Even though DBT has a lot going for it, it’s not perfect or ideal for everyone.

It can fall short in some areas:

1. High time commitment

DBT is intense.

A standard DBT program usually includes:

• • Weekly individual therapy.
  • Weekly group skills training (around 2 hours).
  • Homework assignments.
  • Optional phone coaching.

This heavy schedule can feel crushing for those already battling depression, low energy, or executive dysfunction.

Treatment dropout rates for DBT can be high, sometimes around 24%–34%, depending on the population.

2. It requires active participation
   
   

DBT is very skill-based.

You’re expected to practice mindfulness exercises, emotion regulation strategies, and interpersonal skills outside of therapy sessions.

It can be extremely hard to engage with the program if someone is not ready, too emotionally devastated, or lacks stability (serious substance abuse, homelessness).

3. Limited availability of fully trained therapists

True, evidence-based DBT requires a therapist trained specifically in DBT methods, ideally in a full DBT team.

However, fully trained DBT providers are rare in many places. Some therapists might offer “DBT-informed” therapy instead, which may not deliver the same results.

4. Expensive and not always covered

It can be pricey.

Because it often involves both individual and group therapy, costs can add up fast, and insurance companies don’t always fully cover comprehensive DBT programs.

It could lead to starting therapy and then having to drop out halfway if people can’t afford it, which can feel demoralizing.

5. Emotionally challenging
   
   

DBT pushes you to face painful emotions head-on through mindfulness and distress tolerance.

For people early in their healing process or with very complex trauma histories, diving into this kind of work without proper emotional preparation can backfire, causing even more emotional flooding, dissociation, or worse, depression in the short term.

It’s not that DBT causes harm, but without the right pace and support, it can feel destabilizing at first.

6. Not the best fit for every diagnosis

While DBT is great for:

• • Borderline personality disorder (BPD).
  • Chronic suicidal ideation.
  • Depression with emotional dysregulation.
  • PTSD.

It’s less effective for:

• • Primary psychotic disorders such as schizophrenia.
  • Severe cognitive impairments.
  • Individuals who are not emotionally dysregulated.

Some adaptations of DBT (like DBT-PE for PTSD) exist, but still, it’s not the best match for every mental health issue.

7. Therapist burnout
   
   

Interestingly, DBT can be hard on therapists, too.
Since it’s designed for high-risk clients (e.g., chronic suicidality), therapists face emotional exhaustion, secondary trauma, and professional burnout.
If a therapist isn’t properly supported within a DBT consultation team, it can impact the quality of therapy you get.

A study in 2015 (Harned et al.) highlighted that DBT providers without good team support show higher rates of burnout, which risks therapy effectiveness.

Potential risks in specific situations

• • Suicidal clients: DBT could leave serious gaps in safety nets if not delivered properly (without thorough risk management planning).
  • Complex PTSD clients: Mindfulness exercises can trigger flashbacks or dissociation if introduced too quickly.
  • Substance use clients: DBT alone may not be enough; integrated substance abuse treatment might be necessary.