Dialectical Behaviour Therapy
DBT is a skills training type therapy that is particularly useful and valuable for you, if you
Have alcohol/drug addictions
Have suicidal thoughts
Suffer from depression
Suffer from bi-polar
Suffer from post-traumatic stress disorder (ptsd)
Have other addictions
Have eating disorders
Perhaps you have very intense and and frequent negative emotions? This can lead to emotional vulnerability which in an of itself often leads to difficult and impulsive reactions that can make your life seem like a rollercoaster!
The most important goal in DBT is helping clients create ‘lives worth living’. What makes a life worth living varies from person to person – for some, it may be getting married and having kids. For others, it could be finishing varsity and finding a life partner. Others might find that its becoming clean and maintaining sobriety after decades, sometimes, of abusing chemicals/alcohol.
Whilst all goals differ, all clients have in common the task of reducing and in some cases, eliminating difficult behaviours that could result in death!
DBT organises treatment into 4 stages with targets (targets refers to the problems being addressed at any given time in therapy)
Shifting from being out of control of one’s behaviour.
Reduce and then eliminate life-threatening behaviours e.g. relapse in terms of drug/alcohol or process addiction, suicide attempt, intentional self-harm, suicidal thinking
Reduce behaviours that interfere with treatment – e.g. sporadic completion of homework assignments, non-collaboration with therapist etc. This target includes reducing and eliminating the use of hospitalisation as a way to handle crises!
Lessening Behaviour/moods/illness that destroy the quality of life
Non-attendance at school or work
Neglect of medical problems
Lack of money
Not having friends
Not feeling depressed and anxious all the time
Learn skills that help you do the following:
Focus your attention, so that you can stop worrying about the future or obsessing about the past.
Start new, healthier relationships, improve current relationships or end toxic relationships
Understand what emotions are, how they function, how to experience them in a way that is not overwhelming
Tolerate emotional pain without resorting to self-destructive behaviours.
Moving from being emotionally shut down to experiencing emotions.
The main target of this stage is to help clients experience feelings without feeling the need to shut down, dissociate, avoid life or having symptoms of post-traumatic stress disorder (PTSD). At this stage, clients may feel more in control, so to speak but, to use jargon, they are probably ‘white knuckling it’ or to use DBT speak, are in ‘quiet desperation’. Teaching someone to suffer in silence is most definitely not the goal of treatment. This is a crucial stage of treatment in which the therapist teaches the client to experience all his/her emotions without shutting them down and without letting them take the driver’s seat! Talk about a fine line…..!
Building an ordinary life, solving ordinary life problems.
In Stage III, clients work on ‘normal’ issues like marital or partner conflict, job dissatisfaction, how to get needs met, how to say no etc.
Moving from incompleteness to connection.
Most people struggle with ‘existential’ problems despite having completed Stage III. They may feel empty, or incomplete. A client stays alive and comes to therapy in order to solve the problems which are making her miserable. To truly have a life worth living, the client must learn new skills, learn to experience emotions and accomplish ordinary life goals. Therapy is not completed until all of this is achieved!
DBT is a modification (a big one!) of standard cognitive behavioural treatment CBT! I must say that CBT never resonated with me whilst DBT was an instant click!
What seemed to happen with CBT was that clients dropped out of treatment, became very frustrated or shut down or all three. Marsha Linehan ( the creator of DBT and her team, began to notice new strategies that helped clients tolerate their pain and worked to make a ‘life worth living’. As acceptance strategies were added to the change strategies, clients felt more understood! They stayed in treatment longer and improved faster!
The balance between acceptance and change strategies in therapy formed the fundamental ‘dialectic’ that resulted in the treatment’s name. Dialectic means ‘weighing and integrating contradictory facts or ideas with a view to resolving apparent contradictions’. In DBT therapist and client work hard to balance change with acceptance, two seemingly contradictory forces or strategies! Similarly, in life outside therapy, people struggle to have balanced actions, feelings and thoughts – we work to integrate both passionate feelings and logical thoughts. We put effort into meeting our own needs and wants while meeting the needs and wants of others who are important to us. We struggle to have the right mix of work and play!
In DBT there are treatment strategies that are specifically dialectical; these strategies help both the therapist and client get ‘unstuck’ from extreme positions or from emphasising too much change or too much acceptance. These strategies keep the therapy in balance moving back and forth between acceptance and change in a way that helps the client reach his/her ultimate goals as quickly as possible!!!
DBT also involves specific dialectical strategies to help clients get ‘unstuck’ from rigid ways of thinking or viewing the world. Some of these are traditional Western therapy interventions and others draw on Eastern ways of perceiving life!
The point of all dialectical strategies is to provide movement, speed and flow so that therapist and client do not become stuck in ‘i will not do that’ vs ‘Oh yes you will’
I was blessed enough to do DBT training in 2006 at Tara Psychiatric Hospital and I believe that it has been one of the most significant therapies that I have trained in over the past 15 years. I have seen clients learn these skills and practise them and ultimately change their lives with the help of these new skills!