Dialectical behavioral therapy
From Drug Rehab Wiki
Dialectical behavior therapy, often referred to as DBT for short, is a derivative of cognitive behavioral therapy (CBT). Dr. Marsh Linehan of the University of Washington in Seattle first developed the therapy in the late 1970s. Like many clinicians, she recognized the ineffectiveness of traditional therapy models, including regular CBT, for the treatment of individuals with Borderline Personality Disorder (BPD).
People with BPD, due to the nature of the disorder, are typically particularly challenging to treat. They are high users of both inpatient and outpatient mental health services, yet rarely seem to benefit from most types of treatment. They are often inconsistent in their attendance of therapy sessions and frequently place significant demands on their providers, taxing them emotionally over time. Additionally, they notoriously engage in self-mutilation and suicidal behavior, making them very high risk patients.
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Primary Focus of DBT
DBT focuses primarily on helping patients accomplish three things:
• Learn effective coping skills
• Learn how to regulate emotions
• Learn how to have more successful interpersonal relationships
While many people have deficiencies in one or more of these areas, individuals with BPD have significant struggles in all three areas. They have poor emotional regulation, frequently experiencing significant mood fluctuations. Their ability to cope with normal life stressors is severely impaired, and they have a long history of unstable relationships.
Dialectical Premise
According to the website en.wiktionary.org, the definition of dialectics is “a systematic method of argument that attempts to resolve the contradictions in opposing views or ideas”.
To say it another way: you can’t really understand one thing (e.g. darkness) without understanding its complete polar opposite (i.e. light). In DBT, the two polar opposites are client self-acceptance (as well as therapist acceptance of the client) and the need for change. (This is a bit of an over-simplification as a thorough explanation is beyond the scope of this article.) By integrating these opposites – i.e., validating the client while at the same time recognizing his or her need to make significant changes to live a healthier and happier life - a positive outcome can be reached.
For individuals with BPD, other types of therapy, such as traditional CBT, are often distressing because they end up feeling invalidated. In DBT, Linehan stresses the need for client validation so the client will be more likely to stick with the treatment process, and also so treatment is less distressing as they work on their issues.
In DBT, the therapists acknowledges that the client’s maladaptive behavior is understandable considering his or her experience in life; but the therapist doesn’t necessarily condone the behavior and works with the client to learn more adaptive ways of handling difficult situations or painful emotions.
DBT Treatment Process Essentials
DBT is very structured, and unlike most other types of psychotherapy, it consists of 4 different elements, each of which plays an essential role in making this type of therapy effective:
1. Regularly scheduled individual therapy sessions
2. Phone coaching sessions – clients are instructed to phone their therapist if they are fighting the urge to harm themselves in any way
3. Weekly team meetings for therapists – these consultation meetings are crucial because they help the therapists feel supported while they are working with very difficult clients, and also makes them less likely to get burned out in the process
4. Weekly group sessions focusing on skills training – these sessions are highly structured. 4 vital skill areas are covered in the following order:
• Core mindfulness
• Interpersonal effectiveness
• Emotion modulation
• Distress tolerance
Research on DBT Effectiveness
Numerous controlled studies have successfully shown the effectiveness of DBT. It is now being used in the treatment of other types of psychiatric groups, including individuals with substance abuse disorders and eating disorders (both of which also involve behaviors which are self-destructive), and also bipolar disorder.
Article by Dr. Cheryl Lane. Dr. Cheryl Lane obtained her doctorate in clinical psychology from George Fox University in 1996. She has nearly 15 years experience in the mental health field, including inpatient psychiatric, community mental health and private practice. She spent several of those years in a busy hospital ER doing evaluations of both acute psychiatric and substance abuse patients for the ER physicians.
