What is Dialectical Behaviour Therapy?
Dialectical Behaviour Therapy (DBT), developed by Marsha Linehan PhD at the University of Washington, is a type of psychotherapy that focuses on behavioural change for individuals with extreme emotions and distress. The “D” means “dialectical.” A dialectic is a synthesis or integration of opposites. In DBT, dialectical strategies help both the therapist and the client get unstuck from extreme positions. Dialectical strategies keep the therapy in balance and help clients reach their ultimate goals as quickly as possible. The “B” stands for “behavioural.” DBT requires a behavioural approach. This means that we assess the situations and target behaviours that are relevant to our clients’ goals in order to figure out how to solve the problems in their lives. The “T” stands for “therapy” which DBT is.
What type of training should DBT practitioners have received?
The Australian DBT Institute has developed over 14,000 mental health practitioners in the delivery of DBT programs and has facilitated multiple programs annually since 2004. The Institute recommends DBT programs are led by Credentialed DBT Practitioners who meet Australian and International standards in the delivery of DBT programs. In order to be a Credentialed DBT practitioner, mental health professionals must:
- hold professional registration and post-registration qualifications in a mental health vocation such as social work, psychology, mental health nursing, counselling or mental health OT
- have a minimum of 200 hours of clinical practice experience
- have received a minimum of 50 hours clinical supervision
- have completed an intensive training program in dialectical behaviour therapy
- have competence in at least 2 therapeutic approaches in addition to DBT
- meet their annual CPD requirements of their profession
- have undergone the appropriate screening for their employment which includes: Police Check; Working with Children Check; and have had no disciplinary action on Professional Registration
Our professional development program and DBT group programs are led by Dr. Peter King who’s PhD explored the effectiveness of therapeutic interventions for individuals with extreme emotion dysregulation. Dr. King has also completed the 10-day Intensive Training program, 5-day Foundations Program and multiple 2-day programs in DBT with Marsha Linehan’s senior trainers at Behavioral Tech LLC in the USA. Additionally, Dr. King hosted workshops and received mentoring from Marsha Linehan’s senior trainers at Behavioral Tech LLC between 2003 and 2008 during teaching tours in Australia and New Zealand.
Does Research Support Dialectical Behaviour Therapy?
DBT was the first psychotherapy shown to be effective in treating individuals with extreme emotion dysregulation in controlled clinical trials — the most rigorous type of clinical research. While DBT is no longer the only therapy to have shown effectiveness in controlled trials, it has grown a large evidence base and is considered one of the best treatments for individuals with extreme emotions in terms of documented success rates. We are all different so there is no therapy or treatment that can claim to be 100% effective for 100% of individuals.
Is there a Theoretical Basis to Dialectical Behaviour Therapy?
DBT is based on Dr. Linehan’s theory that the core problem in diagnosis such as C-PTSD, Extreme Depression, Bipolar II and BPD is emotion dysregulation. Dr. Linehan believes that that emotion dysregulation results from mixing biology (e.g., genetic and other biological risk factors) and an emotionally unstable childhood environment (e.g., where caregivers punish, trivialise or respond erratically to the child’s expression of emotion) together. The focus of DBT is on helping individuals learn and apply skills that will decrease emotion dysregulation and unhealthy attempts to cope with strong emotions.
What should I expect in Dialectical Behaviour Therapy?
Usually, DBT includes a combination of group skills training, individual psychotherapy and phone coaching, although there are exceptions. Individuals in DBT are asked to monitor their symptoms and use of learned skills daily, while their progress is tracked throughout therapy.
The Australian DBT Institute provides the resources and format for mental health professionals to teach individuals the skills component of DBT. DBT Individual therapy focuses on problems occurring in an individual’s daily life and the skills taught in Skill Group in a way to support individuals acquire and maintain skills to be used in the future. It is suggested skills learned in a skills group will take about a month to become familiar and more likely to be used successful with continued practice. Some individuals are lucky and the skills may be successfully used earlier 🙂
What type of skills that are covered in DBT skills training?
These are 5 sets of skills (or sometimes called modules) covered in DBT Skills Training: Mindfulness, Interpersonal Effectiveness, Distress Tolerance, Middle Path Skills and Emotion Regulation Skills each of which are described briefly below.
Mindfulness Skills. These skills centre on learning to observe, describe and participate in all experiences (including thoughts, sensations, emotions and things happening externally in the environment) without judging these experiences as “good” or “bad.” These are considered “core” skills that are necessary in order to implement the other DBT skills successfully.
Interpersonal Effectiveness Skills. The focus of this skill module is on learning to successfully assert your needs and to manage conflict in relationships.
Distress Tolerance Skills. The distress tolerance skills module promotes learning ways to accept and tolerate distress without doing anything that will make the distress worse in the long run (e.g., engaging in self-harm).
Emotion Regulation Skills. In this module, patients learn to identify and manage emotional reactions.
Middle Path Skills. In this module, individuals learn how to manage close and personal relationships through the development of dialectics, behaviouralism and validation techniques.
I already have a therapist, can I stay with them?
For DBT to be most effective, all participants need to have an individual therapist. Many services claim, that to benefit from DBT, you will need to leave your existing individual therapist and engage with their individual therapists during treatment. This has not been supported by the evidence. Professor Linehan (2015) is clear in stating that programs can be successful when including individuals with individual therapy that is external to the DBT Skills group providers. Professor Linehan (2015, p.38-39) lists the following requirements she has when excepting a participant’s entry into her programs:
- The individual therapist will manage risks including suicidality and hold clinical governance rather than the skills group facilitators. Individual therapists will need to create a crisis management plan with participants and provide this to the group program facilitators.
- The individual therapist agrees to coach participants in using DBT skills in everyday life.
- The group facilitators will not provide reports on behaviours or attendance to individual therapists. This supports the principle of the consultation-to-the-patient strategy outlined by Professor Linehan (2015, p.39).
The Australian DBT Institute respects existing relationships of our participants and their individual therapists and will not suggest discontinuation of treatment or moving to one of the Australian DBT Institute’s individual therapists in order to join our group programs.