Dialectical Behavior Therapy

Dialectical Behavior Therapy was Developed by:  Marsha M. Linehan

Overview of Dialectical Behavior Therapy: "In the late 1970s, Marsha M. Linehan attempted to apply standard Cognitive Behavior Therapy (CBT) to the problems of adult women with histories of chronic suicide attempts, suicidal ideation, urges to self-harm, and self-mutilation. Trained as a behaviorist, she was interested in treating discrete behaviors; however, through consultation with colleagues, she concluded that she was treating women who met criteria for Borderline Personality (BPD).

DBT maintains that some people, due to invalidating environments during upbringing and due to biological factors as yet unknown, react abnormally to emotional stimulation. Their level of arousal goes up much more quickly, peaks at a higher level, and takes more time to return to baseline. This explains why people with Borderline Personality are known for crisis-strewn lives and extreme emotional lability (emotions that shift rapidly). Because of their past invalidation, people with Borderline Personality don't have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.

Briefly, Linehan hypothesizes that any comprehensive psychotherapy must meet five critical functions. The therapy must: a) enhance and maintain the client’s motivation to change; b) enhance the client’s capabilities; c) ensure that the client’s new capabilities are generalized to all relevant environments; d) enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities; and, e) structure the environment so that treatment can take place.

Skills are acquired, strengthened, and generalized through the combination of skills groups, phone coaching (clients are instructed to call therapists for coaching prior to engaging in self harm), in vivo coaching, and homework assignments.

Therapists’ capabilities are enhanced and burnout prevented through weekly consultation team meetings. The consultation team helps the therapist stay balanced in his or her approach to the client, while supporting and cheerleading the therapist in applying effective interventions. (In DBT, a therapist is not considered to be meeting the requirements of the treatment unless he or she meets weekly in a DBT consultation team).

Finally, the environment can be structured in a variety of ways, say by the client and therapist meeting with family members to ensure that the client is not being reinforced for maladaptive behaviors or punished for effective behaviors in the home.

DBT also organizes treatment into stages and targets and, with very few exceptions, adheres strictly to the order in which problems are addressed. The organization of the treatment into stages and targets prevents DBT being a treatment that, week after week, addresses the crisis of the moment. Further, it has a logical progression that first addresses behaviors that could lead to the client’s death, then behaviors that could lead to premature termination of therapy, to behaviors that destroy the quality of life, to the need for alternative skills. In other words, the first goal is to insure the client stays alive, so that the second goal (staying in therapy), results in meeting the third goal (building a better quality of life), partly through the acquisition of new behaviors (skills)." ~Excerpt from Behavioral Tech

Resources Related to Dialectical Behavior Therapy:

Official Website for Dialectical Behavior Therapy

DBT Self Help

DBT in a Nutshell by Dr. Marsha Linehan, PhD

Wikipedia's Page about Dialectical Behavior Therapy

There is a DBT skills discussion list at University of Washington. To subscribe, send mail to the listowner (Kieu) at busserv@u.washington.edu explaining your background and why you'd like to be on the list. It's intended to be a place to share experiences and get support while using DBT skills.

Books Related to Dialectical Behavior Therapy:

Dialectical Behavior Therapy Article Summaries