Dialectical Behavior Therapy: Dialogue & Truth

“I don’t know what else to do. My emotions are intense and all over the board – and the pain is unbearable. I hate myself and my life. Is it any wonder I want to die?”

What an awful way to live one’s life. Time was, therapeutic hope was tough to come by. Frankly, most counselors burned-out over such cases and didn’t want to take them.

No more – enter dialectical behavior therapy (DBT). Let’s chat some good news.

“What is DBT?”

DBT was developed by University of Washington Professor, and Clinical Psychologist, Marsha M. Linehan. It was designed to treat borderline personality disorder (BPD).

DBT is also effective in the treatment of – in psychobabble – the spectrum mood disorders. These are conditions that often accompany depression and bipolar disorder. Self-injury is but one example.

It’s also known to work well for sexual abuse survivors and chemical dependency clients.

What makes DBT unique is its combination of cognitive behavioral techniques – and techniques of mindfulness, distress tolerance, emotion regulation, and interpersonal problem solving.

“Dialectical? What’s That?”

The best way to begin to understand DBT is to establish a solid working definition of dialectic(al)

A method of argument for resolving a disagreement. It’s a dialogue between two or more people who stand-by different opinions on a particular subject. Bottom-line: no one cares who’s wrong or right. It’s about establishing truth through dialogue and reasoned arguments.

“How Did She Come-Up With DBT?”

Dr. Linehan recognized that chronically suicidal clients were typically raised in intensely dysfunctional and self-harmful environments. She believed it made sense to approach and work with such clients in a spirit of unconditional acceptance (they of themselves/counselor of client).

That’s the foundation of a powerful therapeutic alliance.

“How Does It Work?”

First and foremost, after accepting one’s emotional dysfunction – a commitment is made to self and the alliance. The next order of business is the therapist earning the client’s perception of her/him as an ally, not an opponent.

Within that context, the therapist accepts and validates the client’s feelings; however, shoots straight by telling the client when their feelings aren’t working in their best interest.

Of course, it’s the therapist’s responsibility to provide quality alternatives.

Read again the definition of dialectic. This is about an alliance of differing feelings and opinions formed to establish truth.

Individual Work

In one-on-one sessions, client and therapist discuss issues that came up during the previous week. The client recorded these on diary cards. And then it’s on to treating these matters in priority…

Suicidal and self-injurious behaviors, quality of life issues, and working toward improving one’s overall life.

By the way, this work is done individually so suicidal urges or uncontrolled emotional issues don’t disrupt group work.

Group Work

Typically once a week for some two hours, specific skills are taught and given a practice forum. It’s all about learning how to regulate emotions and behavior in a social context.

The Four Modules

Behind each and every bit of DBT-work are these four modules…

Mindfulness: The capacity to pay attention, non-judgmentally, to the present moment. Key is experiencing one’s emotions and senses fully, yet with perspective.  Mindfulness helps individuals accept and tolerate the powerful emotions they may feel when taking-on their habits or exposing themselves to upsetting situations.

Distress Tolerance: This isn’t a matter of changing distressing events and situations. No, it’s an issue of accepting, finding meaning in, and tolerating distress. DBT places emphasis upon learning to bear pain skillfully. One may not like or approve of their circumstances, but they’re real and present. The mission is to learn how to make prudent action-decisions.

Emotion Regulation: This is a task of identifying and labeling emotions and obstacles to change, reducing vulnerability, becoming aware and non-judgmental of self, and taking the opposite action of what first comes to mind.

Interpersonal Effectiveness: The work here is grounded in assertiveness and interpersonal problem solving. It’s all about learning how to ask for what one needs, saying no, and coping with interpersonal conflicts. Simply – developing the skills to change, or resist harmful change.

That Will Do It

There’s no way I could have gone into detail on every aspect of DBT. And that speaks well for Dr. Linehan’s pioneering work – and for those who have furthered it.

I’ve always been very impressed with DBT. It’s detailed, direct, logical, and compassionate. And it works for some very difficult situations!

That’s called hope.

Maybe you’re seeing a counselor and you’re just not progressing. Perhaps DBT is a fit. Ask her/him if they’re qualified to use it. If not, ask for a referral. Are you looking for a counselor? Ask about DBT?

Here’s a link to Dr. Linehan’s website: Behavioral Tech, LLC.

image thank you positivepsychologynews.com