What is Dialectical Behavioral Therapy?

Dialectical behavioral therapy (DBT) is a type of therapy that draws both on many ideas in eastern philosophy, particularly in Zen Buddhism, and on the structured form of therapy known as cognitive behavioral therapy (CBT). The American psychologist, Marcia Linehan, developed this form of treatment specifically for the types of patients who didn’t respond well to CBT. These especially include those with borderline personality disorder (BPD), those with constant suicidal ideation, and those people who cut or self injure in other ways. Since then, DBT has been used as a treatment for other people who might fall outside one of these diagnoses, and there now are now thousands of therapists trained to work in this area.

It’s important to have some concept of the way Linehan defined dialectical, which incorporates a more Eastern approach to cognition. Dialectic can refer to the way Socrates (as represented by Plato) arrived at logical conclusions. It was through repeated discussion or dialogue that the truth was reached. While this bears some similarity to DBT and the methods in CBT that question assumptions, Linehan more specifically defines dialectical as the possibility of two opposites both being true. In particular, seeing a person in therapy who both wants to change and can’t, is an example of the dialectical self, and it is the therapist’s responsibility to recognize these two realities and help the patient recognize them: to at once validate the current status as fine and beloved, while moving the client to change.

The practice of dialectical behavioral therapy is done through a series of steps that validate the person’s true desire to change and that help rid the person of any frightening or negative behaviors that may be occurring at first, like thoughts of suicidality or self injury. There are different aspects of the DBT therapy experience. People learn set skills and will do actual homework to practice new skills learned. Gradual exposure to negative feelings and thoughts increases, and cognitive behavioral skills are applied to recurrent though patterns in order to replace negative self-talking or beliefs with more truthful assertions. Emphasis is placed on concepts like mindfulness and on seeing situations in multiple ways that may all be true. Also, any opposing concepts are subject to constant dialectic, to find middle ground or middle paths.

Other things that form part of dialectical behavioral therapy are that the therapist has to assume a dialectical stance when working with a client. One reason Linehan developed this method for treating people with borderline personality disorder was due to outcome for people or therapists in CBT. Therapists could burn out or patients would leave. Adopting an approach where the patient and his or her actions are understandable within the context of the patient allows for the therapist to promote a more accepting front that usually doesn’t scare off the patient. This doesn’t mean the therapist doesn’t realize actions are potentially dangerous or frightening, it is just he or she understands that they’re comprehendible, and by offering this sympathy, likelihood of a patient remaining in therapy increases.

There have been several studies on dialectical behavioral therapy and these have shown success particularly for those suffering from one or more of the conditions described above. Given the number of therapists trained in this method, it’s often possible to find at least a couple therapists even in a small community who are trained in this area. Therapy of this type, like CBT, can be homework intensive and commitment to do the homework usually increases chance of successful treatment.

People work in several ways with DBT too. They may attend a weekly group, have a personal therapist and remain in contact with that therapist by phone during the week. Rudimentary elements of dialectical behavioral therapy may also be used in mental institutions, partial mental hospitalization settings and in some correctional facilities.