Dialectical Behavior Therapy:

(DBT)
Philosophy and Applications
 DBT Clientele Attributes

• Unbalanced interpersonal relationships

• Unstable self-image
• Impulsivity
• Recurring suicidal or self-harming behavior
• Mood instability
• Perfectionism
• Attachment / abandonment issues
• Borderline traits
 DBT Incorporates:

• Dialectics
• Zen tradition
• Cognitive behavioral therapy
 DBT Philosophy
Dialectical Worldview

• Interconnectedness
• Opposing forces.
– Thesis – Antithesis – Synthesis – Thesis – Etc.
• Walking the middle path.
• Change is constant.
– Example: Cutting relieves emotional pain versus
health implications and dangers= Finding healthy
ways to relieve emotional pain.
Choose the Dialectical Statement

• People hate me / everyone thinks I am the

coolest / some people enjoy being around me and
others do not.

• I can’t do anything right / I have strengths and

things I am learning / I have it all figured out

• There are things I like and dislike about others/ I

hate them / They are so perfect
 DBT Philosophy
Zen Tradition
• Mindfulness
– Wide mind
– Non-judgmental stance
– Observing
• Acceptance as a balance to change
• Irreverence versus warmth
• Radical acceptance
– Example: Clients may not have caused all of their
own problems, AND they have to solve them anyway.
 DBT Filosophy
Cognitive Behavioral Therapy
• Thoughts, feelings, behaviors.
• Eliminate negative secondary gains.
– Example: Crisis call to therapist after self-
harming, therapist will ensure 911 is called
and call will end.
• Behavior skills training.
– Example of Dear Man
 Mindfulness Activity

What Skills:How Skills:

Observe: Pay attention to what is Non-Judgmentally: See and do not
going on around you. 5 senses. evaluate. Do not judge your judging.
Describe: Use words to say what Stay Focused: Do one thing at a time,
you are observing. let go of distraction, concentrate.
Participate: Enter the experience Do What Works: Act skillfully, play by
fully. the rules, let go of feelings that hurt you.
 Biosocial Theory of BPD

• Emotional vulnerability
• Invalidating environments.
• Biological issues.
• One cannot ignore the 75% prevalence of
sexual abuse among those diagnosed with
BPD.
 DBT Therapy Assumptions
• Clients are doing the best they can.
• Clients want to improve.
• Clients need to do better, try harder, and be more
motivated to change.
• Clients must learn new behaviors in all relevant contexts.
• Clients cannot fail in DBT.
• Clients may not have caused all their problems, and they
have to solve them anyway.
• The lives of suicidal BPD clients are unbearable as they
are currently being lived.
 Modes of DBT
Individual Therapy
• Individual therapist is main contact.
• Commitment to program and safety
• Eliminate life threatening and therapy-interfering
behaviors.
• Improve quality of life.
– PTSD treatment, application of skills, and self concept
development.
– Processing is to take place in individual therapy.
Links and Chains Mad Lib
 Modes of DBT
Group Skills Training
In parallel with individual therapy – skills focus.

•Core mindfulness
•Interpersonal effectiveness
•Emotional regulation
•Distress tolerance
•Walking the middle path
Interpersonal Effectiveness Activity

•Validation Exercise
 Modes of DBT
Telephone Consultation
• Individual therapist contact.
• Support and assistance with skills before
crisis.
• Clear limits and boundaries.
 Distress Tolerance Activities
• Radical Acceptance
• Ice
• Pros and Cons of unhealthy behavior
 Modes of DBT
Therapist Consultation Meeting
• Weekly meetings
– Team acquires skills
– Provides support
– Integrates DBT philosophy
– Plans treatment for clients.
Emotional Regulation Activity

• Rope Challenge
 DBT at Children’s Outpatient
• 16 weeks of skills group. No more than 2 client
absences.
• Open ended with entry dates every 4 weeks.
• Mandatory guardian and client attendance.
• Staff supervision one hour weekly.
• YOQ monitoring.
• 2 hours of group and family/individual session
weekly.
• Broadened client symptomology.
 References
• Linehan, M. (1993a). Cognitive- behavioral
treatment of borderline personality disorder.
New York, NY: The Guilford Press

• Linehan, M. (1993b). Skills training manual for

treating borderline personality disorder. New
York, NY: The Guilford Press