Dialectical Behavior Therapy (DBT)
My therapist suggested I do DBT. Does that mean I have Borderline Personality Disorder (BPD)?
It makes sense that people think DBT is only for BPD. It was originally developed to treat BPD and most books and articles published regarding DBT are about treating BPD. But the truth is that DBT is helpful for folks with many other diagnoses too, including eating disorders, drug or alcohol problems, depression, and even pathological gambling. What all these disorders tend to have in common is that they stem from emotional dysregulation. Emotional dysregulation means that emotions are intense, seem uncontrollable, and can lead to impulsive behaviors that may relieve the distress temporarily, but create dissatisfaction with one’s life in the long run. DBT can help people feel less emotionally dysregulated.
What does “dialectical” mean?
It’s a term from philosophy. Dialectics can seem difficult until you work with them for a while, so don’t be too concerned if it seems complicated right now. The idea is that absolute “truth” is never a certainty. In fact the world is full of paradox and contradiction. Dialectics as they’re used in DBT are a mode of thinking through which contradiction is a starting point for contemplation, where every “absolute” has a polar opposite with which it can be synthesized (combined) to form another “absolute,” and so on. So rather than viewing opposites as ideas that clash and can’t be reconciled, from a dialectical perspective opposites are a jumping off point for reaching a more realistic view, a closer approximation of “truth,” but one that’s always open to question.
What does DBT treatment entail?
“Full” DBT treatment at the Awakening Center entails attending a 90-minute skills training group once a week and one 45-minute individual DBT treatment session. However, many people who are already in individual therapy with a non-DBT therapist can benefit from coming just to the skills training group and sharing what they learn in DBT with their individual therapist.
What is DBT about?
DBT is about learning options for managing emotions and the behaviors that happen as a result of them. Participants identify “target behaviors” which are things they do when distressed that they would like to stop doing. They apply DBT skills to help reduce or eliminate their target behaviors. There are four skill areas that make up the “DBT skills”, which are the foundation of the treatment. Briefly, the skill areas are:
1) Mindfulness: cultivating awareness of thoughts, emotions and present-moment experiences.
2) Emotion Regulation: understanding what emotions are and ways to deliminate, de-escalate or change them.
3) Interpersonal Effectiveness: ways to get your needs met without damaging relationships.
4) Distress Tolerance: ways to tolerate distressing emotions when you can’t change or eliminate them.
For a more detailed discussion of DBT and the skill areas, go to http://www.borderlinepersonality.info/dbt.htm.
Why do some people struggle so much to manage emotions and other people don’t?
According to Dr. Marsha Linehan, who developed DBT, some people are born more sensitive to emotion than others. Not only do they feel emotions more quickly and intensely than other people, but it also takes them longer to “come down” from an emotion. That can work out fine if you learn skills for coping with strong emotions early in life within your family or elsewhere. This means that people around you acknowledge the reasonableness of your feelings, help you learn ways to soothe yourself, and/or show you what to do with strong emotions by demonstrating skillful behavior when they themselves have strong emotions. However, if you are raised without the opportunity to learn to cope skillfully with strong emotion AND you’re emotionally sensitive, everyday life -- and the emotions that accompany it -- can be quite difficult.
What are the requirements for being in a skills training group?
1) You have to have an individual therapist and you have to be seeing them as often as they recommend. It doesn’t matter if that therapist isn’t doing DBT with you, but they must be willing to support your DBT work. Your individual therapist doesn’t have to be an Awakening Center therapist.
2) You have to meet with the DBT Skills Group leader once individually before joining a group. In that meeting, you’ll hear more about what DBT is and decide together whether it might be beneficial for you. If so, you’ll make a formal commitment to being a DBT group member. You’ll also set initial “target behaviors.” These are things that you do when you experience strong emotion that you’d like to stop doing.
What if I don’t like being in therapy groups? Is there some other way to do DBT?
If you’ve determined that you don’t like therapy groups based on past experience, you might be surprised at how different a DBT group is. Unlike traditional “process” groups, where members discuss their reactions to each other and work through their conflicts, DBT groups are more structured, and feedback among members is expected to be supportive. Skills learning is at the center of the groups and it may often feel more like an interesting class than a traditional therapy group. While being in a group is the best way to learn DBT skills, in certain circumstances, individual skills coaching is available at the Awakening Center. Particularly if there is some reason it’s impossible to attend a skills training group.
What happens in the skills training group?
The agenda we usually follow is: 1) brief check-in about how each member’s feeling; 2) group mindfulness exercise; 3) homework review; 4) new skill learning and discussion; 5) homework/practice assignment for the week; and sometimes 6) another mindfulness exercise. For a good description of what DBT is like from one participant’s perspective (though not an Awakening Center DBT client), visit http://www.growingstrong.org/mental/dbt.html
What about the group members? How many are there? What kinds of problem behaviors do they engage in?
The groups are small -- typically from 4 to 7 members. Members engage in a wide variety of target behaviors, including self-injury, binging and/or purging, alcohol and/or drug use, isolating, interpersonal aggression, and others.
I’m embarrassed about my target behaviors. What if no one else has the same target behaviors that I do? What if other group members can’t relate?
Many people experience embarrassment around their problem behaviors. It takes courage to seek treatment. One of the guidelines of DBT group is that the members accept rather than judge each other. It’s likely there will be another group member who engages in at least one of your target behaviors. If not, remember that everyone in the group shares the same basic difficulty in managing their emotions. All group members can relate to that.
How much does it cost? Can I use my insurance?
For DBT Skill Training Groups, the fee is $60 per group. For Individual DBT Therapy; for Individual Skills Coaching, the fee is $90 per session. There are a limited number of reduced-fee slots available. Fees are due at the end of each session for individual treatment, and at the end of each month for group treatment.
How do I get started?
What if I have to miss a skills training group?
If it’s impossible to come to skills training group, you must call at least 24-hours in advance. Otherwise, you will be charged for that group. DBT can be hard work and coming to group can feel burdensome sometimes. The cancellation policy is designed to support your commitment to coming and give you a reason not to act on an impulse to miss the group. If you’re getting reimbursed by insurance, you should be aware that they will not pay for sessions you have missed.