What is DBT?: A Patient’s Guide to Dialectic Behavior Therapy
What Is DBT?
Dialectical Behavior Therapy (DBT) is a therapy modality created by Marsha Linehan in the 1970s. The original book, Cognitive Behavioral Treatment of Borderline Personality Disorder, was published in 1993 and laid the groundwork for what DBT is today.
While DBT is considered the gold-standard treatment for Borderline Personality Disorder (BPD), there is also extensive research supporting its effectiveness for many other mental health concerns. So, just because your therapist or someone else recommended DBT does not mean you have BPD. 😊
Traditional DBT consists of four main components:
Individual Therapy
Skills Group
Phone Coaching
Consultation Team (for therapists)
Linehan and her followers have remained very faithful to this model and are often quite rigid about how DBT is implemented. Their conference is even called "Is It DBT?" You may hear therapists say things like, "That's not real DBT," or "They aren't actually practicing DBT." I'll try to explain these statements (as non-dialectical as they may be 😊) throughout this article so you can better understand what's going on in the therapy world.
DBT is founded on the concept of dialectics. In DBT, dialectics involve holding two seemingly opposing truths at the same time. We help people move from "either/or" thinking toward "both/and" thinking. Put another way, we help people move away from black-and-white thinking and join us in the gray.
A classic example of a dialectic is accepting yourself as you are while also recognizing that you need to change. These ideas may seem contradictory, but they can coexist in the same mental space.
Individual Therapy
In traditional DBT, individual therapy usually consists of a few main components. Sessions are typically held once a week (or every other week) and last about 50 minutes.
One major component is the review of a diary card, which the client completes throughout the week. A diary card is usually a one- or two-page document that tracks things such as urges to self-injure, anxiety levels, substance use, exercise, eating behaviors, and more. It is essentially a way of collecting daily data about your emotions, thoughts, and behaviors.
You and your therapist review the diary card together and work through any issues that arose during the week. Individual therapy may also involve processing trauma, managing crises, improving relationships, and working toward other treatment goals.
Skills Group
Skills group is usually held once a week for about 90 minutes.
There are four primary DBT skills modules:
Mindfulness
Distress Tolerance
Emotion Regulation
Interpersonal Effectiveness
These modules can technically be taught in any order, but many programs find it most effective to begin with mindfulness.
Most DBT skills groups allow new members to join at the start of a module. During group, participants are taught specific skills designed for particular situations. Many of these skills are taught using memorable acronyms.
For example, the STOP skill stands for:
Stop
Take a Step Back
Observe
Proceed Mindfully
Participants learn how and when to use these skills through discussion, role-plays, and practical exercises.
It's important to understand that skills group is not a place for processing trauma, deep emotional issues, or personal crises. It is a structured environment designed to teach and practice skills that can be applied in everyday life.
(We'll post separate blogs that dive deeper into each of the four skills modules.)
Phone Coaching
The third major component of DBT is phone coaching.
In traditional DBT, therapists make themselves available for brief coaching calls when clients need help applying skills in real-life situations. These calls are typically around 10 minutes long.
For example, a client may call while attending a social event where they feel an anxiety attack coming on. The therapist might ask which skills have already been tried and help identify the next best step. Together, they might create a plan for managing the situation and discuss what to do if the first approach doesn't work.
That's really it.
Phone coaching is not intended to be a mini-therapy session or a time to process trauma. It is designed to provide support, validation, and skill coaching during difficult moments.
Consultation Team
The fourth component, consultation, is not something clients generally need to worry about.
Consultation teams are groups of DBT therapists who meet regularly to discuss cases, support one another, and ensure they are providing the most effective treatment possible. Think of it as quality control and ongoing professional development.
Finding DBT in Maine
All that being said, it is highly unlikely that you will find full, traditional DBT in Maine. There are a few programs that offer it, but they can be difficult to access and are often very expensive because they do not accept insurance.
We are currently working to get more DBT skills groups up and running, but they can be challenging to organize and sustain.
What Is "Adapted DBT"?
I've coined the term Adapted DBT to describe what most therapists mean when they say they practice DBT.
In Adapted DBT, therapists use the principles and skills of DBT while incorporating them into individual therapy sessions. Many therapists teach DBT skills, use diary cards, and focus on behavioral change, even if they aren't providing all four components of traditional DBT.
Some therapists also have mixed feelings about phone coaching because it can create boundary concerns. That's understandable, and we shouldn't expect every therapist who practices DBT to offer that level of availability.
"Okay, Michael... What Does This Actually Look Like?"
You might be saying:
"Whatever, Michael. Can you just tell me what the hell this might look like for me?"
Yes, reader. I can.
A typical DBT experience with me might look something like this:
A) Intake Session
I ask a ton of questions to get a complete picture of your history and current situation. It may feel like you're telling your darkest secrets to a complete stranger.
We get to know each other, discuss your goals, and determine whether we're a good fit.
B) Treatment Sessions
We begin by addressing the most pressing concerns, with safety always coming first.
If you walk into session and say, "I've been cutting myself and feeling suicidal," we're probably not going to spend the hour discussing your conflict with a neighbor.
We'll likely introduce a diary card, identify treatment targets, and begin learning some skills. I'll probably assign homework or specific skills to practice between sessions.
In future sessions, we'll review your diary card, discuss your skill use, and continue working through whatever challenges arise. Over time, we may also address trauma, attachment patterns, relationships, and other deeper issues.
C) Phone Coaching
I tell my clients:
"I'm available for phone coaching during the week. If you contact me and let me know you need a brief phone call, I'll do my best to fit it into my schedule that day. If it's 7 or 8 at night, there's a good chance I won't be available. If it's an emergency, call crisis services or go to the emergency room. These calls are for skills coaching and getting through the moment. We'll follow up on them in session."
Final Thoughts
That's pretty much it.
You should now have a basic understanding of what you're signing up for when you agree to DBT. It can feel intense at times, but so can life.
Get out there and heal.
