Dialectical Behaviour Therapy (DBT) was developed by Dr Marsha Linehan a psychologist from the University of Washington. Initially DBT was used to treat highly suicidal patients with severe emotion dysregulation and self-harming behaviours, but has now gained considerable evidence for other mental health issues related to eating disorders, mood disorders and anxiety disorders.
At its core DBT attempts to balance the opposing forces of acceptance and change, to help people suffering with psychological illness build a life worth living. DBT works from the premise that by accepting a person’s individual personality and defining characteristics, the therapist and participant can work together to change maladaptive coping mechanisms and behaviours that make life difficult and unmanageable.
The basic definition of dialectics is the process by which two or more people with opposing views seek to establish the truth of a subject through reasoned argument. The underlying theory within DBT maintains that by working toward resolution (or synthesis) of dialectical dilemmas occurring within ourselves, we can achieve personal growth and understanding and reduce psychological suffering.
Through a process of weekly individual therapy and group therapy participants are helped to identify negative self-beliefs, opinions and assumptions that contribute to negative mood states and ineffective behaviour and unhealthy coping. As a group, participants are introduced to new coping strategies (DBT ‘Skills’) and undergo extensive psychoeducation to develop emotional literacy, insight and awareness.
The group process (Group Skills) is unlike traditional models of group psychotherapy in that it is run more like a tutorial whereby participants are taught a new set of skills each week and then given homework to complete during the week. Homework is then shared at the beginning of each Group Skills session. Homework encourages accountability for application of the skills outside of the group, generalises the new coping strategies to everyday life and works to normalise an individual’s emotional suffering through shared experience and understanding. The group is highly structured, and participants are asked to respect group rules and norms and are expected to minimise self-disclosure of problematic behaviour. This helps protect participants from ‘contagion’ of ineffective coping behaviour and negative mood states and works to maintain individual confidentiality and privacy.
DBT is a ‘multi-modal’ therapy and weekly Group Skills is completed in conjunction with weekly individual therapy. Individual therapy is the vehicle by which participants are given the opportunity for self-disclosure and discussion of maladaptive coping mechanisms and behaviour. Through multiple therapeutic strategies the DBT therapist helps the client to identify unhealthy behaviours and thought processes that contribute to their psychological suffering. Individual therapy is also highly structured and involves maintaining a ‘diary card’ which participants are expected to complete daily and bring to weekly therapy. The diary card maps emotional states and moods throughout the week and tracks associated urges to cope in ineffective ways and tallies ineffective behaviours. The diary card is a crucial element in the initial stages of individual therapy. The diary card facilitates analysis of the underlying psychological factors and core beliefs associated with ineffective behaviour. The diary card is the means by which individuals begin to develop awareness of opportunities for intervening more effectively with the new ‘Skills’ being taught during the group process.
DBT is a complex therapeutic process with multiple elements that work together to make it a highly effective treatment for several psychological illnesses. As a DBT therapist I have witnessed its effectiveness in helping people through recovery from mental illness and assist them to build on personal strengths and resilience to build a life worth living. More information on our Cairns DBT Program can be found here on our website.
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