Dialectical Behavioral Therapy
I'm a registered nurse and I work in inpatient Child/Adolescent Psychiatry. Our "house therapy", the mode our hospital works with on all our units, is Dialectical Behavioral Therapy (DBT). I've worked in psychiatry most of the time since 1979, and DBT is among the best and most effective therapies I've seen.
DBT was developed by Marsha Linehan Ph.D. in response to difficulties in treating certain clients - particularly clients who :
- Had experienced significant physical, emotional, verbal, mental or sexual abuse, or serious neglect and abandonment, and as a result of these or other experiences
- Suffered symptoms of Post Traumatic Stress Disorder (PTSD) and/or Borderline Personality Disorder, including depression, nightmares and flashbacks, cognitive distortions, high anxiety and other extremes of emotion
- Had persistent self harming or self destructive behaviors such as suicidal thoughts and attempts, self mutilation, drug or alcohol abuse and eating disorders
- Had intense difficulty forming and sustaining relationships in all areas of life - including psychotherapy
Validation
A special difficulty noted in these clients was their strong reaction to the demands in psychotherapy for progress ; for the learning of new life or coping skills, and the leaving of old maladaptive skills behind. In response to this, DBT places strong emphasis on validation. Validation includes empathy - the accurate perception of a client's responses and behavior, and acceptance of a client as she is ; but also an active effort to discover healthy aspects of the response, even where it is in part dysfnctional. The further crucial step in validation is to communicate this to the client, in terms relevant to her.
For therapists, validation is a differentiated and exact tool, learned through training and experience ; at a same time an art and a science. It assumes clients are at all times doing the best they can, and that there are kernels of truth are to be found even in dysfunctional behavior. While care is taken not to validate harmful or dysfunctional behavior, the effort of the therapist is to discover what is relevant, true or effective in the client's responses, and to affirm this directly.
For clients who have experienced consistently, even crushingly invalidating environments in their lives, this can be game changing. It provides a reflection to them of what remains healthy in them despite all hardship. Ongoing experiences of a "Wise Mind" capacity in themselves encourages clients to exercise it more - to know it's possible and strive to access it further. Validation is employed in all phases of therapy, and helps build trust and commitment to this work.
Dialectics
Dialectics address an aspect of reality often difficult, even unnerving for traumatized persons to grasp ; namely that seemingly opposite facts or experiences can sometimes both be true, at one and the same time.
DBT itself contains a quite fundamental dialectic, in its co-emphasis on validation and progress. A therapist seeks on the one hand to identify what is true, valid and relevant in a client's responses to her experiences, and actively affirm this ; while at the same time addressing dysfunctional aspects of behaviors, and affirming the need for change.
Traumatized persons may find it hard to live with uncertainty, and be inclined to impulsive action, hasty judgements, vehement reaction or withdrawal. Dialectics help such persons recognize and tolerate paradox, and deal with it more effectively. Examples of insights that might arise from this might include :
- "I'm angry with a him/her right now - but I also love this person, and can still see the better qualities in them"
- "I'm having a very hard day today - but I also know I've been making really good progress lately"
- "I'm upset right now, and I feel like doing something extreme. But I know there'll be consequences, and that I'll feel really bad about myself afterwards"
- " I like him / her and really like to spend time with them - but they use drugs and alcohol, and when I'm with them, I do too"
Therapy
Progress occurs in DBT though both individual therapy, and participation in groups. DBT may begin with an encounter through an inpatient hospitalization, but as problems and issues most often did not arise from a single traumatic episode, healing also takes time. Most DBT is done in outpatient group and individual therapy, where progress can occur in key skill areas of
- Mindfulness
- Distress Tolerance
- Emotional Regulation and
- Interpersonal Effectiveness Skills
For more on DBT, visit our page DBT : Frequently Asked Questions or the DBT website www.behavioraltech.org
I'm a registered nurse and I work in inpatient Child/Adolescent Psychiatry. Our "house therapy", the mode our hospital works with on all our units, is Dialectical Behavioral Therapy (DBT). I've worked in psychiatry most of the time since 1979, and DBT is among the best and most effective therapies I've seen.
DBT was developed by Marsha Linehan Ph.D. in response to difficulties in treating certain clients - particularly clients who :
- Had experienced significant physical, emotional, verbal, mental or sexual abuse, or serious neglect and abandonment, and as a result of these or other experiences
- Suffered symptoms of Post Traumatic Stress Disorder (PTSD) and/or Borderline Personality Disorder, including depression, nightmares and flashbacks, cognitive distortions, high anxiety and other extremes of emotion
- Had persistent self harming or self destructive behaviors such as suicidal thoughts and attempts, self mutilation, drug or alcohol abuse and eating disorders
- Had intense difficulty forming and sustaining relationships in all areas of life - including psychotherapy
Validation
A special difficulty noted in these clients was their strong reaction to the demands in psychotherapy for progress ; for the learning of new life or coping skills, and the leaving of old maladaptive skills behind. In response to this, DBT places strong emphasis on validation. Validation includes empathy - the accurate perception of a client's responses and behavior, and acceptance of a client as she is ; but also an active effort to discover healthy aspects of the response, even where it is in part dysfnctional. The further crucial step in validation is to communicate this to the client, in terms relevant to her.
For therapists, validation is a differentiated and exact tool, learned through training and experience ; at a same time an art and a science. It assumes clients are at all times doing the best they can, and that there are kernels of truth are to be found even in dysfunctional behavior. While care is taken not to validate harmful or dysfunctional behavior, the effort of the therapist is to discover what is relevant, true or effective in the client's responses, and to affirm this directly.
For clients who have experienced consistently, even crushingly invalidating environments in their lives, this can be game changing. It provides a reflection to them of what remains healthy in them despite all hardship. Ongoing experiences of a "Wise Mind" capacity in themselves encourages clients to exercise it more - to know it's possible and strive to access it further. Validation is employed in all phases of therapy, and helps build trust and commitment to this work.
Dialectics
Dialectics address an aspect of reality often difficult, even unnerving for traumatized persons to grasp ; namely that seemingly opposite facts or experiences can sometimes both be true, at one and the same time.
DBT itself contains a quite fundamental dialectic, in its co-emphasis on validation and progress. A therapist seeks on the one hand to identify what is true, valid and relevant in a client's responses to her experiences, and actively affirm this ; while at the same time addressing dysfunctional aspects of behaviors, and affirming the need for change.
Traumatized persons may find it hard to live with uncertainty, and be inclined to impulsive action, hasty judgements, vehement reaction or withdrawal. Dialectics help such persons recognize and tolerate paradox, and deal with it more effectively. Examples of insights that might arise from this might include :
- "I'm angry with a him/her right now - but I also love this person, and can still see the better qualities in them"
- "I'm having a very hard day today - but I also know I've been making really good progress lately"
- "I'm upset right now, and I feel like doing something extreme. But I know there'll be consequences, and that I'll feel really bad about myself afterwards"
- " I like him / her and really like to spend time with them - but they use drugs and alcohol, and when I'm with them, I do too"
Therapy
Progress occurs in DBT though both individual therapy, and participation in groups. DBT may begin with an encounter through an inpatient hospitalization, but as problems and issues most often did not arise from a single traumatic episode, healing also takes time. Most DBT is done in outpatient group and individual therapy, where progress can occur in key skill areas of
- Mindfulness
- Distress Tolerance
- Emotional Regulation and
- Interpersonal Effectiveness Skills
For more on DBT, visit our page DBT : Frequently Asked Questions or the DBT website www.behavioraltech.org
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