Dialectical Behavioral Therapy
- What is Dialectical Behavioral Therapy?
- How is it Used?
- How is it Effective for Emotional Dysregulation and Impulse Control?
- DBT at PCH Treatment Center
What is Dialectical Behavioral Therapy?
Dialectical Behavioral Therapy (DBT) is a mode of psychotherapy developed by Marsha M. Linehan, now Professor of Psychology and Director of the Behavioral Research and Therapy Clinics at the University of Washington. It is used to treat persons with emotional dysregulation and impulse control as typified in Borderline Personality Disorder and other psychological illnesses. DBT is also appropriate for persons affected by psychological trauma or struggling with chemical dependency or self-injurious behavior. DBT is derived from Buddhist meditative practices and mindfulness concepts, and has become a cornerstone in treatment for Borderline Personality Disorder.
With DBT, Linehan attempted to address what she saw as three longstanding failings of cognitive-behavioral therapy. First, clients were threatened by treatment that focused on change when it failed to simultaneously acknowledge and accept the client’s existing identity, with some clients experiencing that focus as fundamentally invalidating. Second, the need to address immediate issues like suicidal and self-injurious behavior often took precedence over work on the development of effective behavioral skills, sometimes supplanting that work completely. Third, Linehan noted that client behavior frequently steered therapy in counterproductive directions: If tackling difficult subjects engendered client hostility, the therapist might avoid those subjects despite their importance to successful treatment.
In light of these obstacles, DBT makes therapeutic acceptance central to its approach, addressing one of the most difficult issues encountered in helping individuals with personality difficulties – treatment compliance. Using mindfulness techniques grounded in both eastern and western meditative practice, DBT seeks to forge a therapeutic alliance between client and therapist. In that alliance, treatment becomes dialectical by resolving the tension between two poles: acceptance of the client as he or she is and the necessity of change for the client’s own sake. DBT resolves that dichotomy by synthesizing acceptance and change in a highly structured system of therapeutic interaction.
There is much more than acceptance of the client by the therapist. Internal acceptance, in which the client comes to accept both feelings and external situations non-judgmentally, is equally important. From a new perspective, the client can learn to acknowledge difficult situations, develop greater tolerance for distress and regulate emotions that would otherwise be overwhelming. Linehan called DBT a dance. The therapist must constantly balance acceptance and change strategies, often in the face of enormous client resistance, in order to keep treatment moving forward. DBT provides a detailed framework for this very delicate process.
How is it Used?
DBT is a structured treatment method that typically involves both individual and group psychotherapy, both of which approach the disorder on the two axes of acceptance and change. Therapists work with clients individually on issues that arise between and within sessions, prioritizing those issues according to their relative harmfulness to the patient and to treatment.
Individual and group settings are complementary. One goal of individual sessions is to help clients manage problems that would otherwise disrupt group sessions. Individual DBT allows clients to learn individual and interpersonal skills and to practice those skills in a controlled setting. In keeping with the principles of DBT, skills are divided into the four modules of mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Each of those modules is further divided into highly specific competencies that clients can practice in a group setting and, ultimately, apply to daily life.
How is DBT effective for Emotional Dysregulation and Impulse Control
DBT initially focused on the treatment of suicidal behavior. It has proven effective in that context, but it has evolved to treat a range of disorders, most notably borderline personality disorder, that are characterized by what Dr. Linehan calls “emotion dysregulation.” Accordingly, DBT provides a framework for managing impulsivity in life.
In the DBT model, borderline personality disorder and other personality problems are characterized by deficits in both interpersonal and self-regulating skills, inability to tolerate distress and, because the client’s appropriate behavioral skills are compromised or inaccessible, a resort to dysfunctional behaviors. DBT, with its strategies for mindfulness, acceptance and validation and its emphasis on individual and group skills, addresses each of these issues systematically. Since 1991, when the first randomized clinical trial of DBT was conducted, studies have confirmed the treatment’s value for individuals with borderline personality disorder, suicidal behavior, substance abuse and even eating disorders.
DBT at PCH Treatment Center
At PCH Treatment Center, DBT is an important component of treatment, particularly for clients who have issues around impulse control and emotional dysregulation. Clients participate in group DBT sessions throughout the week and can seek out individual sessions when appropriate to their specific treatment plan. At PCH Treatment Center, we feel that DBT teaches our Clients important tools to help them better manage their impulsivity and dysregulated emotional states. Of equal importance is our rigorous individual psychoanalytically based psychotherapy, which helps Clients to gain insight and understand the origins of their emotional dysregulation and impulsivity. All of our group and individual therapies integrate with our curriculum of holistic healing activities. Because DBT itself incorporates aspects of cognitive and behavioral psychotherapy, western contemplative traditions, Zen Buddhism and assertiveness training, it synergizes well with the PCH Treatment Center global holistic approach.
