What Is Dialectical Behavioural Therapy?

Dialectical behavioural therapy was originally developed by Psychologist Marsha Linehan in the late 1980s as an option to treat people experiencing borderline personality disorder with severe suicidal ideation.

Dialectical behavioural therapy is a type of talking therapy, based on cognitive behavioural therapy, however it has been adapted to help people who have experienced emotions intensely.

This type of therapy is mainly used to treat problems associated with borderline personality disorder. More recently it has been used to treat a range of different types of mental health problems.

What does Dialectics mean?

Dialectics means trying to balance opposite positions and how they go together. You will learn with your therapist to balance acceptance  - accepting oneself -  and change - making the positive changes in your life.

Difference between DBT and CBT?

CBT focuses on helping you change unhelpful ways of thinking and behaving. 

DBT also aims to do this, but it differs in that it also focuses on accepting who you are. DBT places importance on the relationship between you and the therapist, using this relationship to actively motivate you to change.

What are the goals of DBT?

The goal is to help you to learn to manage difficult emotions by letting you experience recognise and accept them. After learning to accept them, you learn to regulate them therefore changing your harmful behaviour. The DBT therapist will use a technique to balance acceptance and change.

Accepting techniques

These techniques focus on understanding who you are as a person and trying to make sense of why you may do the things you do. The therapist might suggest certain behaves may have been the only way you had learnt to deal with intense emotions you had felt at that time. Therefore, even though your behaviour may have been damaging and alarming to others, the behaviour would have made sense to you.

Change techniques

These techniques are used to encourage a person to change their behaviour and learn more effective ways of dealing with distress. Encouragement to replace behaviours that are harmful to the person with behaviours that will help you move forward in life.

How is the treatment carried out?

Delivery of DBT can vary depending on providers. The typical three types of sessions are: 

  • Individual therapy

This involves weekly sessions lasting around 45 minutes. Including a hierarchy of goals to help you feel safe, to reduce behaviours which may be interfering with therapy by addressing any issues which come into the therapy room, help you reach your goals and have a better quality of life by addressing any mental health problems and lastly help you to learn new skills by replacing unhelpful behaviours.

You will normally be asked to complete diary cards as homework which is used to monitor emotions and behaviours.

  • Skills training in groups

You will learn skills in a group, not a group therapy session but more a series of teaching sessions. There are normally two therapists and occur every week. The aim of the sessions will be to teach you skills that you may apply in your day to day life. The four typical skills covered are: mindfulness which makes you focus your attention on your life in the present moment as apposed to distraction techniques, distress tolerance to learn how to deal with crises in a more effective way and without resorting to harmful behaviours, interpersonal effectiveness to teach you how to ask for things and be able to say no, whilst maintaining your self-respect and lastly, emotion regulation which helps you being more aware and able to control emotions.

Within these sessions you will normally be asked to engage in role play and to practise outside of sessions.

  • Telephone crisis coaching with a therapist

DBT is often used within this aspect to support people using skills in day to day life. Meaning you can call a therapist in between sessions when you feel you may need support in situations like: 

  • Dealing with immediate crisis
  • Using a DBT skill, but need advice on doing so
  • Needing help repairing relationship between therapist and self.

Boundaries will be set in relation to calls, and rules agreed between you both.

This type of therapy is becoming more popular and is beginning to be used in a lot of NHS services, a counsellor may carry out additional training to be able to administrate this training. 

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