DBT stands for Dialectical Behaviour Therapy.
I’d never heard of it until 2022, but then read some books and attended a four-day training course with one of the authors. I find DBT a really useful model for change-work.
I’ll explain how it works, and why I think it’s a great model.
DBT developed as an approach to be used with EUPD (emotionally unstable personality disorder – what used to be called borderline personality disorder).
It’s proven effective for this as well as self-harm, depression, drug and alcohol issues. These kinds of symptoms can easily stem from those core fears of rejection and abandonment where low self-worth can become a vicious circle.
It was recognised that something more was needed because this kind of personality disorder is so deep and pervasive – typically beyond the reach of talking therapies like CBT (cognitive behaviour therapy) or things like NLP.
Even if some great emotionally cathartic work is achieved with something like Gestalt work and hypnotherapy – there are often lots of loose ends in terms of the conditioned lifestyle, negative habits and routines that remain.
The core components of DBT
DBT can be quite lengthy, but for good reason, taking around a year to complete a course. It’s accessible on the NHS in UK, but there’s a problem in that the high demand ratio to low practitioner availability means that it can take months and months to get started – which is not ideal if your emotional life is spiralling out of control before you.
Still, being aware of it can be useful if you want to dig deeper to check out local availability.
DBT factors in three main aspects under an overriding philosophy, all of which work well together to help transition to a better place in life.
The format is a mixture of person-centered one-to-one work with a trained practitioner, and group workshops that must be attended to develop skills.
This is a powerful combination – developing skills is something that is often overlooked with therapy.
Mindfulness
As discussed on the prior mindfulness page, this is hugely useful to help develop self-awareness and offer some distance from getting too caught up in the negative emotional chaos that take over the mind. It’s a skill, that takes practice to truly become comfortable with, and to use more automatically when the need for it is most urgent.
Part of the DBT programme will incorporate mindfulness sessions, which is is practiced in your own time as well as in a group setting.
Group sessions might seem daunting at first, but everyone is in a similar situation. The practice of connecting and sharing with others is itself a vital part of the approach – allowing social skills to be developed as well as eroding those scary beliefs that you’re alone.
One-to-one work
You’ll have appointments to check in with a DBT practitioner, where you can review your time since the last meeting and discuss events and needs. This can incorporate a CBT style approach to work on specific responses.
Be aware that the model is quite strict – you won’t even be entered into a programme if it’s felt that you’re not ready for it, or won’t commit. It’s not a softly-softly “show up if you feel like it” system, you’re expected to play your part, which in itself develops a level of self-respect and responsibility.
Skill development
As well as mindfulness, the group workshops will train other skills on a rotating basis.
These focus on areas like emotional regulation, helping you to recognise triggers and situations when overbearing feelings can emerge, as well as ways to more effectively manage them to create more flexibility and options for how you respond.
You’ll also develop interpersonal skills, learning to become more self-aware of how you might come across to others, developing empathy and a greater rapport to help with connecting to people.
All of this can be really confidence building, which starts turning those vicious circles of response -> outcome -> negative belief toward a more positive experience.
The dialectic – the underlying philosophy
The ‘dialectical’ part of DBT is one of its more unique contributions as a therapy model.
It’s about holding two things in mind at the same time, which can seem opposite but actually go together perfectly.
It’s the idea of ‘radical acceptance’ – accepting the way things are, alongside the belief that you can simultaneously evolve, grow, develop and change.
Radical acceptance is another version of something I call ’embracing chaos’. It’s about seeing the absolute truth of reality, what’s happened or is happening, and accepting that yes – that is what happened, or that is what’s happening.
It’s like a form of mindfulness for external events – observing, and accepting without judgement, shoulds and shouldn’ts.
Without acceptance for the way things are, the various trappings of emotions tied up with how things should have happened, how things should be, will always be a barrier.
All the self-persecution, guilt and shame wrapped up in feeling broken, feeling alone, feeling unfixable or unworthy of a better experience – a person doesn’t deserve to feel any of these things. But they need to be acknowledged, and accepted as happening, before they can be worked with.
While fairly unique within therapy, the dialectical approach isn’t new. It’s right there in the serenity prayer used in twelve-step programmes: “grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference”.
DBT is always striving to keep those awarenesses dovetailed.
Unconscious change-work
I’ve included DBT here because it’s overall effect is not dissimiliar to hypnotherapy – it erodes unwanted self-beliefs and builds positive new ones.
The added benefit is that there is more opportunity for real-world experience – meeting people, connecting, sharing experience, and developing actual life-skills to assist with the ongoing changes. In that way it’s far more holistic than a few hypnotherapy sessions.
Here are some examples of automatic beliefs and how they develop towards a far more positive outlook:
“I am alone” -> “My core issues are very human, and shared by others”
“I am unfixable” -> “My mind actually works fine, it’s just been protecting me in ways that are no longer useful. I have the capacity to develop new, more positive responses to events”
“I have no control over my life” -> “I am taking control of my life”
“I deserve to feel this way” -> “My experiences happened for reasons beyond my control, I can own my part in how I respond to things”
“I have no skills or future” -> “I have plenty of resources, skills and capacities”
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