Dialectical Behavior Therapy

Comprehensive DBT (also known as “standard” or “full model”) has four defining components:

The client receives:

• 1 session per week of individual therapy with a trained DBT therapist

• 1 session per week of group skills training

• Between session, after-hours phone coaching

AND

The therapist sits on a DBT consultation team that meets weekly.

One of the DBT Skills courses may be the best option.  DBT Skills with Marsha Linehan covers the four modules of DBT Skills and is a suitable introduction to DBT Skills. The applied skills courses in Trauma, Mood Disorders and Anger & Shame focus on how clinicians incorporate DBT skills into their work to address specific problems that cross client populations, presenting problems, and diagnoses.  If you work with adolescents and families, the DBT Skills for Adolescents and Families also covers the four DBT Skills modules, plus another module specifically for this population - Walking the Middle Path.

A couple of helpful things to consider:

1. Does the client fit into the research population of DBT? (Not all are required)

   1. High emotion sensitivity and intensity

   2. Behavioral dyscontrol that functions to regulate or escape from emotion intensity

   3. Multiple problems over multiple areas of their lives

   4. Life-threatening problem behaviors like suicide and self-injury 

2. Does the “BioSocial Theory of Emotion Dysregulation” provide the best conceptualization of the client’s experience and functioning?

   1. Biological vulnerability defined as high emotion sensitivity, high emotion intensity, and slow return to physiological baseline

   2. Developmental history of pervasive invalidation in important environments

   3. Transactions of biology and social environments that increase emotional and behavioral dysregulation over time

Clinicians and programs often incorporate DBT skills in their work with a variety of clients across presenting problems, goals, and diagnoses.  They may teach skills to individuals in session, or in group skills classes.  A DBT skills class that operates outside of a comprehensive program is similar to other stand-alone groups that focus on nutrition, life skills, mindfulness, or social skills.  

An important distinction is that it would not be accurate to call that approach “doing DBT,“ but rather that DBT skills are part of clinicians’ tool box of strategies and not part of a structured, evidence-based treatment model.