FHWS specializes in Dialectical Behavior Therapy (DBT). We have provided the following information to help explain how DBT is unique from other therapies. You can also learn more about DBT from its creator here.
DBT is a distinctive treatment model that was developed by Marsha Linehan, Ph.D. In its essence, DBT is a derivative of Cognitive Behavioral Therapy (CBT). What makes DBT different from traditional CBT models is the integration of Eastern philosophy and meditative practices with evidence-based Western behavioral therapy treatment. Unlike more traditional cognitive therapy approaches which emphasize teaching people tools to help them change their lives, DBT incorporates acceptance strategies as well as change strategies. DBT acknowledges that while people seek change, they also need to feel understood, learn to accept themselves and tolerate aspects of their lives that they cannot change.
The "D" in DBT stands for dialectic. This is the philosophical idea that opposite truths can co-exist. For example, patients can need to both change and to accept their current struggles. Dialectics are used in DBT to help patients resolve confusing conflicts within themselves and others.
Who will benefit from DBT?
DBT was originally designed to help patients with Borderline Personality Disorder, a chronic personality style characterized by instability in mood, thinking, identity and relationships. It has since been adapted to treat many different populations including those with mood disorders, substance abuse problems, and troubled teens. Much research has been done to support the efficacy of DBT treatment with different ages and presenting concerns. At FHWS, we often treat:
Anxiety disorders (including school avoidance)
Cutting or other forms of self-injury
Post-Traumatic Stress Disorder (PTSD)
High conflict families
Personality disorders, including borderline personality disorder
Do DBT therapists receive special training?
Yes. While all of our clinicians have obtained doctorates in psychology or are licensed clinical social workers, we have also all completed specific training in DBT. Both partners of this practice have completed Intensive Training (a special training program offered by Dr. Linehan's company, Behavioral Tech). All new practitioners are trained and supervised by Drs. Gingold and Loonin, and are required to obtain DBT intensive training through Behavioral Tech as schedules and availability allows. Our practice is considered an Intensively Trained Adherent DBT Consultation Team, which means we offer our DBT services with all of the components suggested by Dr. Linehan's model.
What else does DBT entail?
DBT involves several components. While patients are participating in individual (and often group) sessions during the week, they also have several tasks outside of sessions.
Phone Coaching: We have a 24/7 skills coaching line available for all patients engaged in DBT skills training at FHWS. Phone coaching helps a person “borrow another person’s wise mind” when they are emotionally dysregulated. Phone coaching is intended to help patients apply newly learned skills in their lives outside of therapy.
Diary Cards: All DBT patients are expected to fill out diary cards daily to increase self-awareness. Diary cards include having a person identify what is happening emotionally, and how intense those emotions are when they are having “their urge” or their target behavior; what is happening in their body when they are having that urge, and rate their level of “willingness” to not act on their urge. Subsequently, patients track if they use skills, which skills they use, and what happens when they use those skills. Ultimately, DBT treaters believe that if a person is “radically willing” to not act on an urge when they are emotionally dysregulated, they will find a skill to support behavioral changes.
DBT Consultation Team: Adherent DBT Consultation Teams (like the FHWS team!) meet weekly to address issues which interfere with DBT treatment teams providing the most effective treatment possible. These meetings are highly structured, and provide the support for each case of an individual therapist’s caseload to be treated by the team as a whole. DBT Consultation team meetings give clinicians an opportunity to identify and resolve their own therapy interfering behaviors as well as review skills and programmatic issues.
What are the DBT skills?
DBT has five skills-based components, which are typically taught in skills groups and reinforced in individual therapy sessions.
Core Mindfulness: Harnessing attentional and awareness processes to help individuals slow down, become less reactive and more effectively participate in life.
Emotional Regulation: Understanding one’s own emotions, and learning to minimize the damaging aftereffects of painful emotions.
Distress Tolerance: Developing skills to distract from problems that are unsolvable or cannot be solved in the moment, and to accept difficult aspects of reality.
Interpersonal Effectiveness: Learning to communicate more effectively so that a person’s objectives are better met, relationships are maintained and one’s self-respect is nurtured.
Walking the Middle Path: Learning to adopt a dialectical problem-solving style to become more flexible, create compromise, and gain an overall sense of mastery in one’s life.