Dialectical behaviour therapy (DBT) is a type of talking therapy which was originally developed by an American psychologist named Marsha Linehan. It is based on cognitive behavioural therapy (CBT), but has been adapted to meet the particular needs of people who experience emotions very intensely.

dialectical behavioural therapy (DBT)

DBT is mainly used to treat problems associated with borderline personality disorder (BPD), such as: repeated self-harming, attempting suicide, using alcohol or drugs to control emotions, eating problems, such as binge eating and purging and unstable relationships.

Amongst other interventions, such as behavioural chain analysis, the DBT Therapist uses two main approaches of intervention, Acceptance techniques and Change techniques. 

Acceptance techniques focus on understanding yourself as a person, and making sense of why you might use self destructive behaviours, such as self harm, mistreat yourself, or misuse alcohol or illicit substances. A DBT therapist might suggest that this behaviour may have been the only way you have learned to deal with the intense emotions you feel – so, even though it’s damaging to you in the long-term, and might be very alarming to other people, your behaviour actually makes sense and works at the present moment when it's needed.

DBT therapists use change techniques to encourage you to change your behaviour and learn more effective ways of dealing with your distress. They encourage you to replace behaviours that are harmful to you with behaviours that can help you move forward with your life. For example, you can learn how you can distract yourself from difficult emotions during a crisis, by engaging in activities, instead of self-harming, or turning to substances that distort the way you view reality. You can also start challenging your unhelpful thoughts and develop a more balanced way of looking at things. 

How is dbt carried out traditionally? 

DBT is carried out as a treatment package and is not traditionally used as a stand alone therapy (so its not like other therapies where you just see a therapist once a week say). To be considered as receiving pure DBT there has to be 4 elements to your therapy, and they have to be active at the same time (or scheduled to be active at the same time).

Firstly: you have to be in group therapy, skills training. Skills Training is a really important aspect of the work, and the group process used to deliver these skills training modules is incredibly useful as it allows people in the program to share challenges in relation to using and learning skills with others, and get a mixed shared experience on how to overcome things. The groups are facilitated by two trained DBT therapists and the skills cover the four major areas of DBT Skills Training which include, Mindfulness, Emotional regulation, Distress tolerance and Interpersonal effectiveness skills. A full cycle of DBT Skills training lasts 1 year, and usually theres an expectation of repeating that year which makes a typical DBT therapy program last up to 2years. 

Secondly: you have to be in personal therapy with an individual therapist. This is where your journey with DBT will usually begin. Within this first stage of therapy, you will spend time identifying goals, and exploring why you should even bother with therapy at all, this is called commitment work. DBT as with any therapy can be tough and at times incredibly challenging, so your therapist will explore with you in detail your motivation and help you work out what you can use to get you through when things get tough. Your individual therapy will then run concurrently with your group skills training. Both will be once a week, and its around this time that your individual therapy will start to look at difficulties that you have identified and want to change as part of your goals. The sessions are contracted and very structured which is helpful for both you and therapist to know exactly what ground your going to be covering and the reasons behind it. The agenda will usually be guided by the goals you have identified within your sessions with any safety issues taking a priority. 

Thirdly: you have to have access to phone coaching. Phone coaching is usually part of your crisis plan and allows you to be able to call your therapist and get support to overcome challenges as they arise. Your therapist would talk you through how and when to use this function and what to do while your waiting for a call back if the therapist doesn't pick up the first time around. Phone calls are usually very structured and very specific, to whats going on in the moment and supportive of what you need to do to manage a situation your facing. Your phone calls will also be discussed as part of the individual therapy so it all links up. 

Fourthly: Your individual therapist has to be part of a consulting team. This aspect is perhaps not something you would be actively aware of in the process of engaging with DBT therapy. The use of a team to support your therapist is helpful as it gives the therapist a chance to get help in thinking about your situation, they say two heads are better than one, but if one of them heads has access to a few more and everyone is routing for you to achieve your goals, that can only be a good thing right? Your therapist would explain more to you about this process, why its useful and how your confidentiality is maintained if you were in a full DBT program. 

So these are the four aspects of a full DBT program. If your missing any one of the above four things, then you're NOT in DBT. 

So how how is Dbt provided at clearview?

This is a really good question, and something that I always make sure that people seeking DBT are fully aware of before we even arrange a first appointment. 

Given the complex nature of a full DBT program, full DBT is not offered by myself at ClearView. However, I am trained to deliver DBT Skills Training and work in a DBT informed way. I have worked on an inpatient unit where DBT was the primary model of therapy being used and been part of a DBT team. I have received training in DBT and as a result through this training and experience I am able to offer Skills training and individual aspects of DBT (such as chain analysis, acceptance & change approaches) which will be used to inform our work together.

Its important to understand that whilst I have supervision within the guidelines of my professional registration I am not part of a DBT Consultation Team. I do however have access to specialist consultation from other DBT practitioners should this be needed and isn’t something that you would notice me making use of. All supervision is held within the boundaries of confidentiality. Also its important to be clear that I do not offer phone coaching in moments of crisis. However, because of this our work together will focus on crisis planning which will include who you can phone when things are becoming really challenging and how you can make use of the resources you have available to you should you move to a position of crisis during the course of our work together.

So what do sessions look like if your using a dbt APPROACH?

If a client comes to me looking specifically for help with a personality disorder (Borderline or Emotionally Unstable) it is likely that they have already seen a psychiatrist who has provided them with this diagnosis. It is really important to understand that only a qualified person can provide this diagnosis this is usually either a Chartered Clinical Psychologist, or a Psychiatrist. 

Our sessions will take the standard format as any other session that I offer however there will be some differences.

The first session will be 90minutes as I offer any client. During this session we will look at your motivations for seeking help and also talk about the expectations of therapy. We will start to explore what you want to get out of therapy and put together some goals around the specific areas of your life where you want to see change. The first session is as much about you meeting and getting a handle on me, as it is me getting on a handle on if I can help you. 

Following the first session our sessions together will follow a very specific agenda which we negotiate between us but will usually take the following format, half review and half skills training. Given that there is presently no option available to give you separate skills training, I look to spend some of the session time on exploring how your week has been, and looking at any challenges, and then the second part of the session introducing a new DBT skill. I work primarily from the ‘DBT Skills Manual for Adolescents’ by Alec L. Miller, Jill H. Rathus 2014 edition, and ‘The Decider Skills Manual’ by Ayres & Vivyan 2015 edition. I tend to find that the skills sheets from these manual’s are more informative and "user friendly" for both adults and adolescents alike, I do also have the standard DBT manual published by Marsha Linehan if a client prefers this however, I generally find most prefer the two aforementioned manuals.

The skills we cover in session are then set as homework for you take home and practice in preparation for the next session. During the review period of the following session, we will spend a short time recapping the skill and exploring if there are any issues that have come up, we will then move onto the next skill. 

How long will i be in therapy for if i'm in dbt with you?

If you are specifically seeking DBT therapy from me its important to understand that you're not being forced to come. So you can drop out when ever you like. However, if you want to see positive change, dropping out is not really advisable. Therapy of ANY kind is a massive personal commitment. Whilst everyone is different, as a general rule of thumb I advise for clients who are seeking help with personality disorder or who are struggling to regulate or manage their emotions and are looking for DBT to be help, I always suggest you need to be committed to undergoing therapy for at least 6 - 12 months, perhaps longer. This doesn't mean in any way that you will only see positive changes after 6-12months, but it does mean that realistically you need to be signed up in your own mind for at least this period of time for us to be able to start to see some definitive changes.

how often do i come to therapy if we are working with dbt in this way?

Whilst I rarely prescribe the frequency of sessions to clients that I meet with, and prefer this matter to be directed by the client on how often they would like to attend, when we are working using DBT for specific reasons I do tend to offer some strong recommendations. I will always recommend weekly sessions if there is a known diagnosis of personality disorder, or evidence of risk such as self harm, suicide or if other kinds of risk are apparent. If a client is not able to manage weekly sessions, then I suggest weekly for at least the first 6 to 8 weeks so we can really focus on the subjects of commitment, goal setting and get in some key skills training. There after I encourage no less than fortnightly but with an agreement that we both keep in mind there maybe times where we need to move back to weekly depending on the challenges your facing at the time.

so whats next?

If you have read this page and you still think that working with me using DBT informed approach could work for you and you want to find out more, then I offer a free no obligation phone discussion to all clients who are interested in working with me. You can call me now on 07747197180 for more information or click here.

Areas of work & specialisation

Stress & Anxiety

Stress & Depression & Mood related concerns

Adolescent & Young People (16+y.o.a.)

Counselling for Men & Male Mental Health

Self Harm

Poor or Negative Coping

Personality Disorder (Emotionally Unstable & Borderline Types)

Long Term & Short Term work

(ClearView Counselling & Psychotherapy is a trading name of ANJ Consultancy Ltd)