DBT FAQs: Development, Structure, and Focus

Dialectical Behavior Therapy (DBT) is a comprehensive behavioral intervention designed to treat individuals with severe mental disorders and out-of-control cognitive, emotional and behavioral patterns. It has been commonly viewed as a treatment for individuals meeting criteria for Borderline Personality Disorder (BPD) with chronic and high-risk suicidality, substance dependence or other disorders. However, over the years, data has emerged demonstrating that DBT is also effective for a wide range of other disorders and problems, most of which are associated with difficulties regulating emotions and associated cognitive and behavioral patterns. It is also assumed that there are multiple causes as opposed to a single factor affecting the client. In Dialectical Behavioral Therapy, “dialectical” means, A synthesis or integration of opposites (aka- finding the balance between opposites). In DBT, the main “dialectical” tension, or balance, is between the opposite ideas of ACCEPTANCE and CHANGE. In this framework, DBT therapists balance treatment strategies of validation and problem solving.
Marsha M. Linehan

Marsha M. Linehan

American Psychologist, Founder of DBT

“My main goal for people who come into therapy is that they get out of hell…and that they stay out of hell…to build a life worth living.” Marsha M. Linehan, founder of Dialectical Behavioral Therapy (DBT) BehavioralTech.org

There are four stages of DBT, as follows:

Pretreatment

Focuses on orienting the client to the structure and philosophy of DBT, beginning to using the Diary Card, creating values-based goals, and establishing therapy agreements between therapist and client. The Pretreatment phase ends when the client begins attending skills groups.

Stage 1

Focuses on the client learning and using skills (skills acquisition) to target emotional dysregulation, Cognitive Instability, Interpersonal Instability, Behavior Instability and Self Instability. The client participates in 3 skills groups and repeats each group twice. This stage lasts for approximately 18 months – or until the client graduates from the skills groups.

Stage 2

Focuses on PTSD/past trauma as client is ready. Once a client has a firm understanding of skills and is able to apply the skills to their lives, the therapist uses a variety of therapies, in addition to DBT, to resolve past trauma. If the client does not have past trauma, or has resolved trauma, Stage 3 begins.

Stage 3

Focuses on resolving problems of living and the client’s respect for self. If the client is still struggling to maintain self respect, a safe environment, and meeting values-based goals, the therapist will help them balance acceptance and change skills to resolve these issues.

Stage 4

Focuses on attaining sense of joy and freedom. This stage is sometimes a type of “maintenance” phase, and the parameters are established between the therapist and client to help them continue experiencing joy and freedom in their lives.

DBT Treatment Components

1

Individual Therapy

50 minute sessions

2

Skills Training Group

2 hour sessions

3

Between-Session Phone Coaching

brief phone call

4

Therapist Consultation Team

held weekly
between therapists

DBT Treatment Components

1

Individual Therapy

50 minute sessions

2

Skills Training Group

2 hour sessions

3

Between-Session Phone Coaching

brief phone call

4

Therapist Consultation Team

held weekly between therapists

DBT Treatment Priorities, or Treatment Hierarchy, followed during individual therapy sessions

  1. Decrease Suicidal and/or Self-Injurious Behaviors
  2. Decrease Therapy-Interfering Behaviors
  3. Address Quality-of-Life Behaviors
  4. Skills Acquisition

The 5 areas of instability that clients may experience in daily life*

  • Emotional Dysregulation
  • Cognitive Instability
  • Interpersonal Instability
  • Behavior Instability
  • Self Instability

*Cognitive-Behavioral Treatment of Borderline Personality Disorder, Marsha M. Linehan, 1993; p. 60

DBT Skills Groups

Skills Trainings Modules include: Core Mindfulness (first 3 weeks of each group), Emotion Regulation (14 weeks), Interpersonal Effectiveness (10 weeks) and Distress Tolerance (10 weeks)

Skills training is delivered in a group format that meets one time per week for approximately 2 hours. Skills training is organized in two segments – review of homework practice from the preceding week and teaching of skills. The DBT skills group is not a processing group – meaning it is not a group where clients discuss and process individual challenges. It is a group that is led by a therapist and co-therapist, and is structured to teach clients behavioral skills to:

  1. Enhance an individual’s capability by increasing skillful behavior
  2. Improve and maintain a client’s motivation to change and be engaged with treatment
  3. Ensure generalization of change occurring through treatment
  4. Enhance the motivation of therapists to deliver effective treatment
  5. Assist the individual in restructuring or changing their environment such that it supports and maintains progress and advancement towards goals

Between-Session Phone Coaching

  • An opportunity to combine therapist feedback with instruction
  • In-the-moment coaching on using skills to effectively cope with situations that arise in everyday life
  • Help to avert crisis behaviors prior to engaging in them (including self-injurious/suicidal behaviors)
  • Reports of “good” news to therapist when a client has success in skills use
  • Repairing any misunderstandings or behaviors that may interfere in the therapist/client relationship
  • Contact with the therapist is brief, focused, and target-oriented
  • These coaching sessions are not a time for complaining and venting problems, it is for help in using DBT skills

For more information about DBT, watch this video:

Read about DBT on BehavioralTech.org:

https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/

Information About Diagnoses:

We believe in the power of therapy.

We believe that acceptance and change can happen.

We believe that you can have a life worth living!

Please contact us for a free 15 minute telephone consultation to help you decide if Dialectical Behavioral Therapy is a fit for you.