What is the goal of DBT?

Our goal is to help you build a life worth living. We want to help you formulate and reach your own personal goals by understanding your own reactions to distress and using DBT skills and other strategies.

What does DBT stand for?

Dialectical behavior therapy. DBT is based on Marsha Linehan’s treatment manuals, Cognitive-Behavioral Treatment of Borderline Personality Disorder (1993) and Skills Training Manual for Treating Borderline Personality Disorder (1993). An updated Skills Training Manual is due to be published in 2014.

How effective is the treatment?

DBT is the most researched treatment for borderline personality disorder. Although there are a few other treatments with promising data, DBT has the most solid evidence at this time.

Do I have to attend skills group?

Skills training group is a formal part of DBT for many of our clients. Skills group is designed to teach you new ways of responding, and is therefore considered a very important part of our treatment program. However, there are exceptions. For example, some of our clients only need training in one module, or have already learned many of the skills in another setting. Each client will have a treatment plan tailored specifically to his/her needs, so this question will be best answered by your own provider.

Can I do DBT and keep working with my current therapist?

We find that receiving treatment from two therapists at once can be very confusing, and in some instances, actually harmful. For this reason, our clients take a break from working with their former individual therapists while in DBT; we are happy to facilitate a return to that therapist once DBT has been completed.

How long does treatment take?

Most research suggests that for individuals with multiple, chronic problems related to emotion dysregulation, clients benefit from a year of DBT. Once again, there is wide variability. You and your therapist will establish an estimated length of treatment in your first few sessions. You may successfully complete therapy before that date, or you may choose to stay beyond that date to work on additional targets, but typically we aim for one year.

How is DBT different from CBT?

DBT is a form of CBT. DBT uses all of the strategies from CBT, with much more emphasis on emotion than is found in traditional CBT. Learning how to identify emotions, experience them effectively, regulate them, and increase pleasant emotions are all strongly emphasized in DBT.

Additionally, while CBT is typically designed for a particular problem or psychiatric diagnosis, DBT is designed for individuals with several chronic problems and/or diagnoses. DBT’s target hierarchy allows the provider to target multiple problems in a structured fashion. If we think there is a less intensive, briefer treatment that will work for you, we will be sure to discuss that option with you.

Because DBT is designed to address multiple problems, our DBT therapists are well trained and experienced in a wide variety of CBT treatments. As needed in your treatment, your therapist will use other evidence-based treatments for the diagnoses and problems relevant to you.

Do you have evening appointments?

Yes! You may work out your appointment schedule with your specific provider, but most of our providers offer at least some evening appointments. We do not typically offer weekend appointments.

What is a dialectic?

Dialectics refers both to a means of communication and to a world view. Both are central to the DBT model. This is a complex topic, so we will just give a brief answer here. If you have more questions about this, please be sure to ask your provider.

In brief, a dialectic exists when two opposites co-exist. Instead of focusing on which position is “right” and “wrong,” dialectics would assume there is validity in both points. When one thinks dialectically, one assumes something is being left out from any one point of view; instead of assuming one is correct, one considers what is missing in one’s own perspective, seeks out the opposing view, and can hold both sides as true at the same time. For example, when one is cut off in traffic, instead of thinking, “What a jerk!” one could consider both that he/she does not like being cut off AND there are reasons why the other driver did so. Dialectical thinking can be extremely helpful in increasing flexibility and decreasing “black and white” or rigid thinking that can lead to intense emotions.

There are many examples of dialectics in DBT, but the primary dialectic is that of acceptance and change. Rather than focusing only on acceptance, or only on change, DBT puts equal, intense emphasis on accepting an individual just as he/she is AND working hard to change the responses (emotions, thoughts, overt behaviors, etc.) that are causing problems.

A dialectical world view also emphasizes the interconnection of all things. A relevant example relates to the “identified patient” in a family. Instead of laying blame on a particular person (e.g., the client, the parents, etc.), a dialectical world view suggests that each family member’s behavior influenced the other members, and that with enough interactions over time, both sides can have significant influence on the other. In other words, our responses are caused by events, and our responses in turn cause other events; we can understand and change these patterns without judgment and blame.

There are many other ways dialectics arise in treatment, including creating balance in one’s life and in one’s therapy sessions. Your DBT therapist will discuss this concept with you and provide more examples.