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More about Dialectical Behaviour Therapy DBT

philosophical idea, but in practice it refers to strategies in which opposing views of a situation or extremes of a feeling are considered, and an attempt is made to identify “a middle path” of thinking and behaving which incorporates or combines elements of both opposing positions, that is, achieving an integration or synthesis of opposites.  The main dialectic in Dialectical Behaviour Therapy DBT is that of acceptance and change. Marsha and her team realised that previous, largely unsuccessful, treatments for Borderline Personality Disorder often stalled because clients struggled with the essentially change-based focus - clients felt invalidated, become upset and angry and /or withdrew from treatment when they felt continually pushed to change. A balance between acceptance and change was introduced and is a central theme of Dialectical Behaviour Therapy DBT.


Change and Acceptance

Many of the strategies in Dialectical Behaviour Therapy DBT are traditional cognitive and behavioural strategies and have a change focus, and Marsha has incorporated acceptance strategies derived from the traditions of Zen and contemplative prayer. DBT therapists acknowledge people’s wish to be accepted as they are, and a simultaneous wish to change. These positions are opposite, but in dialectical terms can both be true at the same time i.e. the person wants to both change and not change. Therapists communicate acceptance of clients as they are, while also acknowledging that in order to build a life worth living they have to change. Clients are validated, and it is made explicit that their behaviours, even deliberate self-harm, make sense in real ways. Therapists actively communicate that clients’ thoughts, feelings and behaviours are valid and that they can learn how and when to trust and use their own internal experiences and judgement.


Skills training in DBT

A central component of Dialectical Behaviour Therapy DBT is skills training, with four modules of skills. Two are largely change oriented, Interpersonal Effectiveness and Emotion Regulation, and two are acceptance-based, Distress Tolerance and Mindfulness. Skills are usually taught in a group format, although they can also be taught in individual sessions. Skills acquisition is a very significant component of the effectiveness of Dialectical Behaviour Therapy DBT, and skills help clients move from feeling largely out of control of their emotions and behaviour to feeling in control. Clients learn to control their attention and awareness of the present moment, use interpersonal skills that are effective, start new relationships and improve current ones, understand how to regulate emotions, and tolerate emotional pain without feeling compelled to resort to behaviours that may be self-destructive.

Who can benefit from DBT?

Dialectical Behaviour Therapy DBT may be a suitable treatment for people struggling with


  • Substance dependence

  • binge eating and bulimia

  • trauma-related difficulties

  • difficulties with mood management including Bipolar Disorder and Depression.

  • feelings of emotional numbness or overly intense emotions including anger

  • turbulent or otherwise difficult interpersonal relationships

  • urges to self-harm

  • frequent suicidal thoughts

If you or someone close to you is experiencing any of these kinds of problems, please consider making an appointment so that we can discuss whether DBT would be a suitable treatment for you. I invite you to also review my other articles at Dialectical Behaviour Therapy DBT including Borderline Personality Disorder - Emotional vulnerability and What is Dialectical Behaviour Therapy DBT ?

Dialectical Behaviour Therapy, often referred to as DBT, is a psychological treatment developed by Marsha Linehan, a clinical psychologist from Seattle. Marsha developed this form of behavioural treatment for highly suicidal young women who engage in self-injurious behaviour and who struggle with intense and poorly controlled emotions. Often these women meet the criteria for a disorder called Borderline Personality Disorder (BPD), and have co-existing mood disorders, post-traumatic stress disorder, eating disorders, and alcohol and drug problems. Clearly, this was a group of people with a great deal of psychological difficulties, and prior to Marsha’ publication of her first treatment manual in 1993 adequate treatments were not available. Dialectical Behaviour Therapy DBT is now the golden standard treatment for Borderline Personality Disorder, and is also an evidence based treatment for depression, substance dependence, post-traumatic stress disorder (PTSD) and eating disorders.

How is Dialectical Behaviour Therapy DBT different from standard cognitive and behavioural treatments? The major innovation in Dialectical Behaviour Therapy DBT is the use of dialectics. This term is used to describe a rather complex 

Sadness is a difficult emotion to regulate at times
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