What is Dialectical Behaviour Therapy and why is it important?
Dialectical Behaviour Therapy (DBT) was originally developed as a comprehensive treatment for adult women with borderline personality disorder (BPD), particularly those with persistent suicidal behaviour and ideation. It is a highly structured program involving weekly individual psychotherapy, weekly group skills training, and telephone coaching between sessions (McMain & Korman, 2001; Robins & Chapman, 2004). Therapy usually extends over 12 months. Individual psychotherapy includes supportive counselling and therapy focusing on the client’s personal experiences of dysregulated emotions, behavioural responses, and current crises. The group-based skills are taught in four modules: mindfulness, emotion-regulation, distress tolerance, and interpersonal effectiveness.
Modifications have been made to adapt DBT to the specific needs of adolescents. The program was shortened to 15 weeks, a family therapy component was added, and the adult skill development lessons were simplified and adapted to fit the developmental needs and interests of adolescents (Miller, Rathus, Linehan, Wetzler, & Leigh, 1997). Unless clinically inappropriate at least one caregiver is asked to commit to 15 weeks of skills training. A key aim of including parents or caregivers is to help them coach their adolescent and to improve their own skills in interacting with adolescents.
When should it be used?
The elements of DBT described below are appropriate for use with clients who experience overwhelming emotions (e.g. extreme feelings of distress, despair, self-loathing, anger etc) and / or associated compulsive behaviours (e.g. suicidal behaviours and ideation, self-harming behaviours, substance use, other risk taking, aggression and violence towards others). Elements of DBT can be helpful in the management of overwhelming emotions and behaviours even in the absence of a diagnosis of Borderline Personality Disorder as will be the case for clients under 18 years.