Dialectical Behavior Therapy an Option for Some
> 6/24/2008 3:37:00 PM


Dialectical Behavioral Therapy (DBT) is a therapeutic model falling under the Cognitive Behavioral heading. It was initially created as a preventive approach for clients exhibiting suicidal behaviors, but grew into a discipline almost exclusively applied to the treatment of individuals with borderline personality disorder. Today therapists also utilize DBT with clients diagnosed with bulimia or binge-eating, as well as dysfunctional adolescents and chronically depressed seniors.

Combining both one-on-one therapy and regular group sessions, DBT looks to facilitate the development of better-adjusted individuals by heightening their awareness of their own actions, teaching them to better respect themselves, and helping them to develop more effective psychosocial skills. Many clients even receive situational coaching over the phone. Like other forms of CBT, dialectic therapy works from the premise that, for certain patients, learning new behaviors is far more important than developing the personal insights gained through traditional psychotherapy.

DBT grew from the work of late-20th century psychologist Marsha M. Linehan, drawing particular influence from her fondness for the Buddhist principle of mindfulness. By strict definition, mindfulness is a consciously enhanced awareness of and sensitivity to one’s thoughts, motives, and actions, particularly as they include and affect other people. Mindfulness among DBT clients entails the development of a greater sensitivity to the results of their own behavior and an empathy for those who may be affected. The ultimate goal of this understanding is the development of alternative behaviors.

Dialectical therapy, in keeping with the “dialect” aspect of its name, focuses on the client/therapist exchange by establishing mutually accepted goals. As in other CBT treatments, therapists encourage clients to list relevant issues that have emerged each week in a diary or notecard format for later review. Once in therapy, both parties examine these issues and incidents in order to identify the series of events that brought them about and determine how to avoid their unwanted outcomes in the future. Self-harm, which is a very common behavior among borderline clients, takes precedence over all other issues due to professional concerns about individual well-being. In longitudinal studies, DBT has proven effective in reducing the number suicide attempts and incidents of self-harm among affected clients.

Improved social skills are also central to the DBT model. While many borderline clients are able to interact with others fairly well on a very casual level, they have trouble both reading and expressing emotional states and desires, and often grow frustrated when others fail to interpret their actions correctly. Interpersonal conflicts may prove intractable, leading to extreme anxiety and unacceptable or violent behavior. Recognizing emotional outbursts and learning to contain them is crucial to the client’s ultimate goal of becoming a better-adjusted individual, and the extensive weekly group therapy sessions included in any DBT regimen contribute greatly to this pursuit. By offering gentle suggestion and real-world solutions like mastering the art of self-distraction to avoid recurring negative thoughts, therapists attempt to teach clients how to recognize unproductive behavioral patterns and better repress their urges when confronted with anxious situations. Stress tolerance is an exceptionally difficult skill to master, but it serves a central role in DBT therapy as recognizing and learning to manage one’s anxieties also facilitates the process of emotional regulation to an otherwise impossible degree. According to the DBT approach, the importance of accepting and dealing with given circumstances is just as important as acquiring the power to change them. One may, in fact, lead to the other.

Unlike other forms of CBT, dialectical treatment courses are long-term, and full rehabilitation over 16 sessions is highly unlikely - most groups skills classes last at least one year. While DBT may not be sought out specifically by those who stand to benefit from it the most, through the course of other therapies or interactions with healthcare professionals it may be arrived at. As with other therapy strategies, those who do accept DBT and truly invest in the treatment will find themselves rewarded with time.

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