The philosophy behind Dialectical Behavior Therapy (DBT) is that we can both accept something and choose to change it. This is a difficult concept to grasp, but when we do, it has wonderful effects. This mindset is in direct opposition to some cognitive therapies that tend to promote shame for having “irrational” thoughts (which we all do at times!) Instead, in DBT, the focus is on accepting our thoughts AND recognizing they may not be very functional or may not represent reality – then we can choose to try to alter them or we may simply choose not to act on them.
DBT is a skills-based approach and has 4 major content areas – mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. There are skills related to each of these areas, and some skills that fall into more than one category.
The goal in DBT is to use the skills to create a life worth living. Clients who benefit the most from DBT are those who experience life or their symptoms as extremely painful, maybe even intolerable. In my practice, I use DBT to varying extents depending on each client’s needs, wishes, and level of daily distress. DBT does not provide a framework for why clients have come to experience life as they do; it is less about discovering the underlying source of an issue and more about addressing the behaviors and patterns of thinking that result from the underlying issue so that the person experiences less pain in daily life. Sometimes this is all that clients need or want to do. Whenever possible, further therapy to help clients make sense of how they experience their emotions and relationships is helpful because, without this, old behavior and thought patterns are more likely to return. For information on my other therapeutic approach, Emotionally Focused Therapy, click here.