5 Reasons I Love Dialectical Behaviour Therapy

A new co-worker recently pointed out to me that after being a dialectical behaviour therapist for 12 years I live and breathe DBT. It got me thinking, “That’s true! Why do I love DBT so much?”

1. The structure of dialectical behaviour therapy provides a helpful framework.

Dialectical behaviour therapy (DBT) is an evidenced-based treatment that was originally developed for people living with borderline personality disorder (BPD) who were at risk of self-harm and suicide. It has also been proven helpful for many issues involving emotion dysregulation such as: disordered eating, depression, substance use issues, anger, intimate partner violence, complex trauma, and more.

DBT involves four elements:

• Weekly skills group
• Weekly one-to-one counselling sessions
• Phone coaching in times of crisis
• Team meeting for therapists working together to deliver the treatment

Usually, a full DBT program is a year, which allows you develop a strong relationship with the client. Research shows that using DBT skills groups can enhance patient care and create positive outcomes, even without the other aspects of adherent DBT.

I know DBT skills are helpful, I use them all the time! Even short-term work, or time-limited connection can benefit from adding DBT skills.

Research shows that using DBT skills groups can enhance patient care and create positive outcomes, even without the other aspects of adherent DBT.

2. DBT has a skill for that!

Dialectical Behaviour Therapy has been heavily researched and is loaded with skills that help people with dysregulated emotions. Clients are able to gain more awareness and control of their feelings, impulses, and behaviours, which helps to improve their relationships with themselves and others. It is a manualized treatment with protocols, theories, and outlines for how to teach a DBT skills group.

The skills are organized into four main modules, including:

• Mindfulness skills to enhance the personal awareness of one’s experience
• Skills to help tolerate distress and not make a crisis worse
• Skills to understand, improve, and tolerate emotions
• Communication skills and styles, to help manage priorities in difficult situations

3. The dialectical stance increases openness.

Being dialectical involves seeing both sides and holding two true but opposing ideas. For example, “I love you very much, and I’m really angry with you.”

Being dialectical also means embracing vulnerability. There are many ways to see a situation – no one owns the truth. I see my point of view, while I try to remain open to other perspectives. When I hold my clients in a dialectical light, I feel solid about my work. “This person is working so hard right now, and this is a painful moment that will not be resolved with hard work alone.”

The balance of striving toward change while accepting and validating ourselves as vulnerable and imperfect is something I have always found inspiring. I have noticed that it is often the path to increased self-compassion.

4. Emotional understanding is the foundation.

DBT was developed to help with the key issue of emotion dysregulation. Originally developed to treat BPD, DBT also works for issues that involve emotions that come on quicker, stronger, and last longer, with a slower return to baseline. Clients have described that these emotional storms can leave them feeling out of control and impact their behaviour in negative ways. DBT focusses on increased self-understanding through emotional awareness.

Every module taught in the DBT skills group builds on the previous one, and we always start from a place of trying to understand “what is happening for you right now?”

5. DBT pairs compassionate understanding with a practical lens.

When a client is dealing with the hard consequences of their impulsive choices, I lead with validation. I want to fully understand and demonstrate what is happening for my client from their point of view. I also want them to understand and validate for themselves that their own emotional responses and impulsive behaviours happen for a reason – even if things are harder for them now because of their choices. This  does not mean they are bad, weak, misguided, or broken.

Once I can understand, with my client, what is happening for them (interpretations, emotions, body reactions, urges), we look at how it impacts their responses, and in turn, relationships with themselves and others. Then we get practical!

DBT is Very Skills Based

DBT looks at how to develop skills to work on acceptance and change. We can work on increasing acceptance of the hard things: how we are wired (even the parts of us we don’t like); the reactions that we have; the hard parts of life; and the situations that we cannot change. We look directly at how to decrease the barriers to accepting, and clearly acknowledge, that acceptance is not agreement or endorsement.

Moving towards acceptance means decreasing resistance or avoidance behaviours, and starting to tolerate the reality of where we are and what we want to do about it.

Summary

I have named five points that come to mind when I think about “the work” through the lens of a DBT therapist. I also want to add that since adherent DBT is delivered by a team, I love that my team has taught and supported me every step of the way. Every helper I meet through CTRI workshops is doing both complex and vitally important work; some work independently, some have a team. Working in human services right now is not easy and we are all feeling the impacts of the pandemic on mental health.

I believe that having more access to skills and helpful concepts that are effective, including in high-risk situations, reduces burnout. We all do better when we have skills to help regulate our own emotional reactions while doing this work. We also have something helpful to offer our clients. DBT skills truly are useful to everyone.

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