Dialectical Behavioral Therapy

Dialectical Behavior Therapy (DBT) is an evidence-based form of therapy that combines acceptance and change.

DBT was developed by psychologist Marsha Linehan and was originally designed to help people experiencing significant emotional and behavioral difficulties. It has since been adapted for a wide range of concerns.

The word “dialectical” refers to holding two seemingly opposing ideas at the same time: “I can accept myself as I am AND work toward meaningful change.”

DBT is particularly helpful for people who experience:

• Intense or rapidly changing emotions
• Difficulty regulating emotions
• Impulsive behaviors
• Interpersonal conflict
• Difficulty maintaining relationships
• Difficulty tolerating distress
• Self-destructive behavioral patterns
• Chronic feelings of emptiness or instability
• Strong emotional reactions to perceived rejection or abandonment

DBT can also be adapted for concerns such as depression, anxiety, PTSD, eating disorders, and substance-use difficulties.

Depending on the treatment setting and adaptation, comprehensive DBT can include:

• Individual therapy
• Skills training
• Between-session skills practice/coaching
• Diary cards
• Behavioral analysis
• Treatment hierarchy
• Therapist consultation/team support

A therapist might spend one session teaching a skill and the next session examining how that skill worked—or didn't work—in the client's real life.

One of DBT's defining characteristics is its emphasis on both validation and change.

The therapist might communicate: “It makes sense that you responded this way given what you've experienced.”

AND:

“Let's work on finding a response that is more effective for you moving forward.”

It isn't: Acceptance OR change.

It's: Acceptance AND change.

The broader goal of DBT is not simply to make difficult emotions disappear. It's to help clients build a life that feels worth living, while developing the skills necessary to navigate painful emotions, relationships, and difficult circumstances.