Dialectical Behavioral Therapy

 

THE FOUNDATIONS OF DBT

Throughout my experience as a clinician, I have come across DBT on numerous occasions. In my work with adolescents, I have been fortunate enough to partner with community mental health organizations implementing DBT groups for young people struggling with serious depression, persistent trauma and crippling anxiety. This piece is meant to be a very brief introduction to DBT; a glimpse into its early beginnings and to the concepts underpinning its practice.

WHERE DID DBT COME FROM?  

DBT stands for Dialectical Behavioral Therapy. Marsha Linehan developed DBT in the late 1970’s throughout her work with people who were highly suicidal. She literally went to hospitals and asked them to refer the people who were most acutely suicidal to her. Marsha is credited for creating a treatment for Borderline Personality Disorder, which is what DBT is most known for, however Marsha asserts that her initial aim was to address suicidal and self-harming behaviors. Now, DBT is widely accepted as applicable for a variety of mental health conditions, including Posttraumatic Stress Disorder (PTSD), depression, anxiety, substance use disorders, obsessive-compulsive disorder (OCD) and more. In many clinical settings, DBT is practiced in groups and with an individual therapist simultaneously. Treatment includes skills training to improve emotional regulation, interpersonal effectiveness, distress tolerance and mindfulness. 

Marsha had herself been through a lengthy hospital stay in her early life. For two years, she was institutionalized and isolated for months on end. She developed self-harming and suicidal behaviors and was subjected to numerous drug trials and electroconvulsive therapy (ECT). At this very same time, through her personal struggle, she dedicated herself to supporting others’ well-being.

WHAT IS DIALECTICS?

One way to understand the “dialectics” part of DBT is to think about it as a “both/and” perspective. Rather than label someone’s perspective as “right” or “wrong,” dialectics suggests that multiple truths exist at the same time, neither truth more important or more true than the other. In a dialectical approach, therapists and clients are encouraged to consider holding apparent contradictions at the same time. This perspective creates space for seemingly opposite experiences, for example both wanting to live and wanting to die, to exist simultaneously. In this way, DBT practices a validating stance towards another person’s experience and perspective. 

DBT is an approach which combines behavioral and humanistic interventions. In her work, Marsha found that the people she sought to support in “creating a life worth living” did not respond well to either approach applied on it’s own. Instead, she realized that what was most helpful was finding a balance between change and acceptance. What she found in her research was this: on the one hand, people did not want to be told that they are the problem and something is wrong with them. On the other hand, people were suffering tremendously and needed skills to “find a way out of hell.” Interestingly, DBT was actually the first widely practiced treatment to incorporate mindfulness skills. It is a core practice in DBT, derived from Marsha’s own experience with Zen Buddhism. She explains that this foundational practice is all about non-judgmentally embracing moment and focusing on the only reality that exists: the present. 

WHAT IS WISE MIND?

DBT stresses the importance of cultivating a Wise Mind. First, let’s look at the three states of mind in DBT: Emotion Mind, Reasonable Mind and Wise Mind. Emotion Mind is the state of being where feelings are overwhelming and actions are impulsive. Reasonable Mind is the state of being where rationality is most in control; it is used to solve problems and pushes away emotional experience. Wise Mind is the combination of Emotion Mind and Reasonable Mind, drawing upon knowledge, emotional experience and intuitive knowing. 

A BIT OF PRACTICE

As mentioned above, mindfulness is an essential tool and practice in DBT. To further your own awareness, you may wish to explore your own experience of Emotion Mind, Reasonable Mind and Wise Mind. 

*How do you know you are in Emotion Mind? What are your personal cues (thoughts, feelings, sensations) pointing you to knowing when you are taking actions from an impulsive or overwhelmed place? What might be the cost of being reactive, without taking time to consider consequences, in relationships with others? How about any benefits? 

*In what kinds of situations do you utilize Reasonable Mind? How do you know you are in Reasonable Mind (thoughts, feelings, sensations)? What happens when you make choices without taking a moment to consider your emotions? What might be the cost of being fact-based and analytical in relationships with others? How about any benefits? 

*How do you know you are in Wise Mind, having a sense of balance between being in touch with your emotions and able to consider the facts? How do you notice the differences and similarities between Wise Mind, Emotion Mind and Reasonable Mind in your thoughts, feelings and sensations? When are you most in touch with your intuition?

I am drawn to DBT because it is all about balance and radical acceptance. It is an approach and a practice that prioritizes and trusts one’s own experience of themselves and the world. In forthcoming writings, I will explore further the skills DBT draws upon to maintain balance, to offer clarity and to cultivate the inner knowing of Wise Mind.

by Ashley Gregory, LMFT

https://www.lifebydesigntherapy.com/blog/foundations-of-dbt/2/2021