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Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) is a unique and specialized form of cognitive behavioral therapy used to help adolescents and families build a life worth living.  In a nutshell, DBT aims at teaching people effective ways to manage their emotions and behaviors.  Unlike cognitive behavioral therapy DBT focuses on dialectics-there is no absolute truth. dialectics- the ability to have seemingly opposite or contradictory feelings or thoughts, at the same time (my mom frustrates and angers me so much, and yet I still love her) without these apparently contradictive thoughts causing confusion.

DBT focuses on changing problematic thought patterns as well as teaching skills so clients can effectively manage their emotions, figure out who they are, decrease impulsivity, decrease interpersonal problems and family conflict.     

So why do we use DBT? Not only is DBT a proven and effective method of treatment for people with significant challenges managing severe behavioral and emotional difficulties including Borderline Personality Disorder, Substance Use Disorder and many other mental health diagnoses.  The skills taught can greatly benefit adolescents, adults, and anyone who might want to improve their ability to better manage their emotions, behaviors, and relationships.

The four skills training areas of DBT are:

  • Mindfulness:This area of therapy focuses on being present in the moment and knowing the signs of unregulated emotions and behavioral patterns. Teens learn to improve their self-awareness skills and identify impulse thoughts and behaviors.
  • Emotional regulation: Adolescents use emotional regulation skills to cope with stressful situations by creating pleasant and soothing experiences to protect against emotional extremes.Emotional regulation also helps us to better understand our emotions, and how best to respond to our emotions.
  • Interpersonal effectiveness:With interpersonal effectiveness skills, your child will be able to interact with others appropriately and allow them to feel more supported by their peers. Teens learn how to communicate their wants and needs with others, as well as how to share their ideas. They can develop healthy boundaries, feel comfortable around others and learn how to ask for help.
  • Distress tolerance:Learning how to manage crises, disasters or catastrophes is an important part of life.   Distress tolerance skills teach kids how to react appropriately to stressors and get through emotional crises without making the situation worse. Teens learn how to acknowledge their current painful circumstances and develop a healthy response versus tampering with their feelings or lashing out.
  • The Middle Path —skills for families:The middle path is a skill where kids and parents learn to validate each other, negotiate and compromise and see the other person’s side of a situation.

4 Stages of DBT Treatment

 There are four stages of treatment in DBT, following a pre-treatment stage where the goals of therapy are set. Each stage has specific targets in treatment and helps move the clients from “feeling miserable and being out of control” to becoming more aware and having the ability to regulate their feelings and behaviors.

In the first stage of DBT, the focus is to help our clients move from being out of control of their behavior to being in control.

Once their behaviors stabilize, the clients move into stage 2, where they work on fully experiencing their emotions.

In stage 3, clients focus on building a healthy lifestyle and developing self-reliance. For some, a fourth stage is needed.

In stage 4, clients who seek deeper meaning through spiritual fulfillment work on moving from a sense of incompleteness to a connection with the greater whole.

4 Hierarchal DBT Treatment Targets 

There are also four hierarchies of treatment targets in DBT, which help determine what needs to be addressed as a priority. These targets include life-threatening behaviors, therapy-interfering behaviors, quality of life-interfering behaviors and skills acquisition.

Decreasing Life-Threatening Behaviors

  • Suicidal behaviors
  • Self-injurious behaviors
  • Homicidal behaviors

Decreasing Therapy-Interfering Behaviors

  • Missing or coming late to sessions
  • Remaining silent in sessions
  • Not completing therapy homework

Decreasing Quality of Life-Interfering Behaviors

  • Physical aggression
  • Electronic dependence
  • Trouble in school
  • Relationship conflict
  • Excessive worry over school/life’s demands

Increasing Coping Skills

  • Learning to relate to and communicate better with others
  • Learning to understand and tolerate different emotions
  • Improving acceptance of one’s self
  • Skills for being able to enjoy the present moment more fully

Bellefaire's DBT Program Consists of:

Family Skills Training

Families are encouraged to attend the Multifamily Skills Training where they will learn the same skills their young person is learning in treatment to improve treatment outcomes upon discharge.  The group will:

  • Help caregivers or the client’s support system understand the language and skills taught in DBT
  • Increase knowledge of behavioral management concepts in order to help manage behaviors and the resulting consequences or outcomes as a result of their behavioral choices
  • Increase ability to think dialectically and use dialectics to help improve family interactions and relationships

Daily DBT Skills Training

Paired with group psychotherapy and unit program that embraces the DBT principles, which are:

  • Everyone is doing the best they can
  • Clients and families want to improve
  • Clients and families need to do better, try harder and be more motivated to change
  • Clients many not have caused all of their own problems but they have to solve their problems anyway (skills group will help you learn how to solve problems)
  • Clients must learn new behaviors in all situations and settings (24 hour phone coaching will help with this)
  • The lives of clients are unbearable as they are currently being lived
  • Clients cannot fail in therapy
  • Therapist treating clients need support (therapist sit on a weekly consultation team)


Learn More About DBT From the Video Below!