“What on earth is DBT?” “DBT – I would never want to do that!” “DBT is only for clients with very severe diagnoses”, “DBT is behavioral – ugh!”

As DBT takes on a bigger and bigger presence in the psychotherapy community, many psychotherapists and clients make these statements. This short and informal article is a very, very brief description of a simple, complex, easy, difficult, fun, hard, highly effective approach to learning how to live a better life. (The previous sentence used some examples of dialectics.) Dialectical Behavioral Therapy is a validation, mindfulness, and skills- based psychotherapy method. The DBT philosophy, approach and interventions can be helpful to any client and to any psychotherapist.

A History: In the late 1970s, Marsha Linehan, a behavioral psychologist based at the University of Washington, was simultaneously studying and practicing Zen Buddhism and working with adult women with chronic suicide attempts, suicidal ideation, and urges to self-harm. She began to wonder whether the awareness practices in Buddhism would be helpful to her clients, since she believed that a client has to be aware of the problem in order to understand and change it. She was also noticing that her patients who were receiving standard Cognitive Behavioral Therapy found the constant focus on change in CBT to be invalidating. Her clients needed validation for their “problem behaviors” – these were behaviors developed in an attempt to be effective, not problematic.

She began to experiment with teaching her patients the non-judgmental stance, attention to the present moment, and focus on effectiveness found in mindfulness practice. Mindfulness creates, among other qualities, a uniquely validating atmosphere and environment in psychotherapy.

DBT for BPD
Linehan was also noticing that most of her patients met the criteria for Borderline Personality Disorder. Linehan evolved and refined a bio-social theory of BPD that postulates that people who have significant difficulty regulating emotions often have a history of growing up in an invalidating environment. (Linehan sees an “invalidating environment” as spanning the spectrum between abusive on one end and, on the other end, a mis-match between a sensitive child and a well-meaning parent who doesn’t know how to cope with that child.) Linehan theorizes that many of the extreme behaviors associated with BPD are attempts to validate and regulate emotions. Linehan began to see that her patients didn’t have effective life skills in many areas.

DBT Can Be Useful to Everyone
Dialectical Behavioral Therapy was designed for the severe and chronic multi-diagnostic, difficult-to-treat patient with both Axis I and Axis II disorders. However, DBT is NOT just for people with BPD. DBT focuses on identifying a problem and identifying effective solutions and behaviors. For example, substance abuse, eating disorders, inappropriate anger, over-sleeping, suicide and parasuicide are ineffective solutions to problems. People with depressive disorders, Bipolar Disorder, anxiety disorders, BPD, OCD, PTSD and ORDINARY LIFE PROBLEMS often use ineffective solutions to their problems.

At Mindfulness Therapy Associates, my colleagues and I use many of the techniques, and certainly the stance of DBT, with all of our clients, who range from clients with ordinary life problems to clients with more extreme mental disorders. In our DBT Skills Training Group, Lori Schwanbeck and I often emphasize that, although we do not have BPD, we have grown and changed by using DBT skills and that we believe that anyone can benefit from these skills.

What On Earth Is Dialectics?
A “dialectic” stance emphasizes the synthesis of opposites. For instance, one synthesis of opposites inherent in DBT is the combination of eastern mindfulness practices and western behavioral therapy. Multiple tensions simultaneously occur in therapy with clients with difficult-to- treat disorders. Life is chaotic and contradictory. These conditions are often intolerable to those clients and often lead to ineffective attempts to tolerate the contradictions – self-harm and suicide, for instance. Dialectical thinking is a skill that can replace the rigid, argumentative and polarized position often taken by such a client – DBT teaches that life is full of opposites and that there are ways we can balance in the middle.

The DBT therapist holds a dialectical stance: non-judgmental and transparent and focused on insisting on change. The DBT therapist validates the reasons why her client is using certain (outmoded) coping strategies and behaviors – these behaviors actually make sense, in a way — while pushing the client to develop and use more skillful, effective, coping behaviors. Many of the skills taught in DBT Skills Training have to do with recognizing and living with the fact that life is full of dialectics: two seemingly opposite truths existing in the same moment.