Dialectical behavior therapy works by teaching people skills to manage extreme emotions, tolerate trouble, navigate relationships better, and become more mindful, all while balancing acceptance and change.
- Structure of DBT
DBT typically includes four parts:
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- Individual therapy
- Individual therapy
Weekly one-on-one sessions focus on solving problems and applying DBT skills to real-life issues, such as self-harm, suicidal thoughts, or dangerous behaviors.
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- Group skills training
Clients attend weekly groups (like a class) to learn and practice the four core DBT skill sets:
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- Mindfulness.
- Emotion regulation.
- Distress tolerance.
- Interpersonal effectiveness.
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- Phone coaching
Clients can reach out to their therapist between sessions (within set boundaries) to get assistance using skills in real-time when a crisis happens.
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- Therapist consultation team
Counselors meet weekly with other DBT providers to support each other and stay on track, because DBT is intensive and emotionally heavy work.
- Core concepts that make DBT work
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- Dialectics
The central idea is that two seemingly opposite things can both be true at the same time:
➔ “I am doing the best I can,” AND “I need to try harder.”
DBT aids in stopping seeing everything in black-and-white (all good/all bad) and finding the middle ground, a crucial step for emotional healing.
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- Validation
- Validation
Psychotherapists validate that a client’s feelings make sense given their personal experiences.
Confirmation diminishes shame and defensiveness, making clients more open to changing harmful behaviors.
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- Behavioral change
DBT uses techniques from behavioral therapy (like reinforcement and exposure) to build healthier behaviors and reduce destructive ones.
Each skill module targets a different area of difficulty:
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- Mindfulness
Learning to be present, aware of thoughts and feelings without judgment.
Example: Noticing you’re feeling sad without getting swept away into despair.
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- Distress tolerance
- Distress tolerance
Learning to survive crises without making things worse.
Example: Using cold water splashing, deep breathing, or grounding techniques instead of self-harming.
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- Emotion regulation
Understanding and managing emotional reactions more effectively.
Example: Recognizing when you’re vulnerable to emotional exhaustion and using skills to balance yourself.
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- Interpersonal effectiveness
Communicating needs, setting boundaries, and maintaining healthy relationships.
Example: Asking for help without guilt or saying “no” respectfully.
DBT moves through four stages depending on a client’s needs:
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- Stage 1: Stabilization
Aim to get dangerous behaviors (like self-harm, suicide attempts, substance abuse) under control.
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- Stage 2: Emotional processing
- Stage 2: Emotional processing
Deal with past trauma, emotional pain, and ongoing emotional suffering.
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- Stage 3: Building a life worth living
Concentrate on improving relationships, career, self-esteem, and goals.
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- Stage 4 (optional): Transcendence
For those who want to pursue deeper meaning and spiritual growth after becoming stable.
- Scientific backing
DBT has been shown to radically decrease:
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- Suicide attempts.
- Self-harming behaviors.
- Depression and anxiety symptoms.
- Hospitalizations.
- Relationship problems.
Meta-analyses confirm that DBT is effective across many populations, not just people with BPD.
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