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Dialectical Behavior Therapy

This Dialectical Behavior Therapy (DBT) article will help define Dialectical Behavior Therapy as well as Cognitive-Behavioral Therapy (CBT). Learn about the key elements of Dialectical Behavior Therapy and who can benefit the most from Dialectical Behavior Therapy.

What Is Dialectical Behavior Therapy?

Dialectical Behavior Therapy (abbreviated DBT) is a form of Cognitive-Behavioral Therapy (CBT). It was developed by Marsha Linehan at the University of Washington in the 1970s in the course of treating patients with histories of suicide attempts and self-harm urges. Linehan aimed to respond to three difficulties faced during CBT:

  • The emphasis on change in Cognitive Behavior Therapy was experienced as invalidating by clients, who responded by either withdrawing from treatment or becoming angry.
  • Therapists characteristically lessened their urging of change when clients withdrew emotionally or became angry or exhibited other negative responses and this and other examples of clients controlling the direction of therapy lessened the effectiveness.
  • The "standard" CBT format was judged inappropriate for individuals experiencing numerous, severe, and recalcitrant problems because sessions did not allow time to both deal with important current issues and also learn the Cognitive Behavior Therapy strategies that allow clients to adapt and change.

As with CBT, there are different forms of Dialectical Behavior Therapy, with the one that has been most thoroughly researched being "Standard and Comprehensive DBT."

Key Elements of Dialectical Behavior Therapy

Dialectical Behavior Therapy addressed each of the three difficulties that were found in treating clients with the serious types of problems described above with standard CBT. For one thing, new strategies for acceptance, called validation strategies, were introduced. The therapist became equipped to communicate acceptance of the client in his or her current state and even that self-harming behavior were, in some way, understandable. This acceptance was balanced with the movement towards change through the use of dialectical strategies, which allowed a better way to combine the ideas of acceptance with ideas of the need for change.

The treatment was restructured to include five critical functions, with modes, or methods, designed to carry out the functions. The modes include phone coaching, in vivo coaching, homework assignments, and skills groups for the client and weekly consultation team meetings for the therapist. 

Dialectical Behavior Therapy treatment is also organized by stages and targets, and most often addresses issues in a defined order so that whatever current issues the client is experiencing do not take priority in each session away from the issues that are most deserving of attention. In Stage I, for example, priority begins with issues that threaten the client's life immediately or over time, then those that would remove the client from therapy, them those  (including the client's own behaviors) that damage the client's quality of life, then those that could be better dealt with in alternate ways.

Who Can Benefit from Dialectical Behavior Therapy?

Trials of Dialectical Behavior Therapy have shown its effectiveness in treating Borderline Personality Disorder (BPD) coexisting with substance abuse. It is also being studied for use with eating disorders, specifically, Binge Eating Disorder (BED).



Related Article: Cognitive Behavior Therapy >>

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