What is Dialectical Behavior Therapy

Written by: Callista Forchuk, MA, MSc

How can we achieve change when it is needed while also accepting our current circumstances? To build a  meaningful life, there are times when we need to problem-solve to improve our situation. There are also times in which we are not where we want to be, despite our best efforts. The synthesis of change and acceptance is central to Dialectical Behavior Therapy (DBT), an evidence-based treatment that addresses pervasive emotion dysregulation, problematic behaviours, and difficulties in relationships.

What is DBT?

DBT was originally developed by Dr. Marsha Linehan to develop a “life worth living” using strategies from behaviourism and contemplative practices to solve problems and accept reality as it is. It was originally created to treat highly suicidal clients diagnosed with borderline personality disorder (BPD); it has since shown effectiveness for substance use, eating disorders, and ADHD, among other mental health challenges (Linehan & Wilks, 2015; Rizvi et al., 2024). More generally, DBT addresses emotion dysregulation and its consequences. Comprehensive DBT includes a combination of individual psychotherapy, group skills training, telephone coaching, and consultation meetings amongst DBT therapists. It is often modified in practice according to client needs and available resources, with ongoing research to clarify its effects across different forms or “doses” (e.g., McMain et al., 2022). To address the complex and changing problems faced by clients, DBT is based on guiding principles rather than a rigid manualized protocol, allowing it to be highly flexible and adaptive. DBT addresses multifaceted problems using predetermined hierarchies (e.g., based on symptom severity and risk to self), and distinct modules that address treatment goals.

What Does “Dialectical” Mean?

All therapies are based on assumptions about the world and about people. In DBT,  that world view is based on dialectics. Dialectics refers to the process of creating integration or synthesis from opposites, such as from acceptance on one end and change on the other. Dr. Linehan (1993) uses a visualization to represent the idea of “dialectical” therapy, where she sits on opposite ends of a teeter-totter with a patient, balancing together to come toward the middle in order to rise together to a higher level (i.e., a synthesis). And then this process repeats. With regard to DBT, “dialectics” refers to both a fundamental world view as well as a method of therapeutic persuasion. Broadly speaking, a dialectical perspective highlights that change occurs through continuous interactions and tensions between opposing forces that are themselves part of an interconnected reality. Practically speaking, this translates into an appreciation of contextual factors rather than consideration of any isolated behaviour.  It also reflects the continuous movement inherent to therapy and growth.

Bringing it together

By combining strategies to help clients change with techniques and skills that allow them to accept and tolerate their reality, DBT enables clients to cultivate a life worth living. If you’re wondering what type of therapy is best for you and DBT resonates with you, reach out to our team of Clinical Associates today. Book a free Discovery Call and be matched with one of our therapists quite quickly, usually within 48 hours. Stay tuned for next month’s blog post on DBT and related topics.

References

Linehan, M. (1993). Cognitive behavioral therapy for borderline personality disorder. Guilford Press.

Linehan, M. M., & Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy. American journal of psychotherapy, 69(2), 97-110.

McMain, S. F., Chapman, A. L., Kuo, J. R., Dixon-Gordon, K. L., Guimond, T. H., Labrish, C., … & Streiner, D. L. (2022). The effectiveness of 6 versus 12 months of dialectical behavior therapy for borderline personality disorder: A noninferiority randomized clinical trial. Psychotherapy and psychosomatics, 91(6), 382-397.

Rizvi, S. L., Bitran, A. M., Oshin, L. A., Yin, Q., & Ruork, A. K. (2024). The state of the science: Dialectical behavior therapy. Behavior Therapy, 55(6), 1233-1248.