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 many other issues too, including eating disorders, drug or alcohol problems, relationship issues, anxiety or depression. These disorders tend to stem from emotional dysregulation, which provides
short-term relief but long-term suffering. DBT can help anyone who struggles with handling their emotions.

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?
At The Awakening Center, the DBT group meets each week for one hour and fifteen minutes. DBT is composed of four modules (or units) and each module is covered over a span of five weeks. It might be
helpful to supplement the DBT group with individual therapy as well.

What is DBT about?
DBT is about learning to connect to your Wise Mind so you can learn to respond to your emotions and behavioral urges instead of being reactive and impulsive. There are four modules, or skill areas that are
the foundation of the treatment. Briefly, the modules are:

1) Mindfulness: Cultivating awareness of thoughts, emotions, and present-moment experiences. In this module, we discuss how to take hold of your thoughts and attention.
2) Interpersonal Effectiveness: Exploring ways to balance your needs with the needs of your relationships.
3) Emotion Regulation: Understanding what emotions are and how to explore and express them.
4) Distress Tolerance: Learning ways to tolerate distressing emotions when you can’t change or eliminate them. Increasing skills to cope with urges to engage in destructive behaviors are discussed as well.

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 emotions than others. Not only do they feel them more quickly and intensely, but they take longer to “come down” from an emotion. Those who are validated and taught self-compassion learn to self- soothe in affirming, healthy ways. However, if you were shamed or invalidated, then you might instead seek to avoid unpleasant emotions or distress, which can lead to behaviors that cause long-term
suffering.

What are the requirements for being in a skills training group?
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. An intake session with the DBT Skills group leader is also required. 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.

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, 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 group typically starts by checking in with each participant to see how everyone is feeling. Then members are invited to share homework experiences or insights since the last group. Then the focus shifts to the skills on that night’s agenda. The leader invites members to share experiences and thoughts. The group may run through some examples to help clarify the skills, and then homework for next week is assigned. 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. Most participants at The Awakening Center’s group are in recovery from an eating disorder. But members may also struggle with self-harm behaviors, alcohol/drug use, anxiety, and relationship challenges.

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 similar 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. DBT also focuses on what goes well—the group does not spend a lot of time dwelling on problem behaviors and instead shifts the focus to successes and self-compassion.

How much does it cost? Can I use my insurance?
The fee for the DBT group is $25 each week. There are a limited number of reduced-fee slots available. Many insurance carriers will cover group therapy, but keep in mind that they often require a copay.
Check with your specific carrier and feel free to talk with the group leader about specifics. 

How do I get started?
Best way to get started is to contact Nancy Hall, the group leader, by email: nancyhalltac@gmail.com.  She will update you on space availability and schedule an intake session. If there is space in the group, new members are invited to join at the beginning of a new module. 

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.