Dialectical Behavioural Therapy is a relatively recent treatment modality which was developed by Martia Linehan in the late 1980s. As a BPD sufferer herself, Dr Linehan specifically designed DBT to effectively target and treat those struggling with Borderline Personality Disorder, or individuals with BPD traits. DBT combines typical behavioural therapy approaches (such as CBT) with the addition of a strong focus on Mindfulness techniques. It is currently the main evidence-based treatment approach specifically targeted to treating those with a diagnosis of BPD. It is a ‘solution-based’ approach which aims to both decrease individuals’ suffering and maladaptive behaviours, and eventually help them to start building a life worth living for themselves.
The term ‘Dialectic’ refers to two seemingly opposing truths which can both exist simultaneously despite their questionable compatibility. The primary dialectic within the realm of DBT is that of ACCEPTANCE and validation of where the client is at in that moment, whilst simultaneously allowing and encouraging a process of effective and sustainable CHANGE within them.
DBT consists of four main components: skills groups, 1:1 therapy sessions, crisis coaching and consultation team:
- Skills groups are classes in which the theory and skills of DBT are taught to a group of clients enrolled in a DBT program. These groups are divided into four modules of which two are ‘acceptance-based’ and two ‘change-based’:
– The former are the Mindfulness and Distress Tolerance modules.
– The latter are the Emotional Regulation and Interpersonal Effectiveness modules.
- 1:1 therapy sessions give clients the opportunity to explore and work through presenting behaviours, cognitions and emotions in a structured and individualised setting. They also provide a safe arena to delve into more personal areas including targeting ‘life threatening’, ‘therapy interfering’, and ‘quality-of-life interfering’ behaviours, alongside the important job of exploring and healing past traumas.
- Crisis coaching, usually carried out via a 5-15 minute telephone call between client and therapist, is offered outside of standard therapeutic hours during times of high emotional and mental distress and/or behavioural risk. The client is expected to make contact with their therapist before engaging in any self-destructive or ineffective ‘coping behaviours’. This enables the duo to talk over and decide on appropriate skills which the client is then expected to take away and use, in order to self-regulate and healthily manage the situation.
- Consultation team is essentially therapy and support for DBT therapists themselves. It ensures that members of the client’s team can provide the best care possible, especially when faced with challenging individuals and complex, hard-to-treat disorders. Members of the client’s team (e.g. therapist, psychiatrist, social worker, clinical psychologist) meet once weekly to participate in the consultation team meeting, in which they can exchange updates, raise concerns and seek advice from each other.
I am currently enrolled in a year long outpatient DBT program after having recently returned home from an intensive residential DBT facility. For more information about my own DBT treatment and experiences, feel free to contact me with any questions.