What is DBT?
Dialectical Behaviour Therapy, or DBT, is an evidence-based psychological therapy that helps people understand and manage intense emotions, cope with distress and navigate relationships more effectively. It can be particularly helpful when emotions feel overwhelming or when the ways a person has learned to cope are beginning to create difficulties in other areas of life.
One of the central ideas in DBT is that acceptance and change can happen at the same time. A person can acknowledge that their feelings and experiences make sense while also recognising that some patterns may need to change. This balance is what the word “dialectical” refers to and is an important part of how DBT approaches emotional and behavioural difficulties.
Where did DBT come from?
DBT was developed by psychologist Dr Marsha Linehan in the late 1980s while working with people experiencing chronic suicidal thoughts and self-harming behaviours. Linehan initially used cognitive behavioural approaches, which focused on changing thoughts and behaviours. However, she found that focusing on change alone was not always helpful and could leave some clients feeling misunderstood or invalidated.
DBT therefore brought behavioural change strategies together with principles of acceptance and mindfulness. Linehan also incorporated skills training to help clients develop more effective ways of coping and working towards their goals. The treatment was formally published in the early 1990s and has since been adapted and used across a range of mental health settings.
What does DBT look like in a therapy session?
DBT is primarily a practical and collaborative form of therapy. Sessions are not simply about talking through what has happened during the week. The psychologist and client work together to identify patterns in emotions and behaviour, understand what may be maintaining those patterns and practise skills that can be used when similar situations arise in the future.
An important DBT strategy is behavioural chain analysis. This involves slowing down a difficult event and looking at it step by step. A psychologist may explore what made the person more vulnerable beforehand, what triggered the situation, what they thought and felt, what urges arose, what they did next and what happened as a result. The aim is not to blame the person for what happened. Instead, breaking the experience into smaller links can make it easier to understand why a behaviour occurred and where a different response could potentially be introduced.
Some clients may also use a diary card between sessions. This is a self-monitoring tool used to keep track of things such as emotions, urges, behaviours, vulnerabilities and DBT skills. Reviewing these patterns can help the client and psychologist decide what would be most useful to focus on in a session.
What skills are taught in DBT?
A major part of DBT involves learning practical skills that can be used outside therapy. These skills are commonly organised into four main areas:
• Mindfulness: Mindfulness involves paying attention to what is happening in the present moment, including thoughts, feelings and physical sensations, with less judgement. This can create some space between experiencing an emotion and immediately reacting to it.
• Emotion regulation: These skills help people better recognise and understand emotions, identify factors that can make them more emotionally vulnerable and develop more effective ways of responding when emotions become intense.
• Distress tolerance: Sometimes a difficult situation cannot be changed immediately. Distress tolerance skills focus on getting through highly stressful moments without responding in ways that may make the situation worse.
• Interpersonal effectiveness: These skills focus on relationships and communication. This may include learning how to express needs, say no, set boundaries, manage conflict and maintain self-respect while also considering important relationships.
In a comprehensive DBT program, treatment can include individual therapy, group-based skills training, between-session coaching and consultation between DBT clinicians. In other settings, psychologists may use particular DBT-informed strategies or skills as part of a broader treatment approach rather than providing the full DBT program.
Who can DBT help?
DBT was originally developed for people experiencing chronic suicidal behaviour and self-harm and is particularly well established in the treatment of Borderline Personality Disorder (BPD). However, DBT has since been applied more broadly, particularly where difficulties with emotion regulation, impulsivity, distress tolerance or relationships are having a significant impact on a person’s life.
DBT and DBT-informed approaches have also been used with presentations involving self-harm and suicidality, trauma-related difficulties, substance use, eating disorders, and ADHD-related emotion dysregulation and impulsivity. The suitability of DBT will depend on the individual, their current concerns and treatment goals, so a psychologist can help determine whether DBT or another approach may be the best fit.
Is DBT evidence-based?
Yes, DBT is an evidence-based psychological approach with particularly strong support for Borderline Personality Disorder and associated suicidal and self-harming behaviours. Research and clinical applications have also expanded to other presentations characterised by significant emotional and behavioural dysregulation.
One of DBT’s strengths is that it does not only focus on reducing symptoms. It also aims to help people build skills that can be used in everyday life. Over time, this may involve learning to notice emotions without immediately acting on them, cope more safely during periods of distress, communicate more effectively and make choices that are more consistent with personal goals.
What is the overall goal of DBT?
Ultimately, DBT is about more than simply getting through difficult moments. Treatment aims to help people move towards greater stability and develop ways of managing everyday challenges while building a life that feels meaningful to them. For someone who often feels controlled by intense emotions, urges or difficult relationship patterns, DBT can provide a structured way of understanding those experiences and learning practical alternatives.
At Graham Psychology, quite a few of our psychologists are equipped to use DBT with clients and will determine based on the clients concerns, history with therapy and mental health presentation whether its the most suitable therapeutic modality to use in sessions.
If this modality sounds like it would be helpful for you, explore our team of experienced and compassionate psychologists based in Melbourne to find one you think you would pair well with. Alternatively, our Admin team are excellent at matching clients with suitable clinicians, based on support needs and availability - they can be contacted at reception@grahampsychology.com.au or via phone at (03) 8838 8687.