problems, and other severe mood and behavioral problems. DBT’s treatment philosophy aims primarily at helping each person find an effective balance or ‘synthesis’ between acceptance and change, while learning new and more effective ways to cope. DBT teaches people to live a Life Worth Living!

A primary hallmark of DBT is the use of both Change and Acceptance strategies within each session, frequently. Discovery of each client’s history, neurology/biology, historical experiences related to social interactions throughout the client’s life, and the resulting impact from these variables, define the process known as the Behavior Chain Analysis or BCA. DBT utilizes the BCA as a primary change strategy, serving to teach both client and clinician the functions of all behavior and thought patterns and emotional reactions experienced by the client to then create a new pattern of behavior designed to instill newly learned replacement behaviors and skills that lead to a Life Worth Living. By assisting each client in the process of decreasing ineffective, escape and/or avoidant behaviors while increasing skillful and goal-oriented behaviors, attaining Life Worth Living Goals truly becomes a reality. The DBT clinician and client work collaboratively together to identify times when tension arises in session and aim to use dialectical strategies while maintaining the DBT therapy agreements with an “open curiosity” and a “non-judgmental stance” at all times thus ensuring the health and genuineness of the therapy relationship while continuing the collaborative work involved in generating new solutions and syntheses when solutions aren’t found.

DBT’s philosophical underpinnings clearly emphasize the need for maintaining the stance called “radical genuineness” and the “non-judgmental stance.” The DBT clinician is someone who is real and doesn’t seek to hide or fake flaws, yet is someone open to discussions with their clients as to the impact of their own behavior on the client’s life, progress in therapy and the desire to remain in DBT. DBT philosophy aims to objectively perceive all behavior as just that, behavior. Instead of seeking to find the source of blame or judgment, the clinician demonstrates and teaches the client to eliminate judgment and blame when encountering interpersonal problems and DBT instead helps the client accurately perceive the contributing factors to the problem, and in turn, work to change what can be changed, accept what cannot be changed, while owning and repairing any damage done to the relationship in the service of modeling humility. DBT clinicians seek to model ways of finding new perspectives, challenge core thoughts, use exposure principles (formal and informal) and use problem solving methods to relentlessly find ways through problems once seen as unsolvable or incomprehensible.