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What is Dialectical Behaviour Therapy?

Dialectical Behaviour Therapy, commonly known as DBT, is a type of psychological therapy that draws its ideas from several different approaches.

Dialectics, as applied to therapy, is about the recognition that all things are related. For example, how you are with someone effects how they will be with you. There is also a balance between acceptance and change. For example, at times accepting difficult emotions but also learning to change how you might cope with them. The behaviour part is key as in DBT you will identify several ‘target problem behaviours’ with your therapist at the beginning. These will form the basis of the things you will work on together in therapy to change.

Who is suitable for DBT?

People may benefit if they:

  • Have a diagnosis of borderline personality disorder, but may have other diagnoses
  • Have attempted suicide or seriously self harmed within the last twelve months
  • Self harm by cutting as a coping strategy. This may require sutures or might not but you cut frequently and regularly
  • Want to be able to develop and maintain healthy relationships
  • Want to find new ways of understanding and coping with their emotions (you may feel overwhelmed by your emotions or may feel cut off from them).

What does DBT involve?

DBT involves attending weekly one to one therapy sessions and a two hour weekly DBT Skills Group.

The first stage of DBT is called pre treatment. Here you meet up for several sessions with an individual DBT therapist and identify goals to work on together. In DBT these are called ‘target problem behaviours’. They typically include working towards stopping self harming behaviours and working towards adopting alternative coping strategies such as the skills learnt in the DBT Skills group.

This stage is all about working out together with your therapist if DBT is right for you as it is quite a significant commitment that both clients and therapists make together, as DBT involves weekly one to one and a skills group for up to 12 months. You and your therapist agree a contract together (detailing target problem behaviours you will both work on) at the end of pre treatment and both sign this.

There is one rule in DBT: clients who do not attend four therapy sessions in a row (either one to one or group) can no longer continue with DBT. They would not be considered for any further DBT until their original contract ends and then this would have to be discussed.

What are the skills covered in the DBT Skills Group?

  • Core Mindfulness: Mindfulness is central to DBT. The skills taught are psychological and behavioural versions of meditation practices drawn from Eastern traditions. It focuses on states of mind known as ‘emotional mind’ and ‘reasonable mind’ and attempts to balance these two to produce a third mental state known as ‘wise mind’.
  • Distress Tolerance: The distress tolerance behaviours targeted by DBT are concerned with tolerating and surviving a crisis and accepting life as it is at this moment.
  • Emotion Regulation: The aim here is to learn skills, which will enable you to deal with intense and painful emotional states. Suicidal and self harming behaviours as well as alcohol and substance abuse are viewed as unhelpful coping behaviours, which the individual has developed as a way of dealing with these emotional experiences.
  • Interpersonal Effectiveness: This is learning how to be effective in obtaining what you want, saying no and dealing with conflicts within relationships whilst maintaining self respect. 

Is there anything else I need to know about DBT?

It may be helpful for you to consider the following:

  • You will be expected to attend weekly one to one therapy sessions and a two hour weekly DBT skills group
  • In DBT you are required to complete a diary card every week. You will also complete other questionnaires every eight weeks. This helps us monitor together whether the DBT is being effective or helpful for you
  • If you use drugs or alcohol, it may make DBT less effective. We can support you in getting help for these problems so that you can get the most from DBT or any other interventions offered to you.

For more information

If you are interested in finding out more about DBT please discuss this with your mental health worker and or psychological therapist within the Recovery Team.

Useful information

There are several books describing DBT; but in the first instance you may want to have a look at the website: www.dbtselfhelp.com for more information.

For information about the current evidence for DBT see: National Institute for Clinical Excellence (NICE) Guidelines for Borderline Personality Disorder: www.nice.org.uk/Guidance/CG78

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