What Is DBT (and Who’s It For)?
Today’s information is being shared with you from the point of view of a layperson (that’s me) who has both observed DBT done with my child and participated in a course of DBT, myself. Full disclosure: I’m a life-long chronic depressive who has done years (and years and years) of various therapies, and while I will never be “cured,” I have (mostly) learned how to manage my symptoms and live a normal life. Many of the different types of therapy I’ve done have been beneficial, but DBT remains, to my mind, the single most practical plan for managing difficult emotions and keeping them from disrupting my life. [That said, please note that I am not a doctor or mental health professional, nor do I play one on TV or the Internet.]
If you’ve heard of Dialectical Behavioral Therapy (DBT)—and it’s quite possible you haven’t—you’ve probably heard that it’s an “extreme” approach for people with really difficult-to-treat behaviors such as suicidal ideation. While it’s obvious why this is a treatment of choice for individuals engaging in life-endangering behaviors, I’m here to tell you in all sincerity that I wish DBT was being recommended to every parent dealing with a struggling child or struggling themselves with the difficulties of parenting. But hang on; I’m getting ahead of myself.
DBT was developed by Dr. Marsha Linehan, a clinician who struggled with her own issues for years until she came to this method of both accepting oneself and changing at the same time. In fact, if you go read about it on the National Alliance on Mental Illness’ site, you’ll see this:
Who will benefit from DBT?
While DBT was initially developed to treat chronically suicidal individuals with BPD [Borderline Personality Disorder], it has evolved into a treatment for individuals with multiple different disorders. Although many people who are treated with DBT have BPD as a primary diagnosis, DBT has also been adapted for behavioral disorders involving emotional dysregulation (such as substance dependence in individuals with BPD and binge eating disorder) and for treating people with severe depression and associated suicidal thoughts.
Let’s start with a look at the word dialectical:
1. relating to the logical discussion of ideas and opinions.
2. concerned with or acting through opposing forces.
“a dialectical opposition between social convention and individual libertarianism”
The second definition, above, is what really defines this therapy and sets it apart from other approaches; DBT strives to balance acceptance and change. Other types of therapy may look to change how the distressed person feels, thereby changing resultant action, but DBT says, “Okay, you feel that way. We can accept that. At the same time, we can work to change the associated behaviors.” DBT has a huge component of self-awareness coupled with this acceptance, as many people who wind up in this type of therapy really don’t know how they’re feeling a lot of the time (they’re too busy reacting), and stopping to notice and accept whatever emotions are present is an important first step in changing behavior.
As I already mentioned, I happen to disagree with NAMI’s assessment that DBT is beneficial “for people with extreme behavioral disorders.” I think DBT is beneficial for anyone struggling with emotional regulation issues, whether it be due to mental illness or simply a difficult life situation. Point of interest: the main goal of DBT—noting and accepting your emotions, working towards still practicing behavior which is calm and productive, regardless—is very similar to the philosophy of Al-Anon. Even if you’re not mentally ill, yourself, living with someone who is (or who has an addiction or other destructive disorder) requires the patience of a saint, a heart of stone, or a really good mental toolkit for survival.
For the person struggling with destructive behaviors, DBT offers a path to change that’s pretty pragmatic. The whole “let’s talk about your childhood and get to the root of these issues” approach is a valid one, but it doesn’t work for everyone, and it can take a long time, too. Other therapeutic approaches can seek to change underlying feelings, with varying degrees of success. While working towards change via emotions can work, changing behavior regardless of emotions is not only faster, it often results in emotional change, as well. So with DBT, you start with an honest assessment of the issue, then move on to accepting your feelings and modifying your behaviors: I am engaging in Behavior X and that is [not good for me, hurting people I love, wreaking havoc, whatever]. What feelings bring me to Behavior X? Can I identify them? Those feelings are neither good nor bad, they’re just how I feel. Once identified, what different behaviors can I attempt to engage in, instead, when I have those feelings? It doesn’t make for overnight change, of course, but it circumvents this notion (that’s fairly pervasive in psychology) that people can control their feelings. We can control our actions. Not that many people can actually control their feelings, and if you already feel out of control, being tasked with controlling your feelings is probably a one-way ticket to failure.
For the person (parent) dealing with the destructive person (child), DBT offers a way to cope and ultimately accept the current reality. The mechanisms are very similar, but instead of changing obviously destructive behaviors, it helps prevent emotional overwhelm in the face of difficulty. (In my case, it also stops me from yelling. I know that yelling solves nothing, but when I’m upset I’m prone to anger and a raised voice, which—surprise!—is not useful when things are already out of control.) So here it’s more like: I am getting very upset about this thing I do not have the power to change. It’s okay to have feelings about it, but I have to note them and then let them go, because they are serving no useful purpose right now. The most helpful thing I can do in this situation is remain calm and neutral, and I can do that by noting those feelings and setting them down and continuing on with whatever I need to be doing right now. Again, this is not an overnight change or something that will always work 100% of the time, but it’s a perception shift that can be enormously useful.
The most helpful thing ever said to me in therapy came out of a DBT discussion, and it was this: “When we can do better, we do do better.” DBT is simultaneously demanding (you possess the power to change; use it) and forgiving (you are doing the best you can at this very moment). It’s a very gentle way to view yourself, and an oddly-comforting-in-difficult-times way to view the person you love who’s in crisis. They’re doing the best they can. Maybe it’s not what you wish for them, maybe it’s not what you pictured, but they’re doing their best in this moment. And so are you. And really, that’s all any of us can do.
If you’re interested in finding out more about DBT or locating a certified practitioner, visit the DBT-Linehan Board of Certification site.