Dialectical Behavior Therapy (DBT) is a treatment that was originally designed specifically for individuals with self-harm behaviors, such as self-cutting, suicidal thoughts, urges to suicide, and suicide attempts. People with these behaviors sometimes meet criteria for a condition called borderline personality disorder (BPD). Individuals diagnosed with BPD also tend to struggle with other problems — depression, bipolar disorder, post-traumatic stress disorder (PTSD), anxiety, eating disorders, or alcohol and drug problems.
In our experience, the symptoms people experience exist for a good reason. Their previous experience has led to their developing a manner of coping that helped them survive difficult circumstances. Typically, people who benefit most from DBT are people who are highly sensitive by nature. They feel their own emotions and their environment deeply and intensely. Additionally, highly sensitive people often experience invalidation from their environment. Other people, who are not as sensitive, may not understand or accept a more sensitive person’s experience, and thus try to convince them that they are wrong or bad for feeling as they do. When this happens often enough, it can cause a highly sensitive person to question and mistrust their own reality, their thoughts and feelings, in a way that creates distress. This leads to a vicious cycle of feeling misunderstood, wrong, bad, and miserable. This, in turn, leads to coping behaviors that tend to make the problems worse.
As DBT Therapists, we take the view that people are doing the best they can, and they need to learn to do better, be better at solving their problems. We also believe that people struggle with ineffective behaviors and unsatisfying relationships, not because they are bad or broken, but because they have not yet learned to be skillful in their approach to living and to relationships. Therefore, we look at issues with which people struggle, and the difficult emotions they experience as problems to solve. In DBT we promote the attitude that “even though I did not cause all of my problems, they are mine to solve.” We approach therapy from a behavioral perspective; seeking to identify and promote or strengthen effective attitudes and behaviors, and seeking to identify and reduce or eliminate problematic or ineffective attitudes and behaviors.
3 types of problem behaviors include: Life Threatening Behavior, Therapy Interfering Behavior, Quality of Life interfering Behavior. These are addressed in order of importance, as listed here. DBT also has 3 primary phases. Phase 1 is the skills building phase, where we are focused on eliminating problem behaviors and learning and practicing effective skills. Phase 2 is the trauma resolution phase where, with some stability achieved by eliminating problem behaviors and improving skills, the long-standing emotional patterns are addressed in order to gain relief from chronic painful cycles. The completion of phase 2 often gives clients so much relief and access to skills that they choose to terminate therapy and live their lives. In phase 3, some clients choose to optimize their potential, seeking to pursue self-actualization or to engage in personal growth beyond being free of past patterns.
DBT consists of 4 parts as well, including individual therapy sessions, skills group, and coaching as the foundation of Dialectical Behavior Therapy, as well as a consult group for the DBT therapists to monitor their own use of DBT to be sure they are adherent to the principles and practices. Clients also use a self-monitoring and self-report process using diary cards, in which clients track their own symptoms, thoughts, feelings, and behaviors, and these are reviewed weekly. Skills group teaches 4 primary skills of DBT: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness.
At Spectrum Recovery Solutions, DBT principles, concepts, and skills are incorporated into our treatment process for people struggling with addictive behaviors and relationship conflict. David Llewellyn and Alicia Allen are intensively trained in DBT. Betcy Walter, Michele Band, Paula Wilkinson, and Rena Essrog are trained in DBT skills.
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