You’re Not in DBT, part 1

Today I am going to talk about DBT, or Dialectical Behavior Therapy. I’m a therapist on two DBT teams, and I have noticed a major problem in the therapy community is that clinicians are advertising DBT services when they are not providing them. A lot of folks with “over control” disorders are referred to DBT programs, particularly those with restrictive-type anorexia, so it’s a topic worth discussing.

DBT is a cognitive behavior therapy-related treatment for Borderline Personality Disorder (BPD). It assumes that people with BPD have a biological predisposition to high emotional sensitivity and slow return to baseline emotional state, coupled with a history of an invalidating social environment. This is called the biosocial theory.

DBT addresses the sequelae of these factors, which can include life-threatening behavior, problems with impulse control, cognitive rigidity, emotion dysregulation and ability to tolerate distress, and interpersonal difficulties. It is a mindfulness-based therapy, drawing from the work of Jon Kabat-Zinn as well as the Zen school of thought.

DBT programs are made up of “modes” of treatment, which are:

  • Weekly individual therapy, with a therapist who has training in DBT (via internship/residency, on-the-job supervised by a trained DBT therapist, and/or formal training events)
  • Weekly skills training – individual, group, or family (as a separate appointment, and also with a trained healthcare provider)
  • Access to phone skills coaching in between appointments
  • Therapists and other DBT providers are members of a consultation team with weekly meetings – “therapy for therapists”

If your therapist is not offering these services to you, there is a chance that you are not in DBT.

There are some exceptions. Hospitals, residential programs, and research settings may provide variations on service delivery. You could also be waiting for a therapist or skills trainer but may still have access to other services.

DBT is different from some types of therapy in that it is not an all-encompassing theory with treatments for a large number of disorders. For example, Psychodynamic theory focuses on the impact of early life on conscious and unconscious psychological processes. Another example is Cognitive Behavior Therapy, which is a problem-solving approach and examines the role of present thinking and behaviors on mood state with the intent to change thoughts and behaviors.

DBT is not a theory in itself. It is a specific treatment with protocols within it aimed primarily at BPD and BPD traits (though may work for other disorders).

There is absolutely nothing wrong with therapists using elements of DBT, such as:

  • Using worksheets from the skills training manual in session or as homework because they find them useful.
  • Assuming and teaching the biosocial theory when working with individuals with BPD.
  • Teaching DBT terms to clients.
  • Using a DBT-like session structure.
  • Teaching mindfulness – mindfulness is not exclusive to therapy.

But advertising DBT services when not providing them is not okay.

Worse, many insurance companies will not verify whether or not a clinician is providing DBT services before listing them as DBT providers on clinician directories.

The next post will focus on how to find a DBT therapist, what to expect, and alternatives to DBT.