Dialectical Behaviour Therapy (DBT) was developed by Marsha Linehan, a Professor of Psychology, Psychiatry and Behavioural Sciences at the University of Washington. She was struggling to find solutions for her patients in hospitals and clinical practice who came in repeatedly with chronic suicidal thoughts and suicide attempts. Through her work with DBT, she went on to become the Director of the Behavioural Research and Therapy Clinics at the university. Her primary research focuses on developing and evaluating evidence-based treatments for those with high suicide risk and multiple major mental health issues. All of this information can be found in the “About The Author” section of her book, “DBT Skills Training Handouts and Worksheets” which is also the book we use in our Dialectical Behaviour Therapy Groups at Alongside You.
Now, let me tell you in her own words why Marsha Linehan developed, and is passionate about her own work in DBT. I happened to have the pleasure of doing some training with Marsha last year in Seattle and she summed up the goal of DBT and her work with clients in one sentence: “To have a life worth living.” I can’t think of a better way to explain the goal of DBT. So many of the people I work with, particularly those who struggle with chronic suicidal thoughts and actions, and multiple major mental health issues have ceased believing that it is possible to have a life worth living. This is my job as a therapist and the job of DBT – that is, to help the people I work with see that it is possible to have a life worth living.
How Does DBT Help Clients?
DBT focuses on four major skill areas: Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. The core of DBT begins with an analysis of each client’s behaviour through chain analysis, and missing-links analysis to find the causes of the behaviours and come up with a plan for problem-solving around these causes. Chain Analysis addresses when we engage in the ineffective behaviour, while Missing-Link Analysis addresses when we fail to use effective behaviours. This allows my clients to be aware of their struggles and plan accordingly in a proactive way.
- Mindfulness skills help clients reduce suffering and increase happiness and control of their own mind. Linehan is a Zen Master and incorporates mindfulness into DBT throughout. However, we don’t have to be Zen Masters to make use of mindfulness skills! There are many ways to practice mindfulness and I encourage my clients to try many different methods and find the best fit for themselves.
- Using Interpersonal Effectiveness skills can help clients develop new relationships, improve current ones and deal with conflict. Many of us struggle with asking for what we want or need in relationships, as well as struggling with how to say no to things we need to. Effective relationships is a core need for all of us in building our support systems and our resilience.
- The goal of Emotion Regulation Skills is to reduce emotional suffering. We’re not saying you should try to get rid of emotions because emotions play a very important role in our lives. Rather, we emphasize working on our skills and ability to manage, regulate, and change our emotions when we have a desire or need to.
- Distress Tolerance is described by Linehan as having the skills to tolerate and survive a crisis situation without making the situation worse. This is important for two primary reasons: pain is a part of life that we cannot avoid, and the ability to tolerate distress is a necessary step in making any changes in our lives. Without distress tolerance skills, the stress of making changes will circumvent our attempts to move forward in a different way. Through Crisis Survival Skills and Reality Acceptance Skills, clients learn to tolerate their distress and make lasting changes in their lives.
While DBT was originally developed to help highly suicidal clients, and those meeting the criteria for Borderline Personality Disorder, DBT is also able to help with other issues. For those struggling with Depression, Anxiety, Trauma, Stress Management, Anger Management, Conflictual Relationships, DBT can be a good choice. If you’re struggling with any of the above issues, using these four core skills of DBT can help you build the core mindfulness skills necessary to remain present in our lives. DBT helps you better manage your emotions and reactions to situations, be more effective in your interpersonal relationships, and tolerate the distress involved in making changes in your life. If you’re dealing with any of these issues, I hope this gives you hope. DBT is not the only solution, but it is a proven, effective solution that produces results!