What Is Dialectical Behavioral Therapy?

Dialectical Behavioral Therapy (DBT) is a method of treatment that was devised by Marsha Linehan, faculty at the University of Washington in Seattle, for the treatment of borderline personality disorder (BPD). Typically clients with BPD, as defined in DSM-IV, are notoriously difficult to treat (Linehan 1993a). They often do not attend regularly, frequently fail to respond to therapeutic efforts and make considerable demands on the emotional resources of the therapist (particularly when suicidal and parasuicidal behaviors are prominent). The effectiveness of DBT has been demonstrated in many controlled studies across different research groups. Because of this success and due to similar behavior patterns, DBT is now being used in many settings as a viable therapy for the treatment of bipolar disorder.

Treatment in DBT has four parts, which are all important to effective treatment:

• Individual Therapy

• Telephone Contact

• Therapist Consultation
  - good communication between group therapist and individual therapist is essential to the successful outcome of DBT.

• Skills Training
  - Conducted by a behavioral technician or another therapist usually in a group context.
  - Conducted in weekly sessions of 2.5 hours with a break half way through each session.
  - The focus is on learning and practicing adaptive skills, not personal or specific complaints of the clients and thus, any specific or personal issues are redirected to be discussed in individual therapy.

There are four modules in DBT group skills training:

• Core Mindfulness Skills
  - These are derived from Buddhist meditation techniques to enable the client to become aware of the different aspects of experience and to develop the ability to stay with that experience in the present moment.
  - Treatment lasts for about 2-3 weeks.

• Interpersonal Effectiveness Skills
  - These focus on effective ways of achieving one's objectives with other people: to ask for what one wants effectively, to say no and be taken seriously, to maintain relationships and to maintain self-esteem in interactions with other people (comparable to assertiveness training).
  - Treatment lasts for about 8 weeks.

• Emotion Modulation Skills
  - These skills are ways of coping with intense emotional experiences and their causes. They also allow for an adaptive experience and expression of intense emotions.
  - Treatment lasts for about 8 weeks.

• Distress Tolerance Skills
  - These include techniques for putting up with, finding meaning for, and accepting distressing situations if there is no conceivable solution at present.
  - Treatment lasts for about 8 weeks.