This text aims to make an overview of what DBT is, how it came about and how it is applied in its standard model
Dialectical Behavioral Therapy (DBT, from the original Dialectical Behavioral Therapy) is a psychotherapeutic approach based obehaviouror analysis, dialectical philosophy and Zen Buddhist practice, which, based on the principles of acceptance, change and dialectic, aims to treat problems of mental health, provide relief from psychological suffering and help build a full life (Leonardi, 2018). Developed by Marsha Linehan in the 1970s and 1980s as a treatment for suicidal and self-injurious behaviors, DBT, which is a cognitive behavioral therapy, was recognized as the gold standard in the treatment of Borderline Personality Disorder and, recently, has been extended to other clinical conditions, such as eating disorders, chemical dependency, major depression and adherence to medical treatments, in addition to being adapted for children and adolescents with severe behavioral problems (Leonardi, 2018).
Based on this, DBT is, to a certain extent, a toolbox that favors self-observation, understanding of the functions of emotions and the use of resources both for the prevention/anticipation of episodes of intense emotional suffering and for emotional regulation when it is necessary (I will talk about emotional regulation and dysregulation in another text here on the blog).
When used in its Standard mode, DBT consists of a combination of individual psychotherapy, group skills training, telephone coaching and a consultation team for therapists. In the next sections, we’ll go further into these facets.
Individual psychotherapy is the nucleus that organizes the entire treatment process: it helps the patient to control crises, helps in understanding the functions of his own behavior, monitors behaviors that bring harm, helps in the application of skills, helps the patient to modify his own environment, among others, all with an individual and specific look, taking into account the reality of that individual.
DBT Skills Training aims to assist people change their problematic patterns of behavior, emotion, interaction, and cognition (Linehan, 2018). It is carried out in parallel with individual therapy, and in general, it is carried out weekly with an average duration of 02 hours, going through 4 skill modules: Mindfulness, Interpersonal Effectiveness, Emotional Regulation and Tolerance to Discomfort. It is also possible (although not ideal) to train basic skills (such as those aimed at times of emotional crisis) in individual therapy sessions, as a way to contribute to increasing the behavioral repertoire until skills can be learned more diligently in the training schedule.
On the other hand , telephone coaching , roughly speaking, serves as extra support for the individual therapist through brief calls with different objectives, such as: a) managing risky behaviors; b) help with crisis management; c) assisting in the use of Skills and d) telling good news/fostering the therapeutic relationship.
Finally, the Consulting Group is a team of DBT therapists in which everyone helps each other both with the clinical cases themselves and with regard to the attitude and expertise of the therapist. It is governed by the motto: “a community of mental health professionals who care for a community of patients”.
Thus, DBT integrates a complex, complete and principled treatment, in order to assist in the processes of emotional dysregulation that have been associated with a variety of mental health problems arising from patterns of emotional instability, in impulse control, in relationships interpersonal skills and self-image (Linehan, 2018).
Who is Marsha Linehan?
Marsha Linehan is a psychologist, author, teacher and creator of DBT. Born May 5, 1943, she was admitted at age 17 to the Hartford Clinic in Connecticut. She began self-injuring at an early age, repeatedly burning her wrists with cigarettes and cutting herself with any available sharp item. There she was diagnosed with schizophrenia, treated with medication, numerous sessions of Freudian analysis, and even electroconvulsive therapy! Her desire to die only increased, and she frequently returned to her isolation room, spending 26 months in the hospital. [1] “I was in hell … and I made a promise: when I got out, I would come back and get them out” [1] – Marsha M. Linehan, creator of Dialectical Behavior Theraphy (DBT), 2011, New York Times.
Marsha even wrote a biography where she gives more details about her trajectory and how she integrated different areas of knowledge that then culminated in the DBT model.
That was a brief introduction about DBT in its most general aspects, and I hope to talk a little more about it here!