- People unwilling or unable to commit to the structure
DBT is highly structured and skill-based.
It typically involves weekly individual therapy, weekly group skills classes, daily homework, and sometimes phone coaching.
If someone can’t consistently attend sessions, refuses to do homework, or isn’t open to practicing skills outside therapy, DBT might not work well.
- People seeking only insight-based therapy
Some people want therapy to direct their attention mainly on processing emotions, talking through issues, or gaining insight (like in psychodynamic therapy).
DBT is action-focused because it emphasizes behavior change, skill acquisition, and active coping.
DBT might feel frustrating or “too much” if someone doesn’t want structured tools and prefers purely exploratory conversations.
- People with active psychosis or severe cognitive impairment
If someone is experiencing active hallucinations, severe delusions, or significant cognitive impairments, such as dementia or severe intellectual disability, they might struggle with the cognitive demands of DBT (like mindfulness practice, behavioral analysis, or skill memorization).
Other therapies focused on stabilization and reality orientation would likely be more appropriate first.
- People in acute mania
DBT might not be effective right away if someone is in a current manic or hypomanic episode.
Mania often needs stabilization medication first because it impairs the attention, impulse control, and emotional regulation needed to participate in DBT sessions.
- People with no immediate motivation for change
DBT relies heavily on a client’s willingness to change actions, even small ones.
That’s why it doesn’t work for someone who:
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- Doesn’t see any problems in their behavior.
- Feels 100% forced into therapy by others (court, parents, partner).
- Isn’t open to the idea of working toward goals, because DBT is collaborative and requires active participation.
That said, motivation can change once therapy begins, so sometimes initial reluctance isn’t a hard no.
- People who need crisis stabilization first
If someone is so acutely unsafe that immediate hospitalization or crisis stabilization is needed, DBT may be introduced later.
It’s great for reducing suicidal behaviors long-term, but it’s not designed for emergency psychiatric crisis management on its own.
