What is DBT?

I have been practicing DBT for 25 years so I am pretty biased. I think it is the best therapy out there for many, many people who are struggling with depression, anxiety and social difficulties. The principles of DBT can help you have peace and joy in your life in ways you might not have thought possible. I personally was pretty depressed for a lot of my childhood until I discovered DBT in my early 20's.

DBT was created by a psychologist named Dr. Marsha Linehan, who is essentially a genius. If you want to go directly to the source to learn more about DBT, then go to her website behavioraltech.org

Dr. Linehan spent years doing research on a group of people who were constantly going in and out of the hospital due to chronic feelings of suicidality. These individuals experienced so much emotional pain, and did not know how to manage their pain, so they would hurt their bodies through cutting or other forms of self-mutilation.

At the time, we had no effective treatment for these individuals. And there was also a lot of blame and negative judgements towards these folks. A lot of therapists wrote them off as "untreatable" and that feeling of hopelessness was often conveyed to the patients. Can you imagine a physical condition where doctors hadn't yet found a cure, but somehow blamed the patient and implied to them their situation was hopeless?

Dr. Linehan did not believe that it was the patient's "fault" and was determined to find a treatment that would be effective and she studied this for decades. What she found is that these individuals (those with Borderline Personality Disorder) are biologically hardwired to be more emotionally sensitive and reactive than others. And in addition, many of these individuals also had what she termed, "invalidating environments." This meant they frequently had a parent or someone in their life telling them their reality was wrong. To invalidate someone is to say, "You don't really feel the way you think you do or you shouldn't feel that way." If I say I'm hungry, to invalidate me is to say, "You aren't really hungry, you are just tired." Huh. I thought I was hungry.

When we experience an invalidating environment it really means to experience chronic invalidation, not just occasional. The worst type of invalidation is physical, emotional or sexual abuse, because that is to say to someone, "Your thoughts, feelings or your body does not matter."

When we pair an emotionally sensitive and reactive person with a chronically invalidating environment, it is the perfect storm for creating Borderline Personality Disorder, or individuals who have unstable emotions, chronic thoughts of suicide, chronic feelings of emptiness, fears of abandonment, impulsivity, unstable relationships and unstable identity.

Dr. Linehan then went on to determine what would be most helpful for these individuals. What she found is that these individuals responded best to a combination of both validation/empathy as well as encouragement to learn new skills. She discovered that it was not sufficient to provide only the supportive/belonging empathic side of therapy that was popular in therapy at the time (called a Rogerian approach after therapist Carl Rogers). Although these patients appreciated the support they didn't get as children, it did nothing to help them figure out what to do when they were in high distress and wanted to hurt themselves. It was also not sufficient to only provide change-oriented strategies found in traditional cognitive behavior therapy, because that felt invalidating to these patients given their history. "You are telling me to breathe when I'm in so much pain?!?!" Clearly you have no idea what I'm going through!!" would be a typical response to a CBT suggestion. Dr. Linehan discovered that she needed to balance both acceptance and change-oriented strategies. Through her studies of Zen Buddhism she became aware of the term Dialectical which means "The synthesis of opposites." Two things that on the surface sound like they are opposite can BOTH be true. And hence, DBT was born.

The primary Dialectical Assumption in DBT is that at every moment, everyone is doing the best that they know how. AND, we can all learn new skills to try harder and to do better. What I love most about DBT is that it is 100% judgement-free. It is a blame-free and shame-free. However it is 100% about taking on personal responsibility for the joy and peace in our lives. We are not to blame for what happened to us, but we are the only ones responsible for fixing the ramifications of it.

I was relentlessly bullied as a child. I was miserable. And I spent much of my life waiting to be rescued. I was waiting for someone or something outside of me to whisk me away and make it all better. I was so hurt and angry that this happened to me, when underneath I knew I was a good person and didn't deserve it. It was not until I discovered DBT that I finally realized, I am my own savior. Only I can build my own life worth living. Only I can make my life meaningful, and joy-filled and purpose-driven. Only me. I truly credit Dr. Linehan and DBT for saving my life. I have made it my mission to share the principles of DBT with as many people as I can, which I have done for the last 25 years and will continue to do so as long as I'm able.

Four Core Skills

All participants in DBT engage in both individual therapy as well as Skills Training Groups. In group, participants learn four core skills. They include Mindfulness, Distress Tolerance, Interpersonal Effectiveness and Emotion Regulation.