Why DBT?
So, why DBT?
In this blog I’m going to break down a brief summary of what DBT is. I won’t reinvent the wheel here and go into too much detail about the ins and outs of DBT. Rather, I’d like to share a bit about why I personally love DBT so much and what keeps me motivated to continue running this group therapy format.
But first, let’s just break down a bit about DBT, the Sparknotes version (am I aging myself here? ;))
First up- you might be wondering what does the word ‘dialectical’ even mean??
The main idea of dialectics is that there is an opposite of everything, and we tend to be the most effective when we can find balance between opposites. So, being dialectical means finding balance. We find this balance by incorporating, or including, ideas from two opposite ends of a spectrum.
Dialectical Behavior Therapy was created in the early 1990s by Dr. Marsha Linehan. Dr. Linehan originally created DBT as a treatment for adults who had difficulties with intense emotions and safety issues like suicidal thoughts and/or attempts, and self-injurious behaviors. It was found that this modality helped these individuals to stay safe, act less impulsively and improve their emotions and relationships. Throughout the years, DBT has been proven helpful in a wide variety of settings and for a wide variety of people, teens included!
DBT is a skills-based approach and includes four different modules, or sets, of skills. These modules include:
1. Mindfulness: Mindfulness skills improve awareness of one’s self and the world. They teach you to make wise decisions, focus on one thing at a time, avoid judgments and do what works. Think of mindfulness skills as the foundation; they are necessary for all the others to be effective. That’s why these skills are considered “core skills” and are used in conjunction with all the other DBT skills.
2. Distress Tolerance: The Distress Tolerance module includes two subsets of skills: Crisis Survival and Accepting Reality skills. Crisis Survival skills are about coping with difficult situations without turning to harmful coping strategies like self-injury and drug use. Accepting Reality skills, on the other hand, help you accept what cannot be changed so that you can focus on being effective and doing what works.
3. Emotion Regulation: The Emotion Regulation module teaches skills to help you become more aware of your emotions, act in ways that reduce emotional suffering and create emotional balance through positive and confidence-building activities.
4. Interpersonal Effectiveness: The Interpersonal Effectiveness module teaches communication and relationship skills. These help you be assertive, build and keep healthy relationships (including the one you have with yourself!) and increase self-respect in relationships.
What’s neat about these skills is that they each have unique names and acronyms. This helps you learn, remember and use the skills when you need them most. DBT skill names and acronyms also help us to have a common way of thinking and talking about skills.
Dr. Lineahan’s approach to DBT, which now also goes by “Standard DBT,” is, well… very involved. This standard DBT treatment consists of weekly individual therapy sessions (approximately 1 hour), a weekly group skills training session (approximately 1.5–2.5 hours), and a therapist consultation team meeting (approximately 1–2 hours). This can be a wonderful thing for folks who have access to this type of support and for clinical team settings that have the resources to provide it. But if we’re being real, that’s not always practical or realistic. So we adapt!
I had been using many of these DBT skills during my individual therapy sessions with clients over the years. For folks whose emotions and behaviors were often very dysregulated, learning basic skills to help them navigate the ups and downs they experience was a crucial part of regaining a sense of control over their lives.
So, fastforward to 2020. When 2020 happened and everyone’s lives flipped upside down, seeing how fast the waitlist at my former agency grew made my stomach turn. There were simply so many people seeking help and what seemed like not enough clinicians available to provide that 1:1 professional support. Seeing this tremendous need for mental health services is what finally motivated me to break out of the confines of my comfortable 1:1 therapy setting and lead a group therapy.
I was also drawn to lead a DBT group because of how different it is from 1:1 therapy. At this point into pandemic-life I had been feeling a bit burnt out by 1:1 therapy and was looking to switch things up a bit! Meeting with a 1:1 therapist and participating in a DBT skills group are two very different things. In a DBT skills group, you learn what the skills are and get practice in using them. In individual therapy, you learn how to apply these skills to your own unique life circumstances and situations. Individual therapy also allows more time and space to become aware of your own thought and behavioral patterns that contribute to mental health symptoms. Quite frankly, there is a lot of ground to cover in a one hour, weekly DBT skills group. As such, this does not leave a lot of time to discuss any one person’s issues in depth (I’ll add that because of this, it IS important that those participating in a DBT Skills group do also have their own 1:1 therapist as well, though this is not a strict requirement!).
In the time I’ve spent working with teens, I’ve often found that a barrier to receiving treatment sooner is that the teen was resistant to coming to therapy. Trust me- I get it! Coming to a new place with the expectation to open up and share your inner most world with a complete stranger isn’t exactlyyy what everyone calls a good time and truthfully, it can take a long time before some are ready to take this step.
I love that DBT creates a more realistic starting point for those who might not be completely ready to open themselves up fully or be completely vulnerable. I do say that when it comes to the skills group, “you get what you give.” While there is no expectation that each person is going to come in and share their most vulnerable experiences with the group (because, once again, that’s just simply not the type of group therapy that it is!), it can be helpful for participants to be willing to share a bit about how the skills relate to their life experience. The more honest you are with yourself about when these skills would be helpful to utilize in your life, the more likely you are to see and experience the positive changes for yourself! The reverse is true as well; If you enter into a skills group with the belief that you don’t need to learn or use these skills, you can expect to see very little change in your life. You get out of group what you put into group!
To step back into work-life once my blissful maternity leave comes to an end, I will be kicking it off with a new round of my signature DBT Skills for Teens: 13 Week Dialectical Behavior Therapy. You can read more details on my group therapy page here! If it sounds like a good fit for you or your teen, let’s connect and get you registered! Group maxes out as 6 people so don’t hesitate! :)
As time goes on I’d love to run a DBT for Adults and even a DBT for Parents. I’m pacing myself as I navigate what my work/life balance will look like in this season of life, but I look forward to sharing these skills once again!
Talk soon! Stay skillful! ;)
xO Amy