Dialectical Behaviour Therapy
Dialectical Behavior Therapy (DBT) is one of the most rigorously researched and effective treatments for persons struggling with emotional dysregulation, chronic suicidality, and borderline personality disorder (BPD). Developed by Dr. Marsha Linehan in the late 1980s, DBT evolved from standard Cognitive Behavioral Therapy (CBT) when practitioners realized that a sole focus on "change" felt invalidating to clients in extreme distress.
The core of DBT rests on the "dialectic"—the philosophical concept that two opposing truths can exist simultaneously. In therapy, this translates to the synthesis of acceptance and change. We will work on accepting your reality and your emotions exactly as they are right now (validation), while simultaneously working harder than ever to change the behaviors that are causing you suffering.
The Four Pillars of DBT Skills
While many DBT programs use a group setting to teach skills, in our individual work, we will weave these lessons directly into your sessions. You will learn four specific sets of tools:
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Mindfulness: This is the foundation. It teaches you to take control of your mind rather than letting your mind control you. You will learn to observe and describe your reality without judgment and participate fully in the present moment.
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Distress Tolerance: These are "crisis survival" skills. When pain is overwhelming and cannot be fixed immediately, these tools help you get through the moment without making things worse (e.g., without self-harm, lashing out, or substance use).
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Emotion Regulation: You will learn to identify and name your emotions, understand what they are trying to tell you, and decrease your vulnerability to painful moods.
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Interpersonal Effectiveness: We will practice tools for asking for what you need, saying "no," and managing conflict while maintaining your self-respect and keeping your relationships healthy.
Structuring Our Sessions
Individual DBT is different from standard talk therapy. It is less about "venting" and more about working. To make progress without a separate skills group, we have to be structured and strategic.
1. The Diary Card
This will be our roadmap. Every week, you will fill out a simple tracking sheet recording your urges, emotions, and behaviors. We start every session by reviewing this. It moves the conversation away from a vague "How was your week?" to looking at real data. It helps us spot patterns—like noticing that your anger spikes every time you skip lunch, or that your anxiety drops when you practice mindfulness.
2. The Chain Analysis
When things go wrong—for example, if you had a blowout argument or engaged in a harmful habit—we don’t judge it; we analyze it. We conduct a "chain analysis," which is a micro-examination of the event. We look at what made you vulnerable that day (e.g., lack of sleep), what triggered you, and every thought and feeling that led to the behavior.
This is where the learning happens. As we trace the links in the chain, we will pause and ask, "What skill could have changed the outcome here?" We will then practice that skill together in the office so you are ready to use it next time.
3. Solution Analysis and Commitment
We finish by looking forward. We can’t change the past, but we can plan for the future. We will anticipate the stressors coming up in your week and create a specific coping plan for how you will handle them effectively.
Managing Safety and Support
Standard DBT includes 24/7 phone coaching, where a client can call a therapist during a crisis. However, in our individual framework, I am not available for on-demand coaching between sessions. This means we must place a strong emphasis on safety planning and anticipatory coping.
Because I cannot be there in the moment of crisis, we will work together to create a robust safety plan. This is a clear, written hierarchy of steps you agree to take when you are in distress. It might look like this:
Step 1: Attempt three specific Distress Tolerance skills we practiced.
Step 2: Call a trusted friend or family member identified in your plan.
Step 3: Call a crisis hotline.
Step 4: Go to the nearest emergency room.
By agreeing to this plan, you are taking ownership of your safety. Our goal is to empower you to become your own therapist, using the tools we practice to navigate difficult moments independently until our next scheduled appointment.
Moving Forward
DBT is demanding work. It requires a willingness to look closely at your behaviors and a commitment to trying new ways of living. But if you are tired of feeling controlled by your emotions, this approach offers a path out.
