Dialectical behavior therapy is a treatment that was developed by Dr. Marsha Linehan in the 1980s. It was originally designed to treat borderline personality disorder, but has since been proven to be an effective treatment for a whole host of mental health disorders, including depression, PTSD, and anxiety.
Although it is sometimes compared to cognitive behavioral therapy, dialectical behavior therapy is actually much different, taking place in three to four components, which include:
Individual therapy, during which the person learns DBT skills one-on-one with a licensed DBT therapist;
Skills group, where individuals come together in a classroom-style setting and are taught skills using the Socratic method. They may be assigned homework which is then reviewed and discussed in the next group meeting;
Phone coaching, which allows patients to call their therapist in times of absolute need or crisis. The therapist would then be able to help his or her patient apply the skills learned in individual and group therapy sessions;
DBT consultation team, which is a group made up of DBT specialists who meet regularly to learn from one another and support each other while practicing a challenging and often intense form of treatment for some very serious mental health disorders.
Dialectical behavior therapy has been proven to help many patients come through some very trying seasons in life. It’s been said by many that it’s a life-changing treatment; some say they don’t know what they would have done without this process.
This is Maria’s story, told in her own words. She shares her history, what brought her to DBT, and gives insight on how to prepare for the experience.
Here's more about mindfulness and its role in DBT therapy.
My name is Maria, and I’m a 31-year-old student. I’m in my third year of business in college. I went back to school after I spent a few years in Europe traveling and working.
My parents split up when I was nine. I remember a lot of turmoil in that house. My mom has always been a pretty dramatic person, and when she gets mad, she gets really mad. I remember plates being thrown at the wall. I remember her just grabbing her keys and peeling out of the driveway and not really knowing if I’d see her again.
When my parents decided to get divorced, most people thought I would go with my mom, because that’s usually what kids do, right? But I didn’t. I wanted to be with my dad. He was the calmer one, and his sisters – my aunts – were like my sisters. We were really close, and that’s where I felt safest. It wasn’t that I didn’t love my mom, it was that I think I knew how imbalanced she was and I could even feel that at nine years old. I just wanted stability.
My childhood was pretty good otherwise. I was happy. When I was 15 I got my first boyfriend, and we were together for five years. I grew up with him, essentially. But at 20, when we broke up, I found out he’d cheated on me with numerous girls the entire time we were together. I found out details I wish I never knew. I think it broke me. I ended up dropping out of school, and I became just a really angry person.
There are certain elements to my personality I only really started to notice after I began therapy, but in retrospect they’ve always been there. For example, I’m a really jealous person. I’m very insecure. I look collected and pulled together on the outside, but inside I’m always worrying about how I look or what people think of me or how I sound. I tend to toot my own horn sometimes, but inside I’m beating myself up for never being enough. I’m afraid to be alone and I’m always trying to make friends, but I also pull back from having close relationships because I feel like people are just going to hurt me, or worse, find out who I really am and decide they don’t like me. I’m an extremely moody person, too… and I don’t mean like some days I’m one way, other days I’m another way. No, I mean like, in a single day sometimes I have major mood swings. Happy in the morning, and then something comes up and I’m totally destroyed and I just want to roll up in a ball and hide from everything.
I really noticed all of this stuff when my boyfriend broke up with me, but I thought it was just a natural part of getting your heart broken, especially at that age. But I noticed that even after I did my thing – I went away to Europe, spent time with family, started trying to improve myself – those characteristics stuck.
I tried a few different therapists; I feel like I didn’t really connect with any of them. I totally get it now when people say that finding the right therapist can be like dating – sometimes you find someone you really like right away, sometimes they have to grow on you, or sometimes you just know it’s not going to work. But honestly, for me, I think it was less about the therapists I was seeing and more that I wasn’t personally or even physically ready to get into it with any of them. I felt like I was faking it, like I was putting on this version of myself that they wouldn’t judge. It was really uncomfortable and I obviously wasn’t healing because I wasn’t being truthful or open.
What I learned when I went away was a sense of stillness, which was cool, but it also really freaked me out. I have a lot of emotions on a good day, but I’d never really paid attention to any single emotion. I’d never called myself out on any of them, or asked myself why I was feeling them, or supporting myself for feeling them. It was always beating myself up for feeling any way – like if I was happy, I’d be like, ‘Do you honestly think you have the right to be happy?’ or if I was having anxiety, it was like ‘This is what it’s going to be forever, you idiot. This is your fault.’ Now that I’m saying it out loud, it’s like, wow – I was really abusive toward myself.
Someone told me that this famous actress who had a meltdown and going through a major public recovery was really into DBT. It’s a weird way to hear about it, but that’s how I heard about it. I’d heard about CBT but not about DBT.
It was hard to find a therapist in my area who specialized in it, so I didn’t get started right away. I was Googling it and reading as much as I could, and the more I found, the more I wanted to get into it. I finally found a therapist about half an hour away from me.
It’s been about a year since I started DBT. It’s been so rewarding and so enriching that I wish I could shout it from the rooftops that this therapy works. For me, the ability to regulate my emotions has been the most amazing thing. Like I told you, my mood swings were fast and furious. DBT continues to teach me how to regulate my emotions so I’m not swinging so much.
The other thing I find particularly useful is distress tolerance. I want to be clear here for a second – for me, DBT isn’t one big giant eraser. It’s not like all of a sudden I don’t have mood swings anymore. I still do. I still hurt, a lot. My mind goes in a thousand different directions. But if I can paint a picture for you, it looks like this: five years ago if I was having a panic attack, I’d be running out the house or work or wherever I was and I’d get in a car and just start screaming at the top of my lungs. I would be shaking or crying uncontrollably. I wouldn’t be able to walk myself through it… I’d just be victim to the emotions. Today, I’m able to recognize that I’m in distress, and the skills I’ve learned – and am still mastering – help me control my thoughts before they start spiraling and lead me to crisis-level behaviors.
What I’ve found most valuable about DBT is that I don’t feel like my emotions control me anymore. I lived my life for a long time seeking validation outside of myself. I’m empowered now to feel like, okay, I’m not cured necessarily, but I can handle things. And in a way, that feels better.
If you’re thinking of doing DBT, I want to recommend patient. It’s extremely difficult. It’s challenging, it’s long and it’s painful, and it can feel sometimes like nothing is happening, nothing is changing. I read one blog post once that the girl said she was in DBT for two years before she felt like anything was happening. It hasn’t been that long for me, but it definitely wasn’t an overnight thing. DBT requires commitment, and it requires effort, and a lot of emotional elbow grease.
It’s totally worth it. Learn more about therapy, and why you shouldn't be afraid of it.
To find out more about dialectical behavior therapy, visit us at www.hopetherapyandwellness.com.
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