Hi, I'm Dr. Esme Shaller. I'm a clinical psychologist, and I direct the DBT program at the young adult and Family Center at UCSF. I'm here to answer the question, What the heck is DBT?
If you're watching this, someone has told you that you or a family member could benefit from something called DBT. The goal of this video is to explain quickly and simply what people mean when they say DBT, who DBT is designed to help, and what being in DBT treatment might actually look like. The main goal of DBT is to build a life worth living. This means having things that are meaningful and important to you in your life. So this could mean music to one person, courses to another, and a quiet room with lots of books to someone else. DBT is not a suicide prevention program, or a way to stop people from doing behaviors that bother others. DBT is to help you.
In other words, there is hope if you're suicidal. DBT is one way to overcome these feelings.
Let's start with explaining those letters. Acronyms are always a bit confusing.
The D stands for dialectical. This is a fancy philosophy word based on the idea of a dialectic or two things that can seem like opposites but can in fact both be true at the same time. For example, in DBT, we believe that everyone is doing the best they can and they need to try harder.
We often think of dialectics as a great big scale, tilting back and forth. The main dialectic in DBT is that we are always trying to balance acceptance. You're doing the best you can. This is really how life is right now.
With change. You have to try different things to get the life you want. You have to be motivated and work harder. A DBT therapist is this constantly dancing, trying to make sure they really understand and accept where you're coming from, while also pushing you to change when they can it can be a complicated step.
The B stands for behavior.
A behavior is anything that can be reinforced or rewarded. Okay, let me briefly explain reinforcement to a reinforcer is anything that increases the likelihood that a behavior will occur again. If you study hard and get an A plus on a test, the A plus is the reinforcer that increases the chances you will study again. If your dog sits and you give him a treat, the treat is the reinforcer that increases the chance he will sit again. If you do a favor for a friend, and he brings you a present to thank you. The present is the reinforcer that increases the chances you will do more favors in the future.
The laws of behavior, having to do with these reinforcers affect all living things. Dogs, dolphins, people, even therapists. DBT recognizes this and tries to harness the power of behavior change to move you closer to your goals, your life worth living.
In DBT therapists work with you to establish target behaviors, things that you are working to increase or often in the beginning decrease to make your life better.
Common initial targets in DBT include thinking of suicide, self injury, restricting meals, bingeing and purging, using drugs or alcohol, engaging in risky sexual behavior, reckless driving, physical aggression, and shoplifting. The T stands for therapy, obviously. But DBT is different from other therapies you may have participated in or heard of. DBT therapists have a lot of specialized training in DBT and follow many assumptions and guidelines in their work as DBT therapists that differ from other therapy traditions. All of this is a bit beyond the scope of this video, but I'll let you in on a couple.
Our first goal in DBT is making sure you stay alive. This helps us meet our second goal, making sure you stay in therapy until you can meet your goal, which is by far the most important building a life worth living. DBT therapists believe that the most caring thing a therapist can do is to help push a client toward their long term goals. Sometimes these goals may seem unattainable.
It is a DBT therapists job to understand how hard it is to change and to simultaneously push you to keep you moving forward. DBT therapists also believe that therapy with someone is a real relationship between equals. That means if you ask your therapist a question about their lives, they'll likely just answer it honestly instead of asking you why you're interested. It also means that the work in therapy is carried out by both of you. It's like a DBT therapist is in a rowboat with you and you are both rowing to get to your destination. your therapist shouldn't be laying back silently while you row super hard. And you also shouldn't be in the back of the boat drilling little holes in the bottom while your therapist is up front rowing, thinking you're rowing too. It's about both of you working together towards your goals.
Now who can benefit most from DBT?
DBT has been studied and is currently being studied for a lot of different clinical populations. What most of them have in common is a difficulty in regulating emotions. This may mean that your life feels a bit like an emotional roller coaster DBT might work for you if you get more disappointed than it seems like your friends do. When plans get canceled or things don't go your way. You cry at movies a lot, or even at commercials. You sometimes feel like you were born into the wrong family, like you're a lion cub in a family of house cats. If one or more of these things describes you, you might benefit from DBT.
Lastly, let's talk about what DBT looks like. Full DBT, the kind that has the most rigorous research backing it up, has four modes of treatment.
These are one structured individual therapy, there's a focus on behaviors, like we mentioned, and dialectics that balance of acceptance and change. You'll also be asked to do some tracking of your emotions and behaviors in between sessions.
If you're a teen or sometimes young adult, Family Therapy will also be included as part of your DBT program to skills group. This is a weekly meeting, usually about two hours long, where you get to learn a different behavioral skill each week to help manage emotions, tolerate distress, and have effective interpersonal relationships. This saves time in your individual therapy to talk about the stuff that's most central to you. If you're a teen or young adult, you'll likely attend this group with a family member to so they can learn the skills as well.
Three is skills coaching. This means you can call your therapist 24 hours a day to get help using your coping skills and to avoid engaging in some of those target behaviors we mentioned earlier, you have a personal coach that can help you change how you react to things at times when it is the hardest to do so.
For consultation team, this last one may be less obvious to you as the client, but DBT therapists work on a team, a team that helps them support each other and do the best treatment possible. This is essential because changing life threatening behaviors that have been going on for a long time can be really stressful. If your DBT therapist does not have a team, it's not DBT.
Altogether, this takes about three to four hours per week.
Another goal of DBT is to keep you in your life, going to school, going to work seeing your friends, so it does not take up all of your time like some other intensive treatment options might. So you now know what the heck dialectical behavior therapy is. You've got the acronym down, you know a little bit about who it's designed to help and you know what it involves. Only you can choose if this is the right road to your life worth living. Why not talk to a DBT therapist and see what you think.
