Dialectical Behavior Therapy (DBT) is an approach to helping people who have problems with their emotions or the things they find themselves doing. Its popularity has gained ground since the mid 1990s following successful research trials demonstrating its effectiveness.
What to expect as a patient.
The first thing the therapist is likely to do is to talk to you about why you have sought help - what is bothering you. This will be in some detail and may take some time. Once the therapist feels they have most of the relevant information, a case formulation can be produced. This is an understanding of what the problems are, how they came about, what makes them persist, what assets you have within yourself and around you, and, above all perhaps, a plan of action.
In general terms the plan will usually have the following three components:
1. Developing your existing skills. Often this will be done by attending groups run by somebody other than your main therapist. The skills that are usually addressed are: interpersonal skills, the skill of regulating emotions, the ability to tolerate distress, the skills of mindfulness, and the skill of ‘walking the middle path’. This will usually involve attending group sessions once a week.
2. Individual therapy sessions. Again, these will normally take place once a week, and are with your principal therapist. The purpose of these is: to help you with any motivational problems you encounter, to help with solving any significant problems that present themselves, helping you generalise the skills you learn in the weekly group sessions to your real life, chain-analysing difficulties that crop up, planning what you could do if the same difficulty happens again, and measuring progress.
3. Contact by telephone, text or email. This is mainly to help you generalise the skills you learn in group sessions to your real life in a helpful way.
Additionally, your principal therapist and the person or people running the skills development group will normally discuss progress with a specified colleague or group of colleagues, all of whom practice DBT. The purpose of such meetings is to ensure that everybody is following DBT principles, to share good ideas, and to help each other find good answers to problems that occur. Your confidentiality is respected by these discussions being limited to a specified small group and the members of that group all being governed by the normal rules of professional confidentiality.
How long will it last?
DBT normally lasts for an extended period of time, so you might expect weekly skills development sessions of about one and a half hours and individual therapy meetings of about an hour weekly, both persisting for possibly one year. During that time the therapist will: make every reasonable effort to conduct competent and effective therapy; obey standard ethical and professional guidelines; where possible, be available for weekly therapy sessions and provide necessary therapy back-up; respect your integrity and rights; maintain confidentiality (see above); obtain consultation when needed.
For your part, you will be expected to: stay in therapy for the agreed time; complete progress and needs assessments; attend scheduled therapy sessions; work towards changing targeted behaviors; work on problems that interfere with the progress of therapy; and participate in skills training.