What is Dialectical Behavior Therapy (DBT)?

The primary objective of DBT is to help people learn skills to help manage their emotions, in order to be able to reach their goals and build a life that aligns with their personal values and what matters to them.

Individuals in DBT commonly experience difficulties regulating emotions (including having intense emotions which may fluctuate rapidly), difficulties managing anger, difficulties in relationships, impulsive or risky behaviors, and suicidal, and/or self-harming behaviors.

Dialectics: Dialectics comes from philosophy, and it means that two things that seem like opposites can both be true at the same time. Dialectical thinking can help depolarize conflicts and identify solutions that honor both sides of a conflict, whether internal or interpersonal. One of the core dialectics in DBT is acceptance and change.

Behavior Therapy: DBT is a form of behavior therapy. Behavior therapies are based on the study of how things are learned. Behavior therapies, including DBT, focus on helping people change ineffective ways of coping by learning new ways of coping and solving problems.

Acceptance and change is the central dialectic in DBT. DBT blends behavior therapy strategies, which are focused on helping clients make desired changes, with acceptance and validation strategies, which involve communicating to individuals that they are doing the best they can and that their thoughts, feelings, and behaviors make sense and are understandable given their learning history or present circumstances.

DBT is an “evidence-based treatment,” which means that it has been researched in clinical trials, and, in general, DBT appears as effective or more effective than other psychotherapies for reducing suicidal behavior, substance use problems, anger-related problems, eating disordered behaviors, and interpersonal difficulties.

Most research has been done on Comprehensive DBT (also known as standard DBT), which is the main program we offer. Comprehensive DBT consists of four components: Skills Training Group, Individual Therapy, Phone Coaching, and Therapist Consultation team. For some problems, modifications of Comprehensive DBT are appropriate (i.e., skills training only).

Comprehensive DBT includes 4 components that work together to help clients achieve their goals:

1) Individual therapy (usually weekly)

2) Skills training - typically done in a group format. Unlike many psychotherapy groups, DBT Skills Groups are run more like a class or seminar than a traditional therapy group. For teens, skills training typically involves at least one parent participating.

3) Skills coaching - DBT therapists are available by phone/text to help clients use skills in their lives, and to generalize the skills they are learning to real life challenges in between therapy sessions.

4) Consultation team - DBT therapists meet on a regular basis together to ensure they are implementing the treatment well and to help support one another.

DBT focuses on problems you presently face, that you want to change. We'll work together to understand what is getting in the way of having the life you want to have, and then help you change your behavior.

DBT is supportive and collaborative. DBT therapists believe it is essential for therapy for you to feel accepted, validated, and supported within the context of therapy, while working on changing your life.

DBT is time-limited. We recognize that people don’t want to be in therapy for the rest of their lives. DBT is designed to provide you with the skills you need to continue to work independently, outside of therapy. You become your greatest resource to empowering yourself. Comprehensive DBT lasts for 6-12 months in most cases.

DBT is active. This is not the kind of therapy where you sit on the couch and your therapist nods and takes notes. DBT requires doing work between sessions, outside of therapy, in your life - so that you can reach your goals faster.

Mindfulness: grounded in Zen, and focused on increasing intentional awareness of the present moment throughout one’s daily life, with a one-mindful and non-judgmental stance.

Distress Tolerance: skills to help with getting through moments of very high distress, without acting impulsively in ways that make the situation worse. There are also skills to help with accepting painful realities when we cannot change a situation or when change takes a long time.

Emotion Regulation: skills to help with identifying and understanding emotions, changing emotions you want to change and having emotions when you want to have them, and improving one’s resiliency to withstand stressors in life without frequent overwhelming emotions.

Interpersonal Effectiveness: skills to help with navigating relationships - getting what you want and need from people in your life, maintaining relationships and having people feel good about the relationship with you, and feeling good about yourself in your relationships.

Middle Path: for adolescent clients and families attending multi-family skills group, there are also a few additional skills that help with navigating conflict, improving relationships, and changing behavior effectively.

Dr. Liz LoTempio and Dr. Dorian Hunter, the DBT Center of Tacoma Founders and Directors, are certified DBT Clinicians through the DBT-Linehan Board of Certification. While we plan to get the DBT Center of Tacoma program certified, it is a rigorous process and will take a couple of years to complete.

DBT-Linehan Board of Certification is a non-profit organization founded by Dr. Marsha Linehan, the treatment developer of DBT.

Certification through DBT-LBC is intended to provide clarity to consumers and families who are searching for DBT providers and programs. Certification indicates that a provider or program reliably offers DBT in a way that is consistent with the evidence-based research. Through the certification process, clinicians demonstrate that they have the requisite knowledge and skills to deliver DBT with adherence to the model as it is done in the research.

DBT is a highly involved and at times difficult-to-deliver behavioral intervention. It requires training and skill to deliver competently and with fidelity to the empirically supported treatment. Drs. LoTempio and Hunter believe that, given the complexity of the treatment, and the often high stakes involved, certification is important in DBT. Linehan Board Certification ensures and communicates competency in DBT, as providers with certification have demonstrated that they are able to conduct the treatment to adherence.

If you are interested in reading more about certification, please click here.