How Does DBT Work?
DBT is a system:
The first thing you need to know is that DBT is actually a therapy system. When you begin DBT therapy, you'll probably notice something different from other forms of therapy. DBT, when done thoroughly, has four components that you need. First, you will be seeing an individual therapist. This is a therapist that you meet with on a one-to-one basis. Your individual therapist will help you deal with overwhelming crisis situations and will help reinforce the skills training you receive. Your individual therapist will also help you analyze situations where things went wrong, and help you figure out ways to be more effective in the future; this analysis is called a “chain analysis.” Second, you will be part of a skills training group or will receive specific skills training sessions. These sessions are to teach you things you can do to help you deal with situations more effectively. Third, you will be able to use phone consultations. These phone consultations will not be full sessions, but rather 10-15 minute telephone “coaching” sessions, to help you apply the skills you’ve learned when you need help. These phone sessions, if they stretch further than 10-15 minutes, may be charged as therapy sessions. The idea is to keep these to brief interactions and help you apply the skills you’ve learned, while you’re in the stressful situation. Some individual therapists will do these, and some won’t. If your individual therapist won’t do these, talk to your skills trainer, as you should have some phone support for applying the skills. Finally, you will have “therapy homework” – these are opportunities to practice using these skills and other things you’ve learned in therapy; these assignments will be tailored to help you be effective in situations that previously cause you problems.
What happens in DBT therapy?
Individual therapy within the DBT system is a lot like standard therapy. However, it will also include DBT-specific aspects, including talking about skills and checking in with where you are emotionally using a tool called the “diary card.” In your individual therapy, you will also identify your “target behaviors” – the things you do that are ineffective and tend to cause trouble for you. In your skills group or sessions, you will be learning about different things you can do to help you cope with stressful or crisis situations. An important point to remember is this: DBT skills are meant to help you deal with a lousy situation, so that you don’t make it worse. The focus here is on not making things worse. Many people get confused and think that using the skills will make things better. Sometimes they may do that and we hope they do, but the bottom line is that if you’re not making the situation worse, then the skills are working.
The overall goal in DBT is to create a life worth living – a life you really want. This involves learning and refining skills that change behavioral, emotional, and thinking patterns associated with problems in living – that is, those that cause misery and distress.
How long does all this take?
DBT is not a 6-week cure. These skills take time to teach, time to practice, and time to master. At a minimum, expect your DBT therapy to last at least 6 months. This is the minimum amount of time to go through one full course of the DBT skills. Traditionally, the skills training group is structured into 3 main modules, each lasting approximately 8-10 weeks, depending on the group. Many groups will take one week off in between modules to allow you time to process the material you just learned, and practice that set of skills all together. With Linehan's 2nd Edition materials now available, there are more module options available, and groups can range anywhere from 13 weeks all the way up to the full 27-30 weeks. With the publication of Linehan's 2nd edition of DBT materials, adjusted schedules are also available, and groups may have cycles that run anywhere from 13 weeks to the full 30 weeks.
The first two to three sessions of a traditional module contain the core mindfulness skills, and the rest of the module is devoted to distress tolerance, emotion regulation, or interpersonal effectiveness skills. The reason we include the core mindfulness skills at the beginning of each module is because these skills are the base that everything else is built on. They are also a bit “slippery” – they can be more abstract than most of the skills and take some extra practice to get good at. If your group is on an abbreviated schedule, you'll get mindfulness at least twice: once at the beginning and once in the middle.
Ideally, you’ll be able to go through the entire skills set twice. There are at least two very good reasons for this structure. First, you get a really good chance to both learn and practice the skills. Second, you get the benefit of having a supportive group and therapeutic environment where you can practice skills, work out life issues, and get help in being effective. While having this structure is desirable, it is not always possible. Because it’s not always possible to remain in the DBT program for a full year, we do our best to support you and prepare you to be effective and skillful outside of therapy.
The first thing you need to know is that DBT is actually a therapy system. When you begin DBT therapy, you'll probably notice something different from other forms of therapy. DBT, when done thoroughly, has four components that you need. First, you will be seeing an individual therapist. This is a therapist that you meet with on a one-to-one basis. Your individual therapist will help you deal with overwhelming crisis situations and will help reinforce the skills training you receive. Your individual therapist will also help you analyze situations where things went wrong, and help you figure out ways to be more effective in the future; this analysis is called a “chain analysis.” Second, you will be part of a skills training group or will receive specific skills training sessions. These sessions are to teach you things you can do to help you deal with situations more effectively. Third, you will be able to use phone consultations. These phone consultations will not be full sessions, but rather 10-15 minute telephone “coaching” sessions, to help you apply the skills you’ve learned when you need help. These phone sessions, if they stretch further than 10-15 minutes, may be charged as therapy sessions. The idea is to keep these to brief interactions and help you apply the skills you’ve learned, while you’re in the stressful situation. Some individual therapists will do these, and some won’t. If your individual therapist won’t do these, talk to your skills trainer, as you should have some phone support for applying the skills. Finally, you will have “therapy homework” – these are opportunities to practice using these skills and other things you’ve learned in therapy; these assignments will be tailored to help you be effective in situations that previously cause you problems.
What happens in DBT therapy?
Individual therapy within the DBT system is a lot like standard therapy. However, it will also include DBT-specific aspects, including talking about skills and checking in with where you are emotionally using a tool called the “diary card.” In your individual therapy, you will also identify your “target behaviors” – the things you do that are ineffective and tend to cause trouble for you. In your skills group or sessions, you will be learning about different things you can do to help you cope with stressful or crisis situations. An important point to remember is this: DBT skills are meant to help you deal with a lousy situation, so that you don’t make it worse. The focus here is on not making things worse. Many people get confused and think that using the skills will make things better. Sometimes they may do that and we hope they do, but the bottom line is that if you’re not making the situation worse, then the skills are working.
The overall goal in DBT is to create a life worth living – a life you really want. This involves learning and refining skills that change behavioral, emotional, and thinking patterns associated with problems in living – that is, those that cause misery and distress.
How long does all this take?
DBT is not a 6-week cure. These skills take time to teach, time to practice, and time to master. At a minimum, expect your DBT therapy to last at least 6 months. This is the minimum amount of time to go through one full course of the DBT skills. Traditionally, the skills training group is structured into 3 main modules, each lasting approximately 8-10 weeks, depending on the group. Many groups will take one week off in between modules to allow you time to process the material you just learned, and practice that set of skills all together. With Linehan's 2nd Edition materials now available, there are more module options available, and groups can range anywhere from 13 weeks all the way up to the full 27-30 weeks. With the publication of Linehan's 2nd edition of DBT materials, adjusted schedules are also available, and groups may have cycles that run anywhere from 13 weeks to the full 30 weeks.
The first two to three sessions of a traditional module contain the core mindfulness skills, and the rest of the module is devoted to distress tolerance, emotion regulation, or interpersonal effectiveness skills. The reason we include the core mindfulness skills at the beginning of each module is because these skills are the base that everything else is built on. They are also a bit “slippery” – they can be more abstract than most of the skills and take some extra practice to get good at. If your group is on an abbreviated schedule, you'll get mindfulness at least twice: once at the beginning and once in the middle.
Ideally, you’ll be able to go through the entire skills set twice. There are at least two very good reasons for this structure. First, you get a really good chance to both learn and practice the skills. Second, you get the benefit of having a supportive group and therapeutic environment where you can practice skills, work out life issues, and get help in being effective. While having this structure is desirable, it is not always possible. Because it’s not always possible to remain in the DBT program for a full year, we do our best to support you and prepare you to be effective and skillful outside of therapy.