What is Dialectic Behavioural Therapy?

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What is DBT?

Dialectic Behavioural Therapy (DBT) is an intensive therapy program specifically tailored for those suffering from Borderline Personality Disorder.

The word ‘dialectic’ comes from the Greek, meaning relating to a dialogue. So a dialectic approach means that the therapy is conducted like a conversation, with various viewpoints and approaches.

DBT is not to be confused with CBT (Cognitive Behavioural Therapy) which is kind of like comparing youtube to the entire internet. CBT is a useful skill in treating anxiety, crisis management, and depression, but DBT is like taking a college course on how to be a human being with a broken brain.

The DBT course that I took spanned a whole year and consisted of four modules of study, plus individual counselling. The group met once a week to learn the modules, and I met with the counsellor once a week for support in applying the skills we learned to my daily life.

Individual Counselling

My Counsellor was named Joanne, and she is specially trained to work with people with BPD and knew all the ins and outs of DBT. She was amazingly good at her job, and I am very grateful to her for the progress we made in our weekly sessions. However, I have to mention that there were many times where we clashed, and we came close to having me set up with someone new. We didn’t, we worked out our issues; the point is when faced with conflict during the process we stuck with it together and I came through stronger because of that. I’ll go into more details of my experience with Joanne in another post.

1st Module: Mindfullness

You will get sick of this word. You will get tired of hearing it, but here’s the kicker: It friggin’ works. Mindfullness is a meditation technique and general way of thinking that brings awareness to the present fully and without judgement. When practicing mindfulness one may focus on the sounds around you, or your breathing, or your emotions. You acknowledge the sensations fully in the moment and observe them, non-judgementally, and in some cases, let them pass over you. Sounds very zen, and it is, it’s based on eastern meditation practices. But when you learn mindfulness in DBT it’s specifically meant to train you to be more aware of your thoughts, feelings, and behaviours, so you may gain a greater understanding of them, and acquire the skills to control them.

2nd Module: Distress Tolerance

When I first started this module I thought it was all just a fancy way of teaching us to “suck it up”, but it’s not. First you learn to identify your crises, your triggers, and your unhealthy coping mechanisms, then you learn how to manage your crises in a healthier way. This module covers coping strategies and skills for reducing the likelihood of a crisis. Some of the most difficult lessons are here, things like the half-smile and radical acceptance. It’s important that you stick with it, though, because the skills learned in this module will prove useful in so many ways to make your life more vibrant and fulfilling.

3rd Module: Emotional Regulation

Before you begin this module, do yourself a favour and watch Pixar’s “Inside Out.” https://www.youtube.com/watch?v=seMwpP0yeu4 For some reason, I was the only one in my group who had seen it and it had been out for several years already. Even the moderators hadn’t seen it. Maybe it’s because I have kids, but I feel like even if I didn’t I would have seen it anyway, it’s a friggin good movie.

The reason I highly recommend the film is because it does an excellent job of presenting five major emotions and breaking down their functions in a healthy brain. This module attempts to do the same. Obviously there are more than five emotions, and they are far more complex than a kids movie can possibly present, but identifying and managing your emotions is a very useful and important set of skills. It turns out emotional regulation is a very scientific process, the module includes exercises intended to isolate and identify emotional patterns and re-program your brain to better manage difficult emotions.

4th Module: Interpersonal Effectiveness

This module is all about relationships. Lessons include things like how to maintain healthy boundaries, how to practice validation and how to get what you need from the world. You won’t learn how to control other people’s reactions or attitudes, but you will learn how to manage your own approach to relationships so that you get your needs fulfilled without alienating or damaging the relationships that are important to you. I know it’s hard sometimes to express your needs or maintain boundaries, especially with the fear of abandonment so prevalent in people with BPD, but since it’s the people closest to us who are more likely to get caught in the cross-fire of our emotional dysregulation, it’s absolutely worth learning how to develop and nurture healthy relationships.

Overview:

DBT will almost always start with Mindfulness, and the other modules are not necessarily taught in the order I’m presenting them. This is just the order I learned them so it makes the most sense to me. First I attended the mindfulness module along with others beginning the DBT process, and some who were just there for the mindfulness. Then I went through it again. That’s how important mindfulness is to DBT, you need to understand the theory and practice before you begin the other modules otherwise you won’t absorb the material as easily, and the practise will be a lot harder.

The other three modules took three weeks each to cover, and then I did them again. One of the problems with treating BPD is that often those who suffer are very resistant to therapy. I know I was. The commitment you make to do the program is a serious one and you have to see it through to the end. Doing each module a second time makes sure that you absolutely didn’t miss anything the first time around while your attitude is still raw and defensive. The material is difficult and will force you to do some serious self-speculation and soul-searching that maybe you aren’t prepared to do. That’s why you also have an individual therapist to help you through the tough stuff.

One more thing; the woman who developed DBT is an American Professor and Psychologist named Marsha Linehan. https://behavioraltech.org/about-us/founded-by-marsha/ Many of the material covered is authored by her and she appears in the video material we used. Seriously she is the godmother of all BPD sufferers, and the world would be a much darker place without her! (Prof. Linehan, if you’re reading this, I’d love to take you to dinner and pick your brain!)

So if you’re ready to take your illness by the short and curlies and show it who’s boss then get ready for things to get messy. Don’t worry though, I’ll walk you through it; you’re not alone.