Dialectical Behavioral Therapy (DBT) is an evidenced-based behavioral treatment, which means that the effectiveness of the model has been backed in research. DBT is a highly effective treatment for individuals with a history of failed therapy or multiple past hospitalizations.
DBT has earned its place as the gold-standard treatment for individuals who display difficulty managing ups and downs in their moods, experience excessive self criticism, have patterns of unstable relationships and engage in impulsive or self-destructive behaviors.
Because of the transformational nature of DBT treatment, many therapists are excited to use this model to help their clients. Unfortunately, this also has led to therapists claiming to “do DBT” when they are only using a part of the full and research-backed treatment. This is like the doctor telling you that two Advil will make your headache go away, but instead taking half of one Advil and expecting it to work in the same way.
In order to deliver DBT to fidelity (for treatment that works), the following must be true:
Therapists must have completed a “Foundational” training in DBT (33+ hours) through a reputable education provider, like Behavioral Tech, Treatment Implementation Collaborative or another Linehan Board-Certified Clinician.
Therapists must offer multi-modal treatment, including individual therapy, DBT Skills training group and phone coaching, adherent to the model.
Therapists must participate in a DBT Consultation team, a team of therapists who support the DBT therapist in using skills in their own life while also enhancing the quality of treatment provided by ensuring that it stays true to the model.
If your therapist is offering DBT, be on the lookout for the following red flags that they may be offering an “informed” version (half the Advil) rather than the full model of treatment.
5 signs you’re NOT seeing a DBT therapist…
If your therapist jumps in with a skill to “solve” an emotion you’re experiencing, this is not DBT.
Emotions in of themselves are not problematic and in fact can learn to be tolerated, NOT coped away. Emotions are intended to communicate a message. We want to learn to listen and respond mindfully. The idea that emotions need “fixing” is actually the SAME concept you’re already using with self-harm, drugs and alcohol, binging and purging and more — these behaviors are ultimately solutions to your big emotions. Our goal is to help you relearn how to feel without trying to make emotions go away, not make you a robot with no emotions.
If your therapist does not bring up your suicidal thoughts or self-harm at the onset of treatment and perhaps believes that “rapport” and trust must be built before these topics can be approached, this is not DBT.
DBT therapists target treatment based on a hierarchy and always attend to life-threatening behaviors. Why? Because waiting too long to treat these means that you may not be alive long enough to get to lower level issues like your fight with a friend at school.
If your therapist uses judgmental phrases like “attention-seeking, manipulative or feeling unsafe” or surmises about your “attachment needs” to discuss or describe your experience, this is not DBT.
DBT therapists rely on behavioral precision — we want a clear and objective description in detail of your experiences so that we can gain insight into the solutions that relieve your pain. Vague statements and assumptions are unhelpful and lead to continued suffering. We want a specific situation and an effective description to develop a reasonable hypothesis and solution.
If your therapist has never said the words, “Let’s look at your diary card” to start a session, this is not DBT.
DBT therapists use a diary card to keep clear and accurate information on what individuals are experiencing throughout the week. This information allows us to prioritize what is most important to address in each weekly session. We don't want to spend 40 minutes talking about your frustration with your mom when you’ve acted on self-harm urges or ran away earlier in the week. We want to cut to the core of the most important issues so that your life gets better faster and then we can circle back to the everyday frustrations.
If your therapist has “nice conversations'“ with you and “holds space” to validate your feelings, but you’re still not clear on the prompting events for your problematic behaviors or what reinforcers keep those behaviors in place, this is not DBT.
…If you don’t know what a prompting event or reinforcer is, you are not in DBT.
DBT therapists help you identify in-the-moment triggers for patterns that continue to play out in your life. They help you recognize what made you more vulnerable or likely to act on triggers this day versus that day. They work with you to identify the thoughts and feelings that led to your unhelpful actions. They look at your environment and hypothesize with you what maintains those behaviors so that you can understand how to structure your life to change behavioral patterns at the root.
What Does a Typical DBT Session Look Like?
So how do you know you’re receiving DBT treatment? Read on!
In a typical DBT session, your therapist will start by checking in on your emotions and reviewing your diary card with you. This sets the tone and agenda for what needs to be covered in your session. Your therapist will check in on what you’re learning in group and also touch base on any family sessions you’ve had, any phone coaching calls that took place between sessions and review any homework that may have been assigned to you in your last session.
Your therapist will weave messages of validation and acceptance throughout your session. AND they will also help to move you towards your goals and therefore use change strategies as well. Your DBT therapist will collaborate with you on “Behavior Chains” for understanding your patterns. Together you’ll identify what triggers your behavior, what thoughts and emotions you experience when triggered and what reinforces your behavior or keeps it in place currently.
Now, this part is really important. Not only will you and your therapist work on gaining the insight with the above behavioral analysis, you’ll also work together on solutions and skillfulness to actually change these patterns. This means that you will identify where you can break links in the chain to change the pattern or problematic behavior.
Once you identify what’s really required, you will put this into PRACTICE in session. This means, you may be practicing skills to manage urges, you may be approaching and sitting with emotions and not avoiding them, you may be having conversations with family members about how to best respond when you’re triggered so they don’t accidentally reinforce unhealthy patterns alongside you.
In general, a DBT therapist relies on assessment, precise behavioral descriptions, hypothesizing with you about what is needed to change your behaviors and get you towards your goal and then having you try out and practice this. Together you’ll look at what worked, what’s getting in the way of being more skillful and you’ll work together in therapy to help you create a life worth living.
Your therapist will also ensure that you have sufficient time to center yourself before ending your session. This means ensuring that if “heavy” content was addressed in session that you have a solid plan for how to make safe and healthy choices should your urges surge later in the day.
Your therapist is also available to you between sessions — to help you generalize the skills and solutions you are uncovering in session and to support you in abstaining from action on urges that may arise. It’s easy to be effective in the safety of an office. We are committed to ensuring that you have support to succeed when it really counts — out in the real world where stressors arise.
DBT is an applied science and is a collaborative treatment. We bring you behind the curtain and teach you how to create the life you want. It’s not about “doing therapy” to you. It’s about empowering YOU to be an active player in your own story.
*There are only TEN Linehan-Board Certified DBT Therapists in PA. Katie K. May is one of them. Check out the full list here.