Many of us have heard of Cognitive Behaviour Therapy (CBT), which is a beneficial and effective therapy to help us change our thoughts and behaviours. However, you may have had Dialectical Behaviour Therapy (DBT) recommended to you and wondered ‘what’s the difference?’.
What’s different about Dialectical Behaviour Therapy?
DBT is one of several valuable therapies which came out of the CBT tradition. Dr. Marsha Linehan, who developed the DBT framework, started her career by working with some of the most distressing symptoms which we see as counsellors – suicide attempts, self-harm, addictions and hopelessness. Part of the reason she did that was because – well, she’d been there herself1.
What’s with that word: ‘dialectical’?
The ’dialectical’ in DBT just means opposing – and we come across so many examples of that in our own lives. In DBT, we recognize that there are some things about ourselves and our lives that we may not like, but we have to accept in order to make progress. On the other hand, there are things which we can change, and if we can, we must. This apparent contradiction between acceptance and change (and how to tell the difference), is super-important, and can be very empowering.
DBT is a skills-based therapy. This can seem daunting, because there are quite a few skills to learn, and a full course of DBT skills here at Alongside You takes 24 weeks. However, let’s break down why this may be necessary. We can probably all agree that circumstances in our childhood may get in the way of us learning certain skills (eg emotion regulation). This will mean that, as adults, we will have to learn those skills. We often feel great shame about not having all this ‘at our fingertips’ – but if nobody had ever taught us to read, would we really be surprised if we struggled? Of course not! So we can start removing the shame, and working on learning the skills that will allow us to thrive.
Do I have to have BPD to benefit from DBT?
If you Google DBT, you are going to see reference to Borderline Personality Disorder (BPD). Often, DBT is recommended for BPD which is a distressing condition resulting in difficulties regulating our emotions. It’s clear that adverse childhood experiences are implicated in this condition (some sources suggest up to 90% of clients with BPD have experienced childhood trauma2).
However, this is NOT the only reason to attend a DBT skills group. DBT is a safe and effective therapy for many problems, including:
- Anxiety
- Depression
- suicidal ideation
- self-harming
- rejection sensitivity dysphoria
- and many more3.
I can say, as someone who facilitates these groups, that I personally use these skills every single day of my life. They are practical, simple to understand and relatively easy to implement. That being said, as with every single therapy or intervention, we will get out of it exactly what we put in. The more we practice, the better we’ll get and the easier it will become.
Does it have to be in a group?
Before I became a counsellor, the idea of ‘group therapy’ was something I would totally have rejected. I had a LOT of preconceptions (mostly based on tv and movies!) and a fear of sharing my ‘stuff’ in public. However, having been part of several groups now, I have seen (and felt) the benefits of being in groups. Firstly, concerns about confidentiality can be worrying – however confidentiality is absolutely the first thing we cover in group. Remember, others will be as careful of keeping your stuff private as they hope you’ll be in keeping their info safe! More than anything else, having the opportunity to share your experiences with others who really ‘get it’ and won’t judge you is a truly validating and safe experience. Being able to learn from others’ experiences, have them learn from you and share your triumphs and failures in a supportive environment cannot be overstated. It really is kind of magical – and highly-effective.
Being Effective
Talking about being effective, that’s one of the words you’ll hear most frequently in DBT. Once we start letting go of that judgement (which means letting go of our iron grip on ‘good and bad’ or ‘right and wrong’), we need a helpful way to assess our behaviour and how well it serves us. Enter ‘effectiveness’. Are the behaviours we are exhibiting effective in getting what we want? Or do they make us less effective? It’s a very powerful way for us to evaluate what we’re doing, and how things change when we change.
Freedom Through Control
So, here’s the ultimate ‘dialectic’ (or opposing) concept. When we aren’t good at regulating our emotions, very often our emotions do the reacting and behaving for us. If you’ve ever felt like you are watching yourself having a meltdown while completely unable to do anything about it – your emotions are in the driving seat. Paradoxically, when we gain more control over our emotions, it allows us to choose our response and our behaviour. When we have choices, we gain true freedom. This absolutely does not mean that we learn to squash our emotions down, or ignore them – quite the opposite. By giving them permission to be felt, we can learn how to cope with unpleasant or upsetting feelings, and deal with them in a better way than acting out, hurting others or hating ourselves.
I’m Interested – Now What?
Here is a link to an interview with Dr. Marsha Linehan which explains the essence and basics of DBT4. If you are interested in joining our fall group (starting October 28th), please contact us here to find out more. We look forward to answering any questions you might have!
Citations
1 Full Audiobook (Ed.). (2025, June 12). Building a Life Worth Living: A Memoir Audiobook by Marsha M. Linehan. YouTube. https://www.youtube.com/watch?v=j4x11qE6F-0&ab_channel=FullAudiobook
2 Bozzatello, P., Rocca, P., Baldassarri, L., Bosia, M., & Bellino, S. (2021). The Role of Trauma in Early Onset Borderline Personality Disorder: A Biopsychosocial Perspective. Frontiers in Psychiatry, 12, 721361. https://doi.org/10.3389/fpsyt.2021.721361
3 Core Evidence & Research. Behavioural Tech Institute. (n.d.). https://behavioraltech.org/evidence/
4 HSE Ireland. (2014, December 14). Marsha Linehan – Interview. YouTube. https://www.youtube.com/watch?v=fR7Oi0cyoVo&ab_channel=HSEIreland