Goals and Values
We start with the assumption that you are doing
the best that you can right now. And it is difficult to change the harmful things that you do - or even recognise that they are harmful at all. It is likely that you have been harmed too, but you cannot rely on anyone else to make the changes you need to see in your life. DBT is a method of therapy, teaching and coaching that can build a set of skills that will help you out of a painful emotional existence. The goal of DBT is to achieve a life in which you have more power over your emotions than they do over you, and fulfilling relationships and experiences
are within your reach.
Evidence based
DBT meets the highest standards of evidence for
its effectiveness in assisting people to change self-harming behaviour.
It was developed by Dr Marsha Linehan in the
early 80’s and has since developed into a widely accepted and scientifically validated therapy.
You can read more about her story here.
DBT It is a mixture of Cognitive Behaviour Therapy, mindfulness, interpersonal skills and coaching. There are courses available specifically for adults or adolescents. Many healthcare providers have trained DBT therapists, and may offer the complete therapy, or versions of DBT, as described below.
DBT is delivered in three ways*
1. You attend a weekly group where skills are
taught in a general tutorial type manner, and
assigned some homework and structured
reflection.
2. You meet weekly with your individual therapist.
This is to discuss and examine situations that
you frequently find difficult or distressing, and
reflect and hone skills you have been taught.
3. Your therapist is available for phone coaching,
to help when you anticipate or experience
crisis, and want support to deal with the
situation effectively and with wisdom.
The adolescent course requires at least one parent to also attend and participate. If you do not live with a parent, the courses can be flexible.
The DBT skills are broken into three topic-based modules: Emotion Regulation, Distress Tolerance and Interpersonal Effectiveness. For adolescents and their parents, The Middle Path is the fourth module.
Acceptance into treatment involves a series of meetings with a trained DBT clinician to work
with you to determine your level of willingness to
seek change and be engaged in that process. Ambivalence or wilful opposition does not necessarily preclude entry into the therapy.
Check with your healthcare provider, like your
GP or District Health Board community mental health service to see who offers DBT in your region.
*this is the best practice based model, and may
not be supported by all healthcare providers. Some providers may use a "DBT informed model" or a modified version.
Introduction to DBT
Dialectical Behaviour Therapy (DBT) is a specialised, evidence-based form of cognitive therapy designed to help people who have ongoing difficulties managing their emotions. These difficulties may be apparent in a variety of ways, including self-destructive or self-injurious behaviour, anger management problems, binge-eating, ongoing relationship conflicts and self-hatred. DBT uses a combination of mindfulness-based therapies, which draw from Eastern and Western contemplative traditions, and cognitive behavioural therapies from modern
psychological disciplines.
Who is DBT for?
DBT is a specific type of cognitive behavioural therapy developed in the late 1980s by psychologist Marsha M. Linehan to help better treat borderline personality disorder. It is also successfully used in the treatment of other kinds of mental health disorders, and is appropriate for individuals with long-standing difficulties with impulse control, eating disorders, anger management problems or other self-destructive behaviour.
What does Dialectical mean?
“Dialectical” refers to exploring different ideas and opinions: questioning why we believe what we believe. This is an important concept in the treatment, which is about being able to consider the different ways of looking at a situation, in order to make wise choices. For some people, something like a critical comment may trigger a response, which leads them to harm themselves. By taking a dialectical approach, they are better able to resolve distress without resorting to self-damaging behaviour.
Why is there a separate programme for teenagers?
Adolescence is often a challenging time for both teenagers and their parents. Self-destructive behaviours affect the entire family. Parents may find their usual strategies don’t work. By attending DBT, parents can support their children in learning new ways to cope with emotional distress. Parents also learn to reinforce and role-model these skills. This can also have a powerful and positive impact on the parent-child relationship.
Will I have to be in a group with my Mum or Dad?
For teenagers, the idea of being in the same group as a parent might be awkward. But DBT specifically does not require you to discuss distressing or upsetting topics in front of a group. Anything of a sensitive nature is only discussed with your own therapist in privacy and safety.
What is the DBT timetable?
For teenagers, DBT consists of five modules delivered in four six-week programmes. For adults, it is four modules, delivered in three six-week programmes. Each person attends a weekly two-hour skills group, and catches up individually with their coach/therapist for an hour. Skills practice and independent development, using special journals, is a weekly requirement. The programme generally takes 18 – 24 weeks to complete. It is not unusual for people to repeat it.
What is mindfulness?
Mindfulness is focusing one's awareness on the present moment, acknowledging and accepting one's feelings, thoughts and bodily sensations. Marsha Linehan identified the therapeutic qualities of this practice while researching new methods to help her clients. She spent time with both Buddhist and Catholic monastic communities, where contemplative practices like meditation were observed. Mindfulness takes the “active ingredients” of these practices and utilises them in a non-religious manner. Whatever your worldview, you will recognise the benefits of being able to make wise and calm decisions when you encounter moments of crisis.
How much does it cost?
DBT - as a team-based treatment - is mostly provided by Community Mental Health teams within District Health Boards. The therapy is free through the public health system, but only available to those who meet the eligibility criteria. Many private psychologists also offer DBT content, such as the skills, in their practice. You can be referred by your GP, or you may self refer.
What is meant by ‘targets’ and ‘goals’ in DBT
DBT has a specific purpose: to help people decrease or eliminate certain distressing behaviours, such as deliberate self-harm. The details of this are shared and set between individuals and their therapists, and are a strong focus of therapy. People who experience emotional dysregulation may have many important issues and experiences they would like to work through. DBT prioritises life-threatening behaviours in order to help people later address other problems. These are different for everyone.
If you or someone you know is in emotional
or mental distress call:
Youthline: 0800 376 633 / Lifeline: 0800 543 354