Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is a form of CBT that has new strategies and a reformulated structure of the treatment process. In the case of new strategies, Acceptance-based interventions, frequently referred to as validation strategies, were added. Adding these communicated to the clients that they were both acceptable as they were and that their behaviors, including those that are self-harming, made real sense is some way. Further, therapists highlight for clients when their thoughts, feelings, and behaviors were perfectly "normal", helping clients discover that they had sound judgement and they were capable of learning how and when to trust themselves. This emphasis on acceptance did not occur to the exclusion of the emphasis on change. Clients also must change if they want to build a life worth living.

Dialectical strategies create a means to balance acceptance and change in each session and serves to prevent both therapist and client from becoming stuck in the rigid thoughts, feelings, and behaviors that can occur when emotions run high, as they often can do. Dialectical strategies and a dialectical world view, with the emphasis on holism and synthesis, enable the therapist to blend acceptance and change in a a manner that results in movement, speed and flow in individual sessions and across the entire treatment process.

DBT therapy tends to require more frequent sessions and contact with the therapist on several modes of communication. The client and therapist work on maintaining the client's motivation for treatment and change. Skills are acquired, strengthened, and generalized through a combination of individual therapy, phone sessions (clients are instructed to call the therapist for coaching on specific behaviors that are troublesome), in vivo coaching (in person coaching outside of the therapy session), telemedicine (video conferencing sessions) and homework assignments. Family sessions may also be part of the treatment process to ensure the client is not being reinforced for maladaptive behaviors, punished for effective behaviors, and ensure the client is following through with treatment goals.

Stages of Treatment:

Stage I: The goal is for the client to move from behavioral dyscontrol to behavioral control so that there is normal life expectancy.

Stage II: DBT addresses the client's inhibited emotions. It is thought that the client's behavior is now under control but the client is suffering in "silence". The goal of stage II is to help the client move form a state of quiet desperation to one of full emotional experiencing.

Stage III: DBT focuses on problems in living, with the goal being that the client has a life of ordinary happiness and unhappiness.

Frequency of Sessions:

The frequency of contact between the client and therapist is greater in DBT. The client can expect to commit between 2-4 sessions (including office visits, phone sessions, and or video sessions) each week. A sincere commitment must be established in order for DBT to be successful!

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Dr. Edward Giaquinto, Ph.D. - A licensed, clinical psychologist who has been assisting people in improving their life by increasing their emotional and mental health.