Dialectical Behavior Therapy

Marsha M. Linehan, developer of dialectical behavior therapy (DBT), originally set out to address the needs of women with histories of suicidal ideation, suicide attempts, or tendencies to self-harm through her training as a behaviorist. However, she discovered that in reality she was treating people who were symptomatic of Borderline Personality (BPD). Dialectical behavior therapy (DBT) is founded on the belief that environmental and biological factors that remain undetermined cause some people to respond to emotional states more quickly, and sustain a heightened emotional affect for an extended period of time before they return to baseline. This discovery gives credence to the symptoms of BPD which include lives fraught with crisis and severely shifting emotional peaks and valleys. DBT helps these people learn coping techniques that they did not receive in their invalidated childhoods.

Five Core Criterion of Dialectical Behavior Therapy

According to Linehan, the core criterion that must be met for comprehensive psychotherapy to be valid encompasses five factors. It is essential that the therapy:

  1. Expands and sustains the motivation the client possess to facilitate transformation
  2. Provides opportunity for the client’s skills to be further developed
  3. Assimilates the client’s new skill set to be applicable in multiple relevant situations and circumstances
  4. Develops the therapist’s own abilities while increasing the therapist’s desire to effectively and willingly treat people
  5. Provides a nonjudgmental and secure environment in which the healing process can occur

Team Structure of Dialectical Behavior Therapy

Skills are learned and developed through an integrated system of group therapy, phone contact, in vivo coaching, and additional at home tasks. In order to maintain the enthusiasm and focus of the therapist, regular consultations are required for teams of clinicians. The team structure provides feedback to the therapist and gives a foundation of support to ensure the therapist maintains the most beneficial course of action. In fact, the criteria for this treatment is not met unless a weekly DBT meeting is held. Lastly, the therapy structure can be designed to be inclusive of family members as a method of measuring progress and responses in the home environment.

DBT Stages and Goals

DBT utilizes a system of stages and target goals to ensure that it does not fall victim to treating present issues only. In addition, DBT uses a progression system that focuses on the most prevalent issues first, such as injurious or harmful conditions, and then reverts to the less pressing issues in order of relevancy to the continuation of treatment. Behavior patterns that negatively impact the client’s life, development of coping skills and other extenuating issues are addressed once the primary risk factors have been worked on. Ultimately, the therapist focuses first on sustaining life, secondly on sustaining therapy, and thirdly on providing the resources and tools to effect a positive change in the client’s life.

Resources Related to 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.

Therapist Resources


Last updated: 07-02-2015

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