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What is Dialectical Behavior Therapy?
Dialectical Behavior Therapy (often abbreviated DBT) is a specific type of psychotherapy based on the principles of Cognitive Behavioral Therapy, originally developed to treat individuals who were suicidal or had very serious psychopathology. Over time, DBT has become the frontline treatment for borderline personality disorder, which is one of the most severe forms of psychopathology, and people with this diagnosis are notoriously difficult patients. DBT has also been refined to be used in a number of other treatment contexts and for a number of other issues.
It is important when discussing DBT to recognize the technique’s founder and developer, Dr. Marsha M. Linehan. Dr. Linehan embraced a number of different modes of thought when developing DBT.
The development of DBT occurred as a response to the difficulties therapists encountered when working with individuals who were actively suicidal. These very distressed individuals were at the point of killing themselves because they had come to the conclusion that they did not have the ability to deal with whatever problem made their lives stressful and intolerable. Therapists attempting to treat these people would try and get them to change their beliefs, and these individuals would either become very resistant, drop out of therapy, or become aggressive.
When therapists tried the opposite approach, trying to get these people to accept their feelings as opposed to trying to change them, these clients accused the therapist of being insensitive and not understanding their feelings. Again, clients would become distant, drop out of therapy, or even become aggressive toward the therapist. Therapists working with these individuals believed that they were in a no-win situation.
DBT was developed in an attempt to deal with this type of no-win situation by bringing together these two opposite viewpoints together, such that individuals could change their behaviors and at the same time still perceive reality as harsh and unfair.
The overall aims DBT attempts to fulfill during treatment can be described by three different objectives:
In DBT, the therapeutic alliance is considered to be the main mechanism of change, and the therapeutic alliance is fostered by the client’s support system outside the therapeutic environment. This means that therapists also recruit aspects of the client’s family, friends, and other supports to assist the client in making needed changes.
The therapist concentrates on improving several basic areas:
Often, individuals entering therapy will choose between becoming involved in individual or group therapy sessions. In many instances, individuals participate in both. DBT typically requires that a comprehensive approach be implemented using all aspects of therapy.
Even though there is quite a bit of literature on DBT, the practice requires very specific training as well as long-term supervision from a certified DBT therapist before therapists can employ these techniques. Only licensed therapists, such as counselors, psychologists, and social workers, are qualified to receive specific training in DBT, and not every one of them will be qualified to deliver the technique. DBT cannot be learned from reading a few articles or books, but requires actual hands-on supervision from a qualified DBT therapist who is trained in the technique.
DBT was initially developed to be used in the treatment of very serious forms of psychopathology. Because it is intense and requires quite a bit of participation, some individuals may not be appropriate for DBT. For example, individuals are expected to attend weekly group and individual therapy sessions, and this will typically require approximately 2.5 hours of therapy per week. Therapy sessions are typically one hour, and group sessions are typically 90 minutes in length.
Aside from the commitment issue, DBT can be applied to a number of different situations, and there is research to indicate that it is effective for various problems, including for individuals who are not normally considered to be good therapy candidates, such as individuals with bipolar disorder. In these cases, DBT is often used to develop motivation for the person to comply with medical treatment (e.g., individuals with bipolar disorder requiring regular use of medications). Individuals who are actively psychotic or who have significant cognitive limitations will have difficulty benefiting from DBT due to its reliance on cognitive-behavioral principles.
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