Dialectical Behavioural Therapy: FAQ

Dialectical Behavioural Therapy: FAQ

DBT stands for Dialectical Behaviour Therapy and is a unique and innovative treatment model for Borderline Personality Disorder (BPD). This was developed by Professor Marsha Lineman at University of Washington, Seattle.

There are various training courses and programmes available to book onto for individuals and groups to further enhance your dbt skills and expand your knowledge. However it is understandable to not know where to begin or to get lost along the way, therefore we have brought to you a list of frequently asked questions with answers. We’ve also provided answers to questions for those who aren’t interested in the training itself, but more about understanding DBT as a whole.

What is the difference between DBT and CBT?

It is a common question and can often leave you confused between the two, but CBT stands for Cognitive Behavioural Therapy and focuses on helping an individual to change unhelpful ways of thinking and behaving. DBT on the other hand helps to change unhelpful behaviours, but also focuses on accepting who you are at the same time.

What does ‘dialectics’ mean?

In simple terms, it means trying to balance seemingly contradictory positions. For example, in DBT you work with your therapist to find a good balance between accepting yourself as you are and making positive changes in your life.

What is the treatment like?

DBT is formed of four standard elements: individual therapy, skills training in groups, telephone crisis coaching with a therapist & a therapists’ consultation group.

– Individual Therapy: There are theoretically four stages of this element, but Stage 1 is the main one. This stage has three treatment goals; stopping suicidal and self-harming behaviours, reduce behaviours that interfere with therapy by addressing issues that might come to light during treatment & to improve the quality of life.

– Skills Training in groups: DBT therapists offer skills training to a group of people at once. There are four skills modules that are addressed; Distress Tolerance which teaches you to deal with crises in a more effective way. Interpersonal Effectiveness which teaches you how to ask for things and say no to other people whilst maintain self-respect. Emotion Regulation which focuses on a set of skills you can use to understand, be more aware and have more control over your emotions. Lastly, Mindfulness focuses on a set of skills that help you to focus your attention and live your life in the present.

– Telephone Crisis Coaching: DBT can often use crisis coaching to support you to learn how to use your existing skills in real-life situations. This can be used to contact your therapist outside of sessions for situations such as an immediate crisis regarding suicide for example, when you need advice on how to use DBT skills and when you want to repair your relationship with your therapist.

– Therapists’ Consultation Groups: DBT therapists often work in teams rather than independently. A group of therapists might have weekly sessions with one another to discuss any issues and find solutions.

What is a DBT Consultation Team, and why must I be part of a team in order to do DBT?

DBT is a treatment that is team-based, where Consultation Teams meet every week to assist one another in applying DBT. If in the case of treating difficult cases, your DBT team is your resource for maintaining motivation in order to deliver effective treatment, enhance your clinical skills, and monitor fidelity to the treatment model. Through these weekly meetings, your team provides you with the support you need to treat clients and develop your skills.

What are my options for being on a DBT team?

You can choose one of several options: start a new DBT team where you will be required to attend a ten-day intensive training course. This is designed for those who have begun learning DBT methods from self-guided study from introductory workshops and treatment manuals.

Alternatively, you can join an existing DBT team and attend a five-day foundational training course. This type of course is designed for individuals or a group of therapists who are members of an intensively trained team, but have not yet completed intensive training themselves.

If I can’t join an existing team or start a new team, can I still integrate DBT within my practice?

The majority of data on DBT’s effectiveness has tested the standard model of DBT, which includes individual treatment, skills training, phone coaching, and consultation team. Since there has been minimal research to examine the specific role of the DBT consultation team thus far, more research is needed before researchers can make an empirically supported case for the relationship between consultation team and staff, client, and programmatic outcomes. This means that in order to do DBT to fidelity, you must be on a DBT consultation team.

After people have completed the 2×5 days intensive training – what are the on-going requirements for supervision/governance ensuring safe practice?

DBT is a psychological intervention and therefore we would recommend that in addition to weekly peer supervision in the Consultation Team, that novice team’s access supervision from a more skilled practitioner. This is the same recommendation as for any psychotherapy. Often, however, organisations are unwilling to support teams to access this. Large components of DBT are based on cognitive behavioural problem-solving and each team is selected to have at least one team member with expertise in this area to support the team.