Dialectical Behavior Therapy

An evidence-based treatment designed for working with high-risk individuals presenting with complex issues, including suicidality, self-harm, interpersonal conflict, and ineffective coping skills.

Developed by Marsha Linehan at the University of Seattle in the early 1990's, DBT was designed for difficult to treat clients (Linehan 1993a). Linehan recognized that such clients often do not attend regularly, frequently fail to respond to therapeutic efforts and make considerable demands on the emotional resources of the therapist (particularly when suicidal and parasuicidal behaviors are prominent). DBT has since been broadened as an effective approach with a variety of issues: depression, anxiety, Bi-polar disorder, trauma, adolescents, even addictions. Based in Cognitive Behavioral Therapy with a foundation of mindfulness, the skills and approach taught in DBT can be utilized by many.

Unlike many traditional therapeutic approaches, DBT is an acceptance-based intervention helping individuals to discover their own capability for learning how and when to trust themselves. The term Dialectics refers to our tendency to polarize our thinking. For example we get caught in issues being seen as "right or wrong" or "good or bad". A Dialectical approach emphasizes the ability to balance acceptance and change and utilizes strategies that keep both therapist and client from becoming stuck in rigid thoughts or feelings therefore promoting more movement and flow in treatment.

DBT is ideal for individuals who experience the following patterns in life:

Emotions

• Heightened emotional sensitivity
• Quick and intense emotional reactionsSlow return to normal mood
• Chronic problems with depression, anxiety, anger or anger expression

Behavior

• Repeated suicide threats or attempts
• Self-harm behavior such as cutting and burning
• Relationship difficulties including hypersensitivity to criticism, disapproval, rejection or abandonment
• Impulsive and potentially self-damaging behavior in areas such as binge eating and purging, alcohol or drug abuse, sexual promiscuity, and gambling or spending sprees

Thinking

• Extreme (black or white) thinking

• Difficulty with problem-solving and decision making
• Unstable self-image or sense of self
• “Detached” thinking, ranging from mild problems with inattention to episodes of
• complete dissociation