A Deep Dive into Dialectical Behaviour Therapy

Dialectical Behaviour Therapy seems to be one of those polarising therapies that you’ve either only ever heard of in passing, or really love. In fact I know of a number of people (both clinicians and those who have undergone Dialectical Behaviour Therapy themselves) who joke about how Marsha Linehan has obtained almost cult-leader-like appreciation in some circles (I’m jumping ahead; Marsha is the creator of DBT).

I have to confess, I’ve been on both ends of this spectrum. I first came across DBT whilst doing my clinical training, and have now had the privilege of being involved in a number of DBT programs across different settings. I have to say it’s one of my favourite therapies. I’d like to take this chance to explain why DBT is so amazing, and how it might be able to help you.

The Origins of Dialectical Behaviour Therapy

Let’s start at the beginning; what is DBT? Dialectical Behaviour Therapy was developed in the late 1980s by Dr. Marsha Linehan. Marsha has one of the most incredible and admirable stories of a patient advocating for their needs that I have known, and she is widely respected for this (amongst many other admirable qualities).

As a young woman, Marsha herself struggled with emotion dysregulation and thoughts around self-harm. She recounts in her memoir Building a Life Worth Living how she spent two years admitted to an inpatient psychiatric ward in the early 1960s. She describes experiencing the kind of traumatic ‘treatments’ that we now know usually worsen someone’s mental health, not help it.

What Marsha discovered was that that therapies used at the time did not focus enough on her emotional experience, let alone treat it effectively. So after her discharge she dedicated herself to getting a PhD in psychology and working out a treatment that would. The outcome of all her research and labour was the development of Dialectical Behaviour Therapy, or DBT.

The ‘Dialectic’ at the Heart of DBT

The magic of DBT lies in its synthesis of opposites. Have you ever felt two seemingly opposite things to be true at once? For example, wanting independence, but craving deep connection and closeness at the same time? Or wanting something to change, but also being afraid to make that change happen?

These are examples of a ‘dialectic’, the concept at the centre of DBT. The term “dialectical” comes from the reconciliation of two opposite ideas; when two apparently fundamentally opposed concepts are both true at the same time. It can be a bit hard to wrap your head around in the beginning! (You can read more about dialectics here.)

The heart of DBT is the dialectic of acceptance and change. DBT teaches people to accept themselves and their experiences as they are without judgement, while also striving for positive change. This dual focus helps individuals balance ‘what is’ right now, without losing sight of what they want for the future. The ultimate aim of this is, in Marsha’s words, ‘building a life worth living’.

The Four Core Modules of DBT

The way the central theme of acceptance vs. change is explored is through four core modules:

1. Mindfulness: The cornerstone of DBT, this module teaches people to stay present and fully engage in the current moment. Mindfulness increases emotion regulation and the ability to work towards life goals, via fostering self-awareness and tolerance of current experiences (read more about the benefits of mindfulness here!).
2. Distress Tolerance: Life can be stressful, and distress tolerance skills teach individuals how to cope with painful situations without resorting to unhelpful coping behaviours. This module includes strategies like radical acceptance and self-soothing techniques.
3. Emotion Regulation: Understanding and managing intense emotions is key to a stable life. This module provides tools for identifying and understanding emotions, increasing positive experiences, and reducing vulnerability to painful emotions like sadness or anxiety.
4. Interpersonal Effectiveness: Building and maintaining healthy relationships is a big part of an enjoyable and meaningful life. In this module, individuals learn how to assertively communicate their needs, set boundaries, and manage conflict constructively.

Building on each other, each module equips individuals with skills designed to improve emotional resilience, reduce impulsivity, and foster more satisfying interpersonal interactions.

What can DBT help with? Can it help me?

With its blending of cognitive-behavioural techniques and mindfulness strategies, DBT has gained widespread acclaim not only for treating Borderline Personality Disorder (which is what most people associate the treatment with), but also a range of other conditions. These include anyone struggling with emotion regulation or intense emotions more generally, as well as self-harm or suicidal concerns, drug and alcohol difficulties, eating difficulties, anxiety, trauma (including complex trauma), dissociation, and depression. There is even recent research exploring how DBT can help with the emotion management aspects of neurodivergent conditions such as ADHD and autism (for example, this study).

If you’re wondering if DBT skills are something that you might benefit from, ask yourself the following questions:

• Do you struggle with intense, painful emotions that can feel overwhelming or frightening?
• Or find that your mood can fluctuate significantly, without knowing why?
• If you feel like you’re in a crisis, do you get urges to do things that you sometimes later regret? For example, emotional eating, drinking alcohol, or other unhelpful coping behaviours?
• Do you find it hard to maintain stable and satisfying relationships due to communication or boundary setting difficulties?
• Are you fearful of being alone with yourself, because you find it difficult to be alone with your thoughts? Are you often very self-critical?

If you answered yes to any of the above questions, chances are you might find learning even just a couple of specific DBT skills useful.

Hang on, isn’t DBT a hospital thing? Can I see a psychologist in a private practice for DBT?

DBT can be delivered in several forms. In its original form, DBT involves weekly group therapy to learn the skills, weekly individual sessions to apply those skills, and has what’s called a ‘coaching line’ that can be called throughout the week for help as needed. This is usually called comprehensive DBT, and is often run by hospitals or other specialist community-based settings. Comprehensive DBT is best suited to those struggling with very intense distress, safety concerns, or would benefit from receiving support more than once a week.

However, many psychologists are trained in offering DBT in private practice. This can involve combining the teaching of skills plus how to apply them at the same time, which can result in more efficient progress. It also allows for specific tailoring to the individual, which can be helpful as well. Some private practice psychologists can also team up with a group program run elsewhere, to form part of a comprehensive program as discussed above. Whilst not everyone will be suited to doing DBT with a private psychologist, many people gain a lot of benefit from doing so.

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If you’re unsure whether DBT in private practice is right for you, you can contact our reception team to discuss. They will be able to listen to your needs, and then provide guidance on what might be most suitable for you. If you’re interested in learning more about specific DBT skills , you can do so by listening to The Skillful Podcast, or reading our blogs on self-soothing and acceptance.

If you’d like to understand more about other therapy types, try our blogs on Cognitive Behavioural Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Internal Family Systems (IFS) Therapy and Couples Therapy.