“Wisdom lies neither in fixity nor in change, but in the dialectic between the two.” Octavio Paz

Most people think of self-improvement as a singular forward motion, but human nature as we know it is far more complicated than that. Many of the mental knots we seek to untie often require a mixture of techniques and coaxing over many moments to come undone. Most of us have experienced a time when we felt overwhelmed by what we were facing. Though these are the moments we would most benefit from therapy, we might also feel what our therapist is offering might not be enough. However, there’s a type of therapy that works best for those fighting the hardest battles. Dialectic means “the existence of opposites” and is the basis of Dialectical behavioral therapy or DBT. Therapists who specialize in this type of therapy employ two different major techniques to help overcome intense, dysfunctional, and disruptive emotional tendencies and habits in their patients. In this next part of our ongoing “Types of Therapy” series, we’ll talk about this super effective and flexible therapy, and how it benefits those who are struggling with complex situations.

What is Dialectical Behavioral Therapy (DBT)?

In the 1970s, prominent suicide researcher Marsha Linehan developed the basis for what is now known as dialectical behavioral therapy. At the time behaviorism was popular, yet Linehan realized that it was not particularly effective while dealing with high risk individuals due to its clinical approach. So it followed she attempted to employ a more humanistic approach, which was also not successful, however, it did open the door to her understanding of what might be. Seeing behaviorism and humanism as two ends of a spectrum of caring for patients, she chose to incorporate both to find a method that not only validated their concerns and feelings but presented a model for change that allowed patients to move away from negative behaviors. Her background as a Zen master also encouraged her to incorporate tenets of Buddhist teachings and was the first to employ mindfulness as a core tenet of a therapy type.

Dialectical behavioral therapy focuses on developing acceptance of one's emotions, which allows one to detach and healthily move past them. DBT focuses primarily on developing skills and navigating emotional and social aspects of life. By accepting themselves, and learning to manage their emotions in a healthy way patients can come out of therapy with a renewed perspective on life, better self-control, and esteem. DBT also prioritizes ongoing support and intervention in crisis situations. This makes DBT incredibly helpful for those with borderline personality disorder, depression, suicidal tendencies, PTSD, and eating disorders as it helps them cope with intense emotions. Some of the basic ideas of DBT may sound similar to cognitive behavioral therapy or CBT and you’d be right. The main difference is that CBT focuses heavily on shifting your mentality, whereas DBT focuses on acceptance and change regarding dangerous or unhealthy habits. To put it in perspective, Cognitive behavioral therapy shifts your perspective to remove unhelpful realities and schemas that limit your growth whereas dialectical behavioral therapy helps you create a better reality around your mental state.

What to Expect in Dialectical Behavioral Therapy

Most DBT programs require patients to attend for a full year, however, DBT-informed therapy allows patients to learn the skills and experience the benefits of dialectics without the commitment. When first entering DBT your therapist will gauge your mental state, and there are four major stages you will move through during your time in therapy:

Stage One: The patient is miserable and has out-of-control behavior. Their goal is to gain some control over their behavior and the emotions that cause it.

Stage Two: The patient is no longer harming themself or others, but still is not fully able to overcome their emotions. They may still feel like they are suffering or living a life of quiet desperation. Their goal is to accept their emotional state and be willing to change their lifestyle to facilitate a better situation.

Stage Three: The patient, with help, will begin to define their goals, interact with others in healthy ways, and strike a more normal balance in their emotions and everyday functioning. Some will end at this step. However, to move to the next step their goal should be to dig deeper and understand their purpose. 

Stage Four: Patients will work to establish their life meaning, and other aspects of spiritual existence to drive them.

While moving through the steps, your therapist will meet with you for one-on-one sessions, but depending on your program they might also offer in-the-moment coaching, case management coaching, or group skill-building sessions. Some of these may not be applicable when working with a DBT-informed therapist, but regardless. Due to its focus on humanism, a large part of DBT is developing critical skills that aid in interpersonal connection and well being. This can include developing strategies for self-advocacy (boundaries), emotional regulation, mindfulness, and distress tolerance (coping in a crisis). By working on these skills with a therapist, individuals who struggle with intense emotions, compulsive behaviors, or self-hatred can build a healthier environment that allows them to thrive.

Is Dialectical Behavioral Therapy Right for You?

We’ve spoken at length about how adept DBT is at dealing with those who struggle with intense emotional states, and harmful behaviors but that is not the only people who can benefit from DBT. Dialectical therapy, much like any other kind of therapy can lead to a better self understanding, and DBT approaches it in a uniquely non-judgmental way. Dialectical behavioral therapy excels at meeting patients where they are and is a powerful tool that can inspire anyone to make meaningful changes in their daily lives. Still, if you struggle with eating disorders, borderline personality disorder, PTSD, or depression and suicidal ideation looking into a dialectical therapy program or a therapist who employs DBT techniques in their method might be the key to unlocking a happier, more functional life. We also believe that therapy extends our horizons and gives us valuable tools to cope with whatever life throws at us. Even those who just want to pick up some actionable skills for emotional management, incorporate more mindfulness into their routine, or need additional support to reach their goals we highly recommend DBT.  Basically, this therapy could work great for anyone.

Whether you are struggling with your darkest days, or simply want to improve your life and mental state the point of this series is so you know you have options when working towards your goals. Therapy is a must, and for those of you navigating the challenge of choosing a therapist and starting your therapy journey, it can be overwhelming. For California residents who need a hand, or are interested in taking the next step, bareWell offers free consultations for new patients that match you with a great therapist from our practice, or within our network. We also have a DBT specialist on our team, Sherri Ardekani! We accept a wide variety of insurances and offer payment plans because we know that nothing should stand in the way of getting the help you need.