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(Tldr; DBT stands for Dialectical Behavior Therapy. Comprehensive DBT is a full outpatient program with several modes of treatment, including group, individual therapy, and phone coaching with a DBT provider who participates on a DBT consultation team)


Dialectical Behavior Therapy is unsurprisingly based on the premise of "dialectics." The term “dialectics” or “dialectical” means “concerned with or acting through opposing forces.” Being “dialectical” means holding two seemingly opposing beliefs at the same time. 


One dialectic in DBT is the assumption that people are doing the best they can AND people can and need to do better. This is the dialectic of Acceptance and Change. In DBT, we believe that both statements, on either side of the “AND,” are true simultaneously, and for everyone. DBT therapists purposefully focus on balancing acceptance and change frequently during the course of therapy.


Other dialectics that may come up in therapy are independence vs. dependence, problem solving vs. problem acceptance, being with others AND being lonely, being mad at yourself AND respecting yourself, understanding AND disagreeing. DBT aims to be balanced in it's approach, seeing the validity in opposing viewpoints and finding a synthesis that honors both without watering down either. 

What DBT is Not: A Common Misconception

Before further detailing "What DBT Is," I want to dispel a common misconception by mentioning "What DBT is Not." When many people hear "DBT," they think of DBT skills groups. Many therapists also think DBT skills groups are "DBT!" Contrary to popular belief, simply attending a DBT skills group does not mean someone is "in DBT." Joining a skills group in addition to "treatment as usual" with a non-DBT provider, is great option for some people, but this is not Comprehensive DBT. The distinction is important because people need to know whether the treatment they are receiving has been shown to be effective for the types of problems they are having. Some people benefit more from being in a full DBT program and may not benefit from other treatments or being in just the skills group. Fully adherent DBT  has a large body of high quality research with evidence for improving a wide array of patient outcomes, including use of psychiatric crisis services and self-harm behavior (DeCou et al., 2019; Panos et al., 2014). While DBT skills groups alone can also be helpful, they have less evidence of efficacy than Comprehensive DBT especially for people with high suicide risk and those who self-harm.

Cognitive Behavioral Therapy (CBT) vs. Dialectical Behavior Therapy (DBT)

 DBT is a type of Cognitive Behavioral Therapy (CBT) developed by Marsha Linehan, originally developed to treat Borderline Personality Disorder in adults. Research has since expanded to show that DBT can treat a wider array of problems and populations, including adolescents (Cook & Gorraiz, 2016). Cognitive Behavioral Therapy (CBT) is a somewhat general term for therapy that involves discussing thoughts, feelings, and behaviors and understanding how these facets of personality interact. More people know about CBT than DBT. Most therapists have training in CBT and can say that they provide CBT, whereas DBT is far more specific and requires advanced training to provide. DBT individual sessions follow a specific structure and treatment hierarchy. DBT therapists must also remain on a DBT consultation team so that they can have support in sticking to the treatment model. Not all providers who have training in DBT can actually provide Comprehensive DBT due to the multiple required modes of treatment and need to be on a DBT consultation team.


Modes of Treatment

To be considered Comprehensive DBT, a client must agree to participate in a DBT program that includes several components or "modes" of treatment: 1) DBT skills training (DBT skills group), 2) individual therapy with a DBT trained therapist who participates on a DBT consultation team, and 3) phone coaching. When all these components are present and the client and therapist both agree to the DBT agreements, a client is "In DBT."

At this point, we understand that DBT is based on dialectics (holding seemingly opposing views; aka the opposite of black-and-white thinking), and has several modes of treatment, including skills group, individual therapy, and phone coaching. You may still be curious about what this looks like in practice. Feel free to schedule a free consult call with me to learn more! I love talking about DBT and would be happy to answer all your questions, such as "How are DBT individual sessions different from other types of Cognitive Behavioral Therapy sessions?" "What is the treatment hierarchy?" "What is a diary card?" "Do I need DBT if I don't have BPD?" or any other question you might have. If I don't know the answer, I will try to find it for you. 


Cook, N. E., & Gorraiz, M. (2016). Dialectical behavior therapy for nonsuicidal self‐injury and depression among adolescents: Preliminary meta‐analytic evidence. Child and Adolescent Mental Health, 21(2), 81-89.

DeCou, C. R., Comtois, K. A., & Landes, S. J. (2019). Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis. Behavior therapy, 50(1), 60-72.

Panos, P. T., Jackson, J. W., Hasan, O., & Panos, A. (2014). Meta-analysis and systematic review assessing the efficacy of dialectical behavior therapy (DBT). Research on Social Work Practice, 24(2), 213-223.

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