Dialectical Behavior ❈ Therapy ❈

Founder

❈ Her own diagnosis of BPD & her experiences managing this disorder led to the development of DBT in the 1980s

❈ Earned her PhD from Loyola University Chicago, then went on to found many professional organizations

❈ The Linehan Institute, Behavioral Research & Therapy Clinics (UW), Behavioral Tech Research, DBT-Linehan Board of Certification

❈ Goal of these organizations is to provide effective services for a wide variety of complex MH issues (especially BPD)

Marsha Linehan

Basic Principles:

❈ Individuals are doing the best they can & want to improve 

❈ Individuals may not have caused their problems, but it is up to them to fix them anyways

❈ A balance exists between acceptance & change

❈ This supports clients in creating a meaningful &

satisfying life

❈ Clients are experiencing a dialectical conflict between themselves & their environment

❈ All behavior is functional & serves a purpose

❈ Strong, painful emotions & difficulty regulating these emotions cause psychopathology & problems in living

Based on a dialectical philosophy (a process of contradiction between opposing views), a biopsychosocial view of problems, & the integration of behavior therapy with Eastern beliefs & attitudes of mindfulness, acceptance, & compassion.

Goals of Counseling

❈ Support clients to accept their feelings

❈ Provide tools for emotion recognition & regulation

❈ Decrease emotional avoidance (through psychoeducation & exposure to upsetting situations & triggers)

❈ Understand & increase client motivation

❈ Help clients accept what cannot be changed

❈ Develop dialectical thinking

❈ Reduce suffering & increase tolerance of distress

❈ Improve relationships

Stages of DBT

Role of Counselor

❈ Work hard to understand the worldview of the client

❈ Validate the client's feelings

❈ Help clients consider alternative possibilities

❈ Help clients develop new strengths & teach skills so they can successfully interact in the world

❈ Collaborative, with constant attention to the therapeutic relationship

❈ The relationship between clients & therapists should be reciprocal

Therapeutic Process

❈ Pre-Treatment Stage: Orientation & commitment

❈ Stage 1: Reducing & eliminating life-threatening behaviors

❈ Stage 2: Experience emotions

❈ Stage 3: Work to accomplish goals

❈ Stage 4: Discover and engage in ways to feel complete

❈ Stages are not chronological & same issues may repeat

❈ If applied in a pure way, DBT is an intensive therapy model, with clients receiving at least 1 year of 1 hour weekly individual sessions and 2 hours of weekly group therapy

1. See the dialectic pole inherent in the problem

2. Consider all the options

3. Make a choice that leads toward change

Key Concepts & Skills

Validation & Problem-Solving form the core of DBT

Mindfulness

Interpersonal Effectiveness

Navigating relationships & asserting needs while maintaining respect for self and others

Distress Tolerance

Tolerating & responding to crisis without making things worse

Dialectics

the art of investigating the relative truth of principles, opinions, & guidelines

❈ Involves the belief that two things that appear opposing or contradicting can actually work together

❈ Within every person's story lines an alternative story (a dialectic pole)

The use of dialectics helps clients to...

❈ Develop a broader perspective of their problem

❈ Learn to look for the dialectic pole

❈ Consider more options & possibilities

❈ Get "unstuck" & develop a sense of efficacy & competence

Emotional

Regulation

the ability to respond to emotions in healthy ways

❈ Often involves reducing the intensity of negative emotions

❈ DBT helps clients to recognize how their attempts to deny, avoid, & escape strong emotions paradoxically make those emotions even more intense

❈ Emotional regulation increases the likelihood of understanding & processing through emotions more fully

Focusing on the present moment & being aware of thoughts, feelings, & sensations without judgment

Therapeutic Techniques

❈ Problem-Solving: behavior chain analysis, diary cards

❈ Distress Tolerance: Wise Mind ACCEPTS, self-soothing 5 sense, IMPROVE the moment, diary cards

❈ Interpersonal Effectiveness: expressing wants or saying no (DEAR MAN), keeping relationships (GIVE), keeping respect for self (FAST)

❈ Emotional Regulation: STOPP, opposite action, staying STRONG, diary cards

❈ Mindfulness: Wise Mind, breath work, diary cards

❈ Radical Acceptance: mantras & affirmations

Applications of DBT

LIMITATIONS

Multicultural Groups

✤ Marginalized individuals often face chronic stressors like discrimination or systemic inequities. Distress tolerance skills, such as radical acceptance, can help clients cope with these realities while maintaining agency and resilience

✤ Validation is particularly important for clients who experience marginalization. Recognizing and validating their lived experiences can build trust and reduce feelings of alienation

✤ Clients navigating acculturation stress can benefit from DBT’s emotion regulation and distress tolerance skills

✤ Certain activities for interpersonal effectiveness may not align with the norms of cultures that value indirect communication or deference to authority

✤ DBT is structured and time-intensive and may not be appropriate for all client’s circumstances

✤ Be aware that concepts of mindfulness may differ across cultures