Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) was developed by Marsha Linehan, Ph.D., ABPP, in response to the great need for effective treatment for people suffering from chronic suicidality, self harm, emotion dysregulation, and instability of the self.  Through an evidence-based approach, Dr. Linehan methodically developed an adaptive and comprehensive treatment for Borderline Personality disorder.  Dr. Linehan and her associates continue ongoing research to modify DBT to maintain superior effectiveness and expand DBT to treat complex diagnoses and psychological needs including substance use, trauma, eating disorders, mood disorders, and family conflict.

DBT is built upon a cognitive behavioral foundation, that focuses on the present moment to address distorted and ineffective cognition and thoughts processes, reduce and eliminate problematic or harmful behavior, build and refine effective coping skills.  In addition, DBT incorporates principles of dialectics, that reality exists within the tension of opposing relationships and the synthesis of seemingly polarized ideas manifests new ways of being.  Dialectics brings an innovative and adaptive modality to DBT, to allow and encourage exploration of extremes in an effort to dissolve the rigidity in thinking and being that often keeps people stuck in harmful patterns.

“The awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment.” – Jon Kabat-Zinn

Mindfulness is another foundational principle and practice brought into DBT.  Mindfulness skills build a daily practice of centering the self, purposeful awareness to each moment, in order to rebuild and repair the relationship with the self and our wise mind. Mindfulness also teaches us to effectively select our thoughts and behaviors that are in line with our values and goals.

DBT is most often applied to treat chronic emotion dysregulation, ongoing and pervasive emotional experiences that are overwhelming, expansive, and cause impulsive and potentially harmful behaviors.  This chronic experience is often borne from a natural and biological sensitivity to emotions and exposure to a deeply and consistently invalidating environment. The transaction between these environments and emotion sensitivity can lead to inability to self soothe and cope with emotions, continually overwhelming emotional experiences that take a long time to resolve, and volatile relationships.To address the unique needs of sensitivity and invalidation, DBT incorporates a number of interventions to create a comprehensive treatment.  These include concrete skill building and skills practice, and individual therapy to identify cause and effect of thoughts, feelings and behaviors.

Of note is the role phone coaching plays in effective DBT.  Phone coaching is the opportunity for clients to call their therapist as a “coach” to get assistance in using skills out in their world – home, work, relationships, when and where they are really needed.  Phone coaching is a valuable contributor to the effectiveness of DBT.

Comprehensive and adherent DBT requires that treatment include the following interventions: individual therapy, phone coaching, skill building, and team consultation for therapists.  Many outpatient and private practice providers offer DBT-informed treatment, which can include any of the interventions, but not all.

In my practice, I provide DBT-informed treatment that includes individual therapy, phone coaching, and skill building.  Please ask me any questions or discuss any thoughts or needs you might have about this approach.

For more information please refer to these resources:

The Linehan Institute   http://www.linehaninstitute.org/index.php

Behavioral Tech   http://behavioraltech.org

 

Kelsey J. Harper, Psy.D. Licensed Psychologist PSY26415