What is Dialectical Behaviour Therapy (DBT)?
Dialectical Behaviour Therapy was developed by a woman named Marsha Linehan who was using Cognitive Behaviour Therapy to treat patients who had been diagnosed with Borderline Personality Disorder. She found it didn’t work so well on its own because her patients often felt invalidated by the strong focus on change. What Marsha learnt was that these patients needed more validation and acceptance within treatment. She borrowed some meditation techniques from Buddhists philosophy to form the acceptance skills within this new therapy. She called this Therapy Dialectical Behaviour Therapy.
What does the ‘Dialectical’ part mean?
‘Dialectics’ is a philosophical school of thought which, in short, is about balancing and bringing together contradictory or opposite ideas and trying to find a balance or a synthesis between these two ideas. One of the most important dialectics in DBT is between Change and Acceptance,whereby patients try to find a synthesis between the two. DBT group members are encouraged to look for the dialectic when challenging some of their rigid thinking.
What is borderline personality disorder?
Borderline Personality Disorder is a diagnosis given to individuals suffering from a range of problems. Some of these include, intense negative emotions (anger, shame, guilt, sadness, fear), difficulties in controlling these emotions, usually engaging in impulsive behaviours in an attempt to control them: such as: self-harm, misuse of alcohol or drugs, binge eating, purging,reckless driving etc. They also tend to have unstable relationships, sudden mood swings, feelings of emptiness and chaotic lifestyles. Suicide attempts and/or self-harming are common, and the rate of completed suicide is particularly high in this group.
What causes borderline personality disorder?
DBT answers this important question by introducing what it called the Bio Social Model. Basically this explanation combines two important contributors to the development of Borderline Personality Disorder. The first is the Biology part, which is that Borderline individuals are born with an emotionally sensitive temperament. This means that they experience emotions more intensely than other people and that these emotions tend to stick around for a longer amount of time compared to other people. The second contributing factor is the individual’s environment. This is the ‘Social’ part of the model.DBT explains that if an individual has a sensitive temperament and is then placed in an invalidating environment they are likely to develop the above set of problems. An invalidating environment is where an individual is told by others that what their experience is, is either not real or imagined. Common things told to a Borderline individual are ‘you’re over reacting’, ‘stop being a drama queen’ etc. These sorts of comments made repetitively over time, obviously leave the individual feeling invalidated and not understood.
Do I Have to be diagnosed with borderline personality disorder to do DBT?
In short, no. In fact this program is not in the business of diagnosing people. However, if you can relate to some of these feelings and behaviours from above, especially some of the impulsive behaviours, chances are,DBT could really help you.
How does it work?
Assessment phase
During this phase you will meet with a skills trainer about 3-4 times. What we’re trying to achieve here is for us both to work out whether DBT is suited to you and also whether you are suited to DBT. What we also do is develop a contract together. In this contract we make some goals for your therapy and we work out strategies to prevent you from not completing the full year of DBT.
Orientation
After you finish the assessment phase of DBT you will attend an Orientation session. This is where you will have the opportunity to meet other new group members and where the skills trainers will orient you to what you need to know before joining group. It is compulsory for you to attend Orientation. If you do not attend, you will need to wait 6 months until your contract has finished before joining DBT again.
The DBT group
After Orientation you will attend your first day of group.
DBT is broken up into four modules, Mindfulness, Distress Tolerance, Emotion Regulation and Interpersonal Effectiveness.
The first two weeks of every module begins with the module on Mindfulness.We do Mindfulness at the beginning of all the other three modules because it’s so important and really difficult to practice. Then we work through one of the above modules for six weeks. After this you will have a week break from group (in this week we hold orientation for new group members).
Then we will work through another two weeks of Mindfulness and then six weeks of the next module. Once you complete one cycle of DBT, which will take about six months, you repeat it. What’s the point of repeating DBT? What we usually find with DBT is that on the first cycle, the individual achieves an intellectual understanding of the skills and after the second cycle you get a much deeper understanding of the skills and are more able to put them into practice.
So it looks a little bit like this:
- Assessment phase: 3-4 sessions
- Orientation: 1 week
- Mindfulness: 2 weeks
- Distress Tolerance: 6 weeks
- One week break
- Mindfulness: 2 weeks
- Emotion Regulation: 6 weeks
- One week break
- Mindfulness: 2 weeks
- Interpersonal Effectiveness: 6 weeks
That’s your first cycle completed and then you will repeat it!
DBT is a big commitment. It takes one year to complete the program and you will need to attend the skills training group for 3 hours once a week and a one hour individual session once a week. If you miss three consecutive group sessions then you will need to step out of the group until your contract is up. We usually contract for 6 months at a time. You can only do DBT once at the Hills Clinic, so it’s wise to think hard about whether this is the right time for you to do DBT. As skills trainers we want people to graduate from DBT and we want to prevent you from falling out of therapy,that’s why we meet at least about 3-4 times before you even begin DBT to make sure you are ready and that this is a good time for you.
Assessment of patients for program enrollment and suitability has now commenced and if you are interested in participating or know someone who you feel may benefit, please contact our program coordinator, Rachael Burton on 1300 122 144