Hello, dear friends! I’m so glad you’re here and hope that you’re finding all of the things meant for you to encourage growth, peace, and joy. Today I wanted to talk about one of my favorite modes of therapy, DBT.  What is DBT?

DBT stands for Dialectical Behavior Therapy

Dialectical, in this instance, refers to opposing forces coming together to complete a more true whole. In honesty, dialetic philosophy is fairly complicated so I just want to give you a very basic understanding of the underpinnings (the theory behind or basic assumptions of) the therapy method. DBT is really about bringing about change by examining the extremes that we sometimes experience (or act out) and finding some middle ground as that is much more productive and usually feels much better.

DBT was created by Marsha Linehan in the 1980s. Linehan herself is someone who has struggled with mental illness, being diagnosed with schizophrenia and living in an institution until she was 18. She went on to earn her Ph.D. and graduate with high honors. That is definitely one of the reasons I love this mode of therapy- she herself has experienced mental illness and went on to help countless others, including myself. While she was diagnosed with schizophrenia, she does not feel that’s an appropriate diagnosis and identifies as having borderline personality disorder. Since DBT was created specifically with borderline personality disorder (BPD) in mind, let’s go over what BPD is. Especially since May is BPD awareness month!

BPD is a personality disorder

BPD is a personality disorder meaning that the person is over 18 and experiences many of the symptoms most of the time over a variety of settings (for example, not just in their relationship with their mom, but also with friends, significant others, etc). It’s an illness that has a lot of stigma attached with it, sadly even in the psychology profession. It is true that it has a lot of symptoms that are hard to cope with but people with BPD are usually people who are struggling with their identity, self-worth, fear of abandonment, and super intense feelings.

A DBT therapist I know once said “It’s like living with your nerve endings on the outside of your skin”. Symptoms often include:

  • self-harm
  • substance abuse
  • unstable relationships
  • chronic feelings of emptiness
  • extreme attempts to avoid abandonment

Please don’t self-diagnose, a lot of people with trauma or from unhealthy backgrounds have traits (individual symptoms) of BPD but playing with Dr. Google is often misleading and upsetting when it comes to BPD. Make sure you’re using reputable sources if you do seek out information because there is such a stigma.

What DBT is like

Alright, on to what DBT is like! If you’re practicing exactly as Marsha Linehan laid out, it is provided as both group therapy and individual therapy. Because the symptoms of BPD are often very severe, it is usually an intensive form of treatment with meetings at least 2-3x per week. However, many clinicians (such as myself and many others at Perspectives Therapy Services) use skills from DBT without practicing the whole program which involves having a co-leader (2 therapists) at each group session. These skills are still incredibly useful on their own and are not just helpful for people with BPD. Clinical studies show that DBT can be effective for people with substance abuse, anxiety, and a whole host of other illnesses. Really, the skills are useful for everyone because they break down some topics of emotional health that we aren’t taught as kiddos.

DBT contains 4 pieces:

  • mindfulness
  • distress tolerance
  • emotion regulation
  • interpersonal skills

We’ve talked before (pretty extensively) about mindfulness so I don’t want to go into too much detail here. Suffice it to say that’s it about observing the present moment non-judgmentally. Distress tolerance is about surviving a crisis (e.g.: anything from “I got fired” to “the person I’m romantically interested in isn’t texting me back and I don’t know how to handle it”.

DBT stresses that a crisis is anything short-lived, unpleasant thing that we want over as quickly as possible. Needing to find a bathroom is a crisis. However, when we’re dealing with BPD symptoms, our brain doesn’t differentiate well between a HUGE crisis and a minor setback. They can feel very much the same so we end up self-sabotaging over a “small” setback.

Emotion regulation

Emotion regulation is really, at its core, about creating more positive emotions and creating a life worth living. So many people forget to enjoy life and take pleasure in the small things and DBT teaches a few skills to help such as taking a mental vacation. I keep photos of beautiful places I’d love to visit on my desktop so that, at any time, I can look at them and imagine being there to give myself a little break. Emotion regulation also involves naming emotions that we’re feeling to help normalize the experience. Instead of feeling “upset”, we might be “disappointed” or “angry” and those emotions are something we can do something with, even if it’s just to wait from them to pass.

Emotion regulation is about learning how to cope with those emotions once we identify them. For example, if we’re angry, some responses we can choose are to keep ourselves safe while we wait for it to pass, write a letter to the person or circumstance we’re angry at (i.e.: Dear Addiction…), or take opposite action (watching a comedy when we’re sad or listening to a TED talk when we feel hopeless).

Interpersonal skills

The last skill is interpersonal skills. Many people with BPD didn’t grow up (or haven’t had at all) a validating environment and they learned young that the only way to get their needs met is to be violent towards themselves or others, to threaten or exaggerate, or they learned that their needs don’t matter at all so they don’t even bother asking anymore. I’m sure you can imagine how this plays out in close relationships (familial, platonic, romantic). This is part of what leads to unstable relationships.

A blog post is not a lot of space to cover BPD and DBT but if any of this sounds interesting or helpful, please reach out to a trained professional. I love talking about BPD and DBT and am eager to educate everyone. Be well, my friends, and I will see you soon.

Kayla Valley is a Licensed Master of Social Work (LMSW) who works at the Highland location of Perspectives Therapy Services. She became a therapist to help people struggle with the depression and anxiety that she understands intimately. She loves being a Michigander and is an avid sewist who loves spending time with her cats and sugar gliders.

Perspectives Therapy Services is a multi-site mental and relationship health practice with clinic locations in Brighton, Lansing, Highland, Fenton and New Hudson, Michigan. Our clinical teams include experienced, compassionate and creative therapists with backgrounds in psychology, marriage and family therapy, professional counseling, and social work. Our practice prides itself on providing extraordinary care. We offer a customized matching process to prospective clients whereby an intake specialist carefully assesses which of our providers would be the very best fit for the incoming client. We treat a wide range of concerns that impact a person's mental health including depression, anxiety, relationship problems, grief, low self-worth, life transitions, and childhood and adolescent difficulties.