Dialectical Behaviour Therapy (DBT) was developed by Marsha Linehan at the University of Washington while trying to find an effective treatment for suicidal and borderline personality disorder patients. She started with Cognitive Behaviour Therapy but found that it was lacking in certain areas, so she added aspects to the treatment and made changes to improve treatment results. This resulted in what is now known as DBT. Some of the changes she made were a balancing act between acceptance and change, adding validation, mindfulness, and interpersonal skills.
The focus of DBT is to “build a life worth living” and it is a collaborative type of therapy where the therapist and the client work together to enable the client to build a better life through collaboratively decided goals, therapy techniques, and skill-building.
Behind the DBT is biosocial theory, which believes that invalidating environments are at the root of emotional dysregulation. Emotion dysregulation involves being emotionally sensitive and emotionally reactive and having a slower return to baseline. There are several reasons for emotion dysregulation, such as biological disposition, attachment problems, loss, trauma, and invalidation. When people have frequent prolonged intense emotional reactions, they tend to create neural pathways that are sensitized to these types of reactions. These reactions can become more automatic as time goes on. The emotional reactions can become more and more intolerable as time goes on it can become more difficult to cope with them and choose effective behaviours to deal with them. DBT can help point clients in the right direction of choosing better behaviours to deal with intense emotions and learn how to tolerate them.
DBT works by moving back and forth between acceptance and change. It validates your past experiences yet encourages you to move forward. It offers skills that you can learn to deal better with the world around you and better manage your emotions. These are often skills that people who grew up in supportive environments learned, but people who grew up in less supportive environments did not learn or have deficiencies in their skills.
The skill-building in DBT can really help people to be able to better cope with their emotions, tolerate distress, improve their relationships, and better understand how they can improve how they feel about life. I find this modality really works well with people who have had emotional neglect or developmental trauma because it focuses on the skills that were neglected in their childhood. There are other modalities that work well with the actual inner wounds from childhood, so this form of therapy works well complementing those.
Leona Westra, RCC 