Frequently Asked Questions: Dialectical Behavior Therapy (DBT)
What is DBT:
DBT stands for Dialectical Behavior Therapy. It was developed by Dr. Marsha Linehan, researched heavily, and then published in 1993. In terms of therapy systems, it’s relatively new. In the 1970’s, Linehan was working with people who felt chronically suicidal, had urges to hurt themselves, and had chaotic relationships. She noticed that they also tended to feel emotionally out of control or empty, and tended to engage in reckless or impulsive behaviors. At the time, something called Cognitive Behavior Therapy (CBT) had become popular. CBT focused on how our thoughts affected our feelings, which affected our behaviors. It was very useful, but Linehan noticed that something seemed to be missing.
She found that her clients tended to feel somewhat overwhelmed and distressed by the push to change, and that they tended to withdraw, become angry, or have some combination of the two. She also saw that therapists had a tendency to withdraw when confronted by anger and would then stop pushing for change. Finally, many people who came for this kind of therapy had a lot going on – not only were they dealing with the problems mentioned above, but were also dealing with the consequences of not being effective in how they dealt with them. This pattern led to the clients (and the therapists) feeling like failures, feeling that they were helpless, and feeling that no matter what they tried, nothing seemed to work.
Linehan, who had struggled with these issues when she was younger, thought that modifying traditional CBT might help. One very important addition was validation – communicating that there was a reason people felt the way they did, and looking for the valid pieces of their reactions. Acceptance was another critical change. We tell people that we accept them where they are as they are. There is a reason people react the way they do. At the same point, she introduced the idea of dialectics. A dialectic is a situation where you have two things that seem to be opposites, and yet can both be true at the same time. The major dialectic in working with DBT is this: You are where you are for a reason, and given what you’ve been through, it makes sense that you react the way you do. And, what you’re doing isn’t working for you, so there is a need to change what you’re doing. Acceptance and change – both are necessary and important in this therapy.
At this point, DBT and therapies that use DBT skills are used for many other diagnoses and distressing situations. These include major depression, bipolar disorder, anger management, anxiety disorders (including PTSD, to some extent), eating disorders, and general coping. While it was developed for and is still used for borderline personality disorder, these are simply good, solid coping and interaction skills.
On this series of pages, you'll find information related to commonly asked questions about DBT.
DBT stands for Dialectical Behavior Therapy. It was developed by Dr. Marsha Linehan, researched heavily, and then published in 1993. In terms of therapy systems, it’s relatively new. In the 1970’s, Linehan was working with people who felt chronically suicidal, had urges to hurt themselves, and had chaotic relationships. She noticed that they also tended to feel emotionally out of control or empty, and tended to engage in reckless or impulsive behaviors. At the time, something called Cognitive Behavior Therapy (CBT) had become popular. CBT focused on how our thoughts affected our feelings, which affected our behaviors. It was very useful, but Linehan noticed that something seemed to be missing.
She found that her clients tended to feel somewhat overwhelmed and distressed by the push to change, and that they tended to withdraw, become angry, or have some combination of the two. She also saw that therapists had a tendency to withdraw when confronted by anger and would then stop pushing for change. Finally, many people who came for this kind of therapy had a lot going on – not only were they dealing with the problems mentioned above, but were also dealing with the consequences of not being effective in how they dealt with them. This pattern led to the clients (and the therapists) feeling like failures, feeling that they were helpless, and feeling that no matter what they tried, nothing seemed to work.
Linehan, who had struggled with these issues when she was younger, thought that modifying traditional CBT might help. One very important addition was validation – communicating that there was a reason people felt the way they did, and looking for the valid pieces of their reactions. Acceptance was another critical change. We tell people that we accept them where they are as they are. There is a reason people react the way they do. At the same point, she introduced the idea of dialectics. A dialectic is a situation where you have two things that seem to be opposites, and yet can both be true at the same time. The major dialectic in working with DBT is this: You are where you are for a reason, and given what you’ve been through, it makes sense that you react the way you do. And, what you’re doing isn’t working for you, so there is a need to change what you’re doing. Acceptance and change – both are necessary and important in this therapy.
At this point, DBT and therapies that use DBT skills are used for many other diagnoses and distressing situations. These include major depression, bipolar disorder, anger management, anxiety disorders (including PTSD, to some extent), eating disorders, and general coping. While it was developed for and is still used for borderline personality disorder, these are simply good, solid coping and interaction skills.
On this series of pages, you'll find information related to commonly asked questions about DBT.