Talking Isn’t Enough – Explaining Dialectical Behavioral Therapy

Have you ever gone to therapy and felt like it …. didn’t do much?  I mean, it’s nice to be ‘heard’ and receive validation on your experiences and perspectives, but then what?  I’ve had so many clients come to me feeling a little jaded with therapy, telling me it ‘hasn’t quite helped’ and one of the common missing links people share with me are concrete ‘next steps’ to address the challenges they’re facing.  The ‘how to’ of managing emotions, thoughts, relationships and stressors.

There are MANY different therapeutic modalities, and one of the most common ones that you may have experienced is the ‘Rogerian Client-Centered’ approach where the clinician ‘follows’ the client and meets them where they are.  The client ‘leads the way’.  And while this piece is so critical in a therapeutic relationship, it often leaves out some concrete direction that is much needed.

Research has shown that in fact, just talking and processing through something isn’t always enough for actually moving forward and making needed changes.  And in cases of trauma treatment, processing trauma before having the skills to cope with the intense emotions that arise, can actually be harmful.  

There was a famous example back in 1964 (I know, I know…forever ago) called ‘The Gloria Films – 3 Approaches to Psychotherapy’.  This woman ‘Gloria’ saw 3 therapists with different styles and then commented on her experience of them.  While she said her session with Carl Rogers (famous for ‘Person Centered’ therapy, super chill and validating) was ‘nice’, she said she got more benefit from her session with Fritz Perls (famous for developing Gestalt therapy) who honestly kind of came across as a dick (No offense Perls).  His confrontative style, helped her actually gain some insights and ‘jump the track’ with needed breakthroughs.

OK, So What Is DBT?

If you follow me on Instagram or have been in my online ecosystem for very long, you know that I live and breathe Dialectical Behavioral Therapy (DBT), which I’ve been Linehan Board Certified in providing.  Not only is it  embedded in all the work I do with clients, it’s also something I personally practice, so today we’re gonna dive into what Dialectical Behavioral Therapy is.

DBT was originally established by Marsha Linehan in 1993, after her attempts to use standard Cognitive Behavioral Therapy (How thoughts impact emotions and behaviors) was ineffective with the women she was working with.  Linehan had her own history of mental health challenges including self-harm and suicidality, and was on a mission to help others with similar challenges.

DBT is all about developing a philosophical orientation and concrete skillsets that are going to make real changes in your life.  And before I dive into the deets of who/what DBT was originally developed for, I’ve got to tell you that over my career every single one of my peers (mental health clinicians) that has gone through DBT training and provide this model of treatment has said the same thing – It has drastically transformed their own lives as well.  It is something that, once you learn it, you use it personally forever.

I like to call it, ‘How to be a human’. 

Growing up we aren’t often taught things like how to cope with emotional responses, how to tolerate discomfort, how to be interpersonally effective – and this is where DBT comes in.  It catches us up on socio-emotional tools that we may have missed out on.  This is also what has led me to creating my online courses ‘A Guide To Taming Anxiety’ and ‘Mindful Soul School’ to provide this life changing info on a broader scale.  So let’s get into the specifics of DBT.

The Puzzle Pieces of DBT

A foundational concept that leads in DBT is the BioSocial Theory and how we become the way we are through upbringing (check out my blog post for a deeper dive into this).  It especially highlights the effect of an ‘Invalidating Social Environment’ on our development of a sense of self, worthiness and ability to cope with life’s challenges.

It is also based on traditional Behaviorism (rewards vs. punishment) and how to effectively change our unwanted behaviors (Watson, 1912 & Skinner, 1948).  I dive deeper into this in this blog)  These are WELL-ESTABLISHED modalities, and Linehan jokes that she ‘shamelessly stole’ (with permission of course) all the best psychological theory and packed it into DBT.

There is also a foundational teaching of the philosophy of Dialectics, which in short is ‘flexible thinking’.  Many of our problems as humans arise from ‘all or nothing’ thinking, which creates rigidity and polarized thinking and behavior patterns.  In fact, life is much more complex to be able to define solidly.  Dialectics practice helps us see the world and ourselves with more flexibility, which eases the process of problem solving and improves relationships (with ourselves AND others).  It gets us out of our narrow ‘ego based’ version of reality.

DBT is a ‘Skill Based’ program, and teaches four core skillsets.  It was the first therapeutic modality to formally teach Mindfulness practice, which originates in Buddhism and has ancient roots.  The Core Mindfulness skills teach us to pay attention ‘on purpose’ to our internal experiences and see our external world ‘as it is’.  It enhances positive emotions, helps us move through challenges with more ease, and decreases emotional suffering.  It is ‘turning the light on’ in our consciousness – a necessary ‘first step’.

The Core Mindfulness skills are followed by Distress Tolerance skills, which teach us how to be present with distress and pain that cannot be avoided.  Usually our efforts to avoid pain (through isolation, reactivity, escapism, addiction) only cause more problems.  These  ‘crisis survival’ skills are priceless.  It’s becoming the eye of the storm.

Emotion Regulation skills are the next set of tools that help you learn how to increase the emotions you like, and decrease the ones you don’t like.  It gives us a sense of control and mastery over our emotional experiences.  We are no longer a ‘passenger’ and instead we step into the driver’s seat.

Last but not least is taught the Interpersonal Effectiveness skills, which are a variation of assertiveness skills.  It may sound simplistic, but learning to get our needs met in effective ways is a HUGE part of being an adult.  How do we ask for what we want, or say ‘No’ to what we don’t want, in ways that don’t damage relationships or self-respect.   Let go of guilt-based, people pleasing, conflict avoiding patterns.  I told you DBT was packed with bomb stuff!

DBT in it’s full-model form (which not everyone needs) includes hourly individual therapy each week, as well as a weekly  ‘skill training session’ which includes homework and a weekly diary card.  As you can see, it actually builds use of tools that can impact your life while also including time to personalize your skill application during your individual therapy sessions.

Who Is It For?

While DBT was originally developed to treat Borderline Personality Disorder (characterized by frequent suicidal behaviors, problems with emotion regulation and intense relationship patterns), it has since been researched to be effective with a variety of mental health conditions.  And, as I mentioned earlier, I believe is valuable to every single one of us because guess what – none of us had perfect parents and we all live in a very invalidating society.  DBT has been shown to treat Bipolar Disorder, Post Traumatic Stress Disorder, Major Depression, Panic/Anxiety Disorders and more.

This form of therapy is my JAM and it’s largely what inspired me to create online courses that teach these invaluable skills at a broader level so that they are much more accessible.  Of course an online course does not substitute for a full-model treatment program, or therapy sessions if that is what’s needed, but they DO teach the exact same methods and tools that are taught within the program.  If you ever have any questions about DBT don’t hesitate to reach out!  I’m here to support you.