You’re Not In DBT, part 2

In You’re Not in DBT, part 1, I gave a brief definition of Dialectical Behavior Therapy (DBT) and suggested your therapist may be engaging in dishonesty behavior if claiming to provide DBT services when they are not providing all modes of DBT service delivery.

Today we’ll talk about what to expect from DBT and how to find a provider.

What to Expect (Briefly)

  1. Providing a commitment not to kill yourself or engage in self-harm – and keeping that commitment.
  2. Avoiding psychiatric hospitalization like the plague.
  3. One hour of individual therapy and one to two hours of skills training per week, with homework.
  4. It’s behavioral, so you change your behavior – yes, that’s easier said than done, but the plus side is you get guidance on change.
  5. And there is a big emphasis on acceptance – you are where you are.
  6. Getting comfy with what seem like contradictions – dialectics.
  7. Tracking emotions, symptoms, and skills used on a diary card on a daily basis.
  8. Acronyms upon acronyms.
  9. Structure – all sessions have an agenda, starting with keeping you alive followed by sticking with therapy and ending with everything else. You don’t get much time to ramble.
  10. Being viewed as capable – which means you’re held accountable for your actions.
  11. Many, many “Assumptions,” a noteworthy one being the relationship between the therapist and client as a relationship between equal people. Yep, your therapist is a human, not unlike you.

Where do I find a DBT therapist?

Check the Behavioral Tech “Find a Therapist” directory

Also check the DBT-Linehan Board of Certification website

You can also ask your psychiatrist or get a referral from an inpatient program, if applicable. Chances are pretty good they’ll suggest it before you ask if there is a program close to you, and your risk of committing suicide is high.

Next in the series will feature alternatives to DBT, for those who find DBT ineffective, don’t have access to it, or just don’t plain care for it.

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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.