Dialectal Behavioral Therapy

Dialectical Behavioral Therapy (DBT) is a mode of psychotherapy developed by Marsha M. Linehan. It is used to treat persons with emotional dysregulation and impulse control as typified in “Borderline Personality Disorder” and other psychological conditions. 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.