Dialectical Behavior Therapy: An Introduction to the Philosophy and Skills

Jancey Wickstrom, AM, LCSW

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Overview• Philosophy based treatment• Overall goal: creating a meaningful

life• Skills are easily adaptable to variety

of situations, abilities, and interests• Helps a wide range of behaviors

intended to regulate emotion

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Dialectics• Middle ground

• From either/or to both/and

• Black or White thinking to Black AND White thinking

• Emerged from repeated ineffective interventions

• Counteracts rigidity

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Dialectic of DBT

• Acceptance• Mindfulness• Distress tolerance

• Change• Emotion regulation• Interpersonal effectiveness

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DBT Framework• Four components:

– Skills training

– Individual therapy

– Telephone consultation

– Consultation group

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Consultation Agreements

• Dialectical Agreement

• Consultation to the Client Agreement

• Consistency Agreement

• Observing Limits Agreement

• Phenomenological Empathy Agreement

• Fallibility Agreement

Assumptions in DBT

• Clients are doing the best they can• Clients want to improve• Clients must do better, try harder and

be more motivated to change• Clients may not have caused their

own problems but must solve them anyway

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Assumptions in DBT (cont.)

• Clients’ lives are unbearable as they currently live

• Clients must learn new behaviors in all relevant contexts

• Clients cannot fail in therapy

• Therapists need support

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DBT Principles• People with problems regulating

emotion have:– High sensitivity

– High reactivity

– Slow return to baseline

• Generally raised in invalidating environments.

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DBT Principles (cont.)• “Problematic” behaviors served a

purpose at one point, but are now ineffective.

• Clients reward us for reinforcing old ways of living and punish us for doing DBT effectively.

• Only way to realize meaningful life is through practice and more practice.

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Acceptance: Mindfulness• Becoming aware of and present with

our thoughts and emotions

• Differentiating ourselves from our thoughts and emotions- getting “unfused”

• Practicing controlling our attention

• NEVER about controlling our thoughts -- underlies every single aspect of DBT

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Learning how to control your mind/attention so it does not control you.

MINDFULNESS

Acceptance: Distress Tolerance

• Skills to help get through a crisis situation without making matters worse

• Not intended to help clients feel better

• Anything can help tolerate the moment

• Willingness vs. Willfulness

• Mindfulness: practice going back and back and back to skill being used

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Getting through the moment without making matters worse.

DISTRESS TOLERANCE

Change: Emotion Regulation

• Change our reaction to our emotions

• NOT changing/controlling emotions

• Learn to identify and use emotions as allies not enemies

• Mindfulness: Very skilled at distancing from emotions, must slow down and practice this skill

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Not about changing or controlling our emotions- instead is about changing our reactions to emotions

EMOTION REGULATION

Change: Interpersonal Effectiveness

• How to get along with others more effectively

• Helping clients get their needs met (make requests and say no) in a way respectful to both self and others

• “Manipulation”• Mindfulness: being aware of reactions

to others as well as what goals are

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Getting our needs met while respecting both ourselves and

others.

INTERPERSONAL EFFECTIVENESS

Questions

Other Useful Resources

• Mindfulness resources: Jon Kabat-Zinn; Sharon Salzberg; Pema Chodron; Tich Nhat Hahn

• Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance (New Harbinger). McKay, Wood, Brantley (also available in teen version)

References

• Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.

• Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. New York, NY: Guilford Press.

• Holmes, Paul. Contextual behavioral approaches, personal communication. Emotion Management Program, Orland Park, IL.

Other Useful Resources

• Learning to Breathe: A Mindfulness Curriculum for Adolescents to Cultivate Emotion Regulation, Attention, and Performance. Patricia Broderick

• Don't Let Your Emotions Run Your Life: How Dialectical Behavior Therapy Can Put You in Control (New Harbinger). Spradlin (also available in teen version)

Thank you!

Jancey Wickstrom, AM, LCSW

Jancey.wickstrom@gmail.com

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