Dialectical Behaviour Therapy

What is Dialectical Behaviour Therapy (DBT)?

DBT is a model of therapy that has been developed to help individuals who struggle on a day to day basis with managing their emotional states.  When having these difficulties, individuals may utilise strategies that are less then helpful to them and others. These may include self harming behaviour, suicidal intentions and actions, lashing out and/or rejecting others, and other impulsive behaviours such as over-spending, over-eating, drinking, taking drugs, gambling and promiscuous  activity, to name but a few.

Due to having difficulties in controlling emotions & behaviours, relationships can be difficult to maintain, and those seeking to help can be rejected.  Individuals who experience these difficulties  spanning across their early adult & adult years often attract the psychiatric diagnostic label of “Borderline Personality Disorder, or Emotionally Unstable Personality Disorder’. This can often be an unhelpful diagnosis, as it can lead to ‘professionals’ judging behaviours, and not fully understanding the overwhelming struggles of the individual underneath.

Dr Marsha Lineman, an American psychologist, developed DBT. Her perspective on those with a diagnosis of ‘borderline or emotionally unstable personality disorder’ is  that individuals are actually suffering from ‘emotional regulation disorder’, and this inability to regulate emotions often lies in traumatic early experiences, particularly in relation to inattentive, neglectful, and/or abusive primary care-givers. That, as children, these individuals have not been taught, or experienced how to regulate the primary emotions of anger, disgust, fear, happiness, sadness and surprise (shock). An inability to regulate these primary emotions leads to them becoming overwhelming and then an unhelpful action will be performed (eg self harm, lashing out, etc) to get rid of the emotion, which unfortunately leads to unwanted secondary emotions, such as guilt and shame, and of course the consequences of the unhelpful action that has been taken.

DBT recognises that whilst individuals engage in behaviours that are unhelpful to themselves and others (eg self harming, suicidal, impulsive and risky behaviours are called “Life Threatening Behaviours”), that the individual is doing the best they can, with the resources that they have got. DBT encourages individuals to consider their life goals in terms of having “A Life Worth Living”.

DBT identifies four areas that individuals who struggle to manage their emotions, have not had any help with:

 – Distress Tolerance
 – Emotion Regulation
 – Interpersonal Effectiveness
 – Core Mindfulness, being able to make ‘wise mind’ decisions, rather than take impulsive actions

DBT proposes that having a therapist who respects the individual, and can teach them the core skills that have been missing in their early years, will encourage the individual to value their own life by reducing their “Life Threatening Behaviours’” and work towards “A Life Worth Living”.