Content Warning: Please be advised, the below article mentions trauma-related topics including suicide, which could be upsetting to the reader. If you or someone you love is having suicidal thoughts, contact the 988 Suicide & Crisis Lifeline at 988. Free support is available 24/7.
Dialectical behavior therapy (DBT) is a form of psychotherapy that is often used for treating borderline personality disorder (BPD), though it can also be used for several other mental health conditions, such as post-traumatic stress disorder (PTSD), depression, and anxiety. It can often benefit people experiencing intense and highly challenging emotions.
For many therapists, DBT can be a valuable treatment approach to have in their toolkit when determining how to best care for their patients. Here, we’ll explore the key principles and skills of DBT, core components of DBT in practice, and training and certification options for therapists interested in furthering their knowledge of this approach.
What Is Dialectical Behavior Therapy?
Dialectical behavior therapy (DBT) was developed by psychologist Marsha Linehan for clients with especially challenging emotions. She saw a need for a therapy model that addressed the client’s need to learn specific skills for coping with intense feelings without resorting to unhealthy behaviors like substance use or reckless acts.
DBT combines elements of behavior therapy, Zen principles and practices, and an “overarching dialectical philosophy.” In DBT, “dialectical” refers to this simultaneous focus on both acceptance and change, for both the therapist and the client. Namely, they learn how to simultaneously offer acceptance of harmful and unwanted behaviors while also providing encouragement and pursuing skills needed to change unhealthy behaviors to healthier ones.
Key Skills In DBT
A central aspect of this form of therapy involves teaching and encouraging clients four key skills:
- Mindfulness: This involves calmly being aware of and accepting whatever one is experiencing in the present.
- Distress tolerance: This involves becoming aware of challenging and complex emotions as they happen and learning to tolerate distress rather than trying to change it.
- Emotion regulation: This involves developing a greater understanding of and ability to control one’s emotions.
- Interpersonal effectiveness: This involves developing improved communication skills for interacting with others in a productive and healthy way.
DBT Client Populations
DBT is most often used by clinicians treating clients with borderline personality disorder (BPD), though it has broader applications as well. People with BPD often have extreme fears of abandonment, act impulsively, experience sudden mood swings, and may threaten or attempt suicide or engage in self-harm. Many people with BPD may have experienced sexual abuse while growing up; however, various factors can contribute to the risk of developing BPD.
If you or someone you know is experiencing suicidal thoughts or behaviors, seek help immediately. The 988 Suicide & Crisis Lifeline can be reached 24/7 by dialing 988.
In addition, DBT has been shown to be effective in treating and managing other mental health conditions such as anxiety, depression, eating disorders, and PTSD.
Some practitioners use elements of DBT when working with a wide range of people in their practice. For example, many people with less severe mental health conditions can benefit from learning how to use mindfulness and how to stay on top of emotions in challenging moments. Similarly, many people in therapy need help learning new ways to communicate about problematic topics in their relationships.
Core Components Of DBT In Practice
Implementing DBT with clients in practice involves four primary program components: skills training group, individual therapy sessions with clients, telephone consultations between the therapist and client, and therapists working with a consultation team of others for support and advice on handling individual cases. Let’s look at each of these components in more detail.
Skills Training Group
The skills training groups are led by the therapist and typically meet for approximately two and a half hours per week for 24 weeks. The group is sometimes held for a second 24-week session with the same participants. Skills learned by the participants include two focusing on acceptance through practicing mindfulness and increased tolerance for distress, and two skills oriented toward change, which includes learning to regulate emotions and improving interpersonal communication skills.
Individual Therapy Sessions
Individual therapy sessions for DBT clients typically take place for about one hour on a weekly basis, focusing on motivation and developing strategies for coping with specific life events in a healthy way. Individual sessions occur alongside the group skills training sessions.
Phone consultations or other intersession communications between the therapist and client happen when the client needs immediate coaching during a stressful event. These (generally) brief communications are considered in-the-moment coaching, and they are designed to help the client learn how to ask for help and how to incorporate the skills they are learning into their daily lives.
Therapist Consultation Team
The consultation team for therapists practicing DBT is an essential component of this treatment method. Clients who benefit from this approach typically have serious and difficult-to-treat mental health conditions including challenging behaviors that interfere with therapy. Consultation teams provide a regular opportunity for therapists to work through concerns with the insight and experience of others to find the optimum approach for helping each client. Consultation groups usually convene on a weekly basis and can offer a valuable source of support for therapists practicing DBT.
DBT Training For Therapists
DBT is among the most widely recommended and successful treatment options for clients with BPD and suicidal behavior, and becoming trained in DBT as a therapist can equip you with effective techniques for working with clients experiencing these very challenging concerns.
Therapists interested in becoming certified in DBT can visit the DBT-Linehan Board of Certification website, which details the certification process and the benefits of getting certified. Among other benefits, certification in DBT can provide credibility and confidence to potential clients and can be a key part of upholding the integrity of this treatment approach.
Certification may also allow you to easily connect with other certified therapists to form a consultation team, a crucial component of applying comprehensive DBT with clients.
You can access training sessions for DBT through online courses or in-person classes and meetings. An online training program or other course often includes topics such as:
- How to organize and run DBT skills training groups
- Approaches to handling intersession contacts with clients
- Identifying and resolving therapy-interfering behaviors
- Techniques for enhanced individual therapy sessions with DBT clients
In addition, many courses cover topics such as using DBT effectively with various populations, instructing clients in using diary cards for emotional regulation, effective ways to reduce suicidal behavior and self-harm, and providing for the therapist’s needs while working with challenging clients.
DBT is a form of talk therapy designed for people who face intense and often overwhelming emotions, such as those with BPD, PTSD, and suicidal behavior. DBT combines elements of behavior therapy, Zen principles and practices, and a dialectical philosophy of acceptance and change. The four key skills involved in DBT are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Therapists can seek online or in-person classes to get the training they need to use DBT in their practice, receive certification in this specialty, and continue their education.