by Martha McLaughlin
Dialectical Behavior Therapy is a psychotherapy approach developed by Dr. Marsha Linehan. When Dr. Linehan was a teen, she went through a period where she was was suicidal and engaged in self-harming behaviors. She struggled through various forms of therapy which were unsuccessful in healing her, until she finally had a sort of religious experience where she felt a deep self-love that set her on the road to recovery.
While Dr. Linehan was in the midst of her struggles, she told herself she would get out of her situation and help others with similar struggles. She eventually earned a PhD in psychology with the goal of helping others who struggled as she had. In 2011 she told an interviewer, “I developed a therapy that provides the things I needed for so many years and never got.”1
Linehan began working with patients who’d been diagnosed with borderline personality disorder, a condition in which people have trouble regulating their emotions. She wasn’t fully satisfied with the results she was seeing from either Cognitive Behavioral Therapy, which emphasizes change, or other approaches that were more acceptance-based, so she developed a program to incorporate both.
Dialectical Behavior Therapy acknowledges that clients feel such intense emotions that their behaviors make sense on some level, but that to build a life worth living, new behaviors need to be learned. One practitioner describes it this way: “It’s basically ‘I’m doing the best I can’ on the one hand, and ‘I need to do better.’”2
Although DBT was originally developed for patients with borderline personality disorder, it’s been proven effective for people dealing with a wide variety of conditions. A study of teens with bipolar disorder found that DBT treatment led to improvements in suicidality, self-injury, depressive symptoms and emotional dysregulation.3
Another study of teens with a history of self-harming behaviors found that those treated with DBT saw greater improvements in depressive symptoms, suicidal ideation and self-harm than those treated with enhanced usual care.4
The Goals and Skills of DBT
There are certain general goals to DBT, and each is met in a specific, structured way. Practitioners help clients to enhance their capabilities and motivation, generalize skills to their specific situations, and help them optimize their environment. DBT also contains an element of support for therapists.
Behavioral skills are generally taught in a group setting. Participants learn mindfulness, distress tolerance, interpersonal effectiveness and emotional regulation. Clients also participate in individual therapy, and telephone coaching is available between sessions. The physical and social environment is optimized with case management strategies.
When the program is used with adolescents, parents are involved in the process. If you’ve got a teen in DBT treatment, you’ll participate in skills training and family therapy along with your child. An additional skill taught when the program is used with teens is learning to “walk the middle path,” which involves compromise, negotiation, and learning to validate the experiences of the other person. Therapists always address life-threatening behaviors first, followed by therapy-interfering behaviors and behaviors that affect quality of life.
DBT Skills Training
Parents involved in DBT with their children often report how helpful the skills training is for them personally. Skills training involves the following:
- Mindfulness – Mindfulness includes observing thoughts and feelings objectively, without judging them, and learning to live in the present moment, rather than in the future or the past. When you and your teen learn mindfulness, you’re more able to tolerate powerful emotions, including those that may arise in therapy.
- Distress tolerance – Learning distress tolerance involves training in distraction, self-soothing, relaxation, finding meaning in pain, encouraging yourself, weighing pros and cons, and what DBT calls radical acceptance of reality.
- Emotional regulation – You and your child will learn to identify your emotions, discover what prompted them, identify obstacles to changing negative ones, and increase the amount of positive emotional events. You’ll also be taught to care for your physical health in order to help maintain emotional stability.
- Interpersonal effectiveness – This skill involves learning to express feelings and desires in healthy ways. You’ll be taught conversational skills, including using appropriate language and expressing interest in what others are saying. Other goals include being fair, staying truthful and maintaining values.
- Walking the middle path – You and your teen will learn to validate your own experiences as well as the experiences of the other. You’ll be taught to actively listen and observe and to respond with respect. The goal is to learn that the same situation can be viewed in multiple ways and to find the balance in each situation between acceptance and change.
DBT takes commitment, on the part of teens, their parents and their therapists. Participants need to be willing to devote time and emotional energy to the process. Change doesn’t come overnight, but when teens learn the skills DBT teaches and apply them to their personal situations, life can be calmer and happier for the entire family.
1 Carey, Benedict. “Expert on Mental Illness Reveals Her Own Fight.” The New York Times, June 23, 2011.
2 Garey, Juliann. “DBT: What Is Dialectical Behavior Therapy?” ChildMind.org, Accessed January 28, 2018.
3 Goldstein, Tina, et al. “Dialectical Behavior Therapy for Adolescents With Bipolar Disorder: A 1-Year Open Trial.” Journal of the American Academy of Child and Adolescent Psychiatry, July 2007.
4 Mehlum, L. et al. “Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial.” Journal of the American Academy of Child and Adolescent Psychiatry, July 22, 2014.