What Is Dialectical Therapy?

Dialectical Behavioral Therapy (or DBT) is a therapeutic approach that encompasses the principles of Cognitive-Behavioral Therapy while placing an emphasis on validation and acceptance.

Developed at the University of Washington by Dr. Marsha Linehan, Dialectical Behavioral Therapy is

based upon four core principles:

  1. The primacy of the therapeutic relationship
  2. A non-judgmental approach
  3. Differentiating between effective and ineffective behaviors
  4. Dialectical thinking

The Dialectical Behavioral Therapy process involves a progression through four modules:

  1. Mindfulness
  2. Distress Tolerance
  3. Emotion Regulation
  4. Interpersonal Effectiveness

A paper co-authored by Dr. Linehan and Linda Dimeff described Dialectical Behavioral Therapy as “combing[ing] the basic strategies of behavioral therapy with eastern mindfulness practices, residing within an overarching dialectical worldview that emphasizes the synthesis of opposites.”

What are the Benefits of Dialectical Behavioral Therapy?

Dialectical Behavioral Therapy sessions are designed to accomplish the following five objectives:

  • Ÿ  Enhance the client’s behavioral capabilities
  • Ÿ  Enhance and maintain the client’s motivation to change.
  • Ÿ  Enhance the client’s capabilities.
  • Ÿ  Ensure that the client’s new capabilities are generalized to all relevant environments.
  • Ÿ  Enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities.
  • Ÿ  Structure the environment so that treatment can take place.

The ability, as Dr. Linehan and Ms. Dimeff expressed it, to synthesize opposites is at the core of DBT’s effectiveness. For many people who struggle with behavioral, emotional, and other mental health conditions, viewing the world in stark black/white or good/bad extremes can lead to extremes in thoughts and actions.

Dialectical Behavioral Therapy attempts to change this perception by empowering the DBT patient to see the world (and his/her thoughts and actions) in a less judgmental, more productive manner.

For example, one of the first skills developed during the Mindfulness module is the ability to observe one’s internal and external environment in a nonjudgmental manner.

By focusing on facts rather than emotions or value judgments such as good/bad or fair/unfair, Dialectical Behavioral Therapy clients enhance their ability to respond positively and productively, without descending into self-blame or other destructive thoughts and behaviors.

What Conditions/Disorders Does Dialectical Behavioral Therapy Treat?

Dialectical Behavioral Therapy  was originally developed to treat individuals with borderline personality disorder. Over the years, however, DBT has proven effective for treating individuals with a number of other conditions, including poor self-esteem, self-harm, eating disorders, mood disorders, substance abuse disorders, and trauma.