Dialectical Behavioral Therapy

What is DBT Training?

Dialectical Behavioral Therapy (DBT) was designed to help us regulate our emotions so that we can maintain our equilibrium.  We were “designed” to remain in a state of homeostasis. When something upsets this natural state the body compensates in some way, i.e. an infection causes a fever and overheating causes sweating.  

In much the same way, becoming very emotional drives us to compensate. Unfortunately, we often end up over-compensating. For example, we may overeat, restrict, binge and/or purge, over-drink or shut down emotionally in order to avoid emotional pain. This doesn’t work and as a result we end up suffering more than necessary and often creating new problems. 

DBT training was designed to enable us to reduce the level of arousal that we experience and therefore return us to homeostasis without the overcompensations tht end up becoming the problem.  We accomplish this by learning how to lean into the feeling instead of trying to avoid it or numb ourselves to it.  

The term ‘dialectical’ is derived from classical philosophy. It refers to a form of argument in which an assertion is first made about a particular issue (the ‘thesis’), the opposing position is then formulated (the ‘antithesis’) and finally a ‘synthesis’ is sought between the two extremes, embodying the valuable features of each position and resolving any contradictions between the two. 

“Truth” is seen as a pattern that develops over time in transactions between people, i.e. DBT is transactional in nature, or the result of human interactions. From this perspective there can be no statement representing absolute truth, as patterns are always changing and new truths are always emerging.  In a disagreement, from a dialectical perspective, truth is viewed as the middle way between two opposing points of view. 

The dialectical approach to understanding and treating human problems is therefore non-dogmatic, i.e. it is not restricted to a particular theory of pathology such as psychodynamic, gestalt or behavioral. Instead, the source of a problem, as well as its solution, is always open-ended and emerges over time as a result of a pattern, or patterns, of behavior. 

Another important assumption in systems theory is that problems are not necessarily linear in terms of what causes them. In other words, you may miss a lot if you believe that A causes B, i.e. molestation causes Anorexia.  Sometimes it is A plus B in the context of C&D that actually causes a problem, i.e. 

  • A: An unusually sensitive child; 
  • B: Overhears a negative comment about body fat; 
  • C: At a time when his/her body is changing because; 
  • D: She/He is going through puberty and reacts by restricting food which gets reinforced with weight loss and approval or concern from family and friends

In DBT Training there is always a balance between ‘acceptance’ on the one hand and ‘change’ on the other. DBT includes specific techniques of self-acceptance and self-validation that are designed to counteract the self-invalidation that many individuals with emotional problems experience. 

There are also problem-solving skills that act as a counterbalance to the acceptance skills. Finally, the therapy is mindful and behavioral in that, instead of regretting the past or dreading the future, it focuses is on the present moment.  We cannot change the past and we do not control the future, only our reactions in the moment.