Dialectic Behaviour Therapy (DBT for short) is an approach that works with people on developing psychological skills that they can use in their day to day lives. Most people have three elements to their DBT work. These are skills training, 121 psychotherapy and between-session coaching. In this article, I am just focusing on the skills training because it is what I do most of, as you can see here if you’d like more information.
1) The training assumptions are wonderful
DBT assumes that everyone wants to have a life worth living, but that some of us don’t have the tools to create that. This could be because of an invalidating environment (including abuse, poverty, discrimination, neglect, bullying, oppression or just a social environment that doesn’t meet our needs), predisposing factors (such illness, impulsiveness, emotional sensitivity or reactivity) and the interaction of the two. It talks about the ways in which the environment can be more powerful than us, and how that can undermine our coping. I love the recognition that we don’t always make our problems, but we have to solve them anyway. I’m an especially a big fan of the idea that we can learn specific skills to help us to do that, in the face of a world that is so invalidating to so many of us.
2) It is great to see a compassionate approach created by someone that is so open about her own mental health journey
It is no surprise that the training assumptions come from a woman who had her own violent experiences with the mental health system. She was institutionalised and subject to electroconvulsive therapy as a young person. While she was diagnosed with schizophrenia, she believes this was a misdiagnosis for borderline personality disorder (BPD). She dedicated much of her life to working with BPD, creating DBT as a treatment primarily for the condition. Her work is full of compassionate understandings of out of control emotions and behaviour. The approach she has created is all about helping people to understand the causes of their behaviour and to work with those.
3) The skills are broken down into manageable chunks – even if the practice of them is sometimes really hard
DBT skills are straightforward, but that doesn’t make them easy. They come in 4 categories: mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance. Within these categories are a series of sometimes interconnected skills. These are taught in individual lessons, with homework given between classes to be discussed at the start of the next training session. There are lots of handouts and worksheets to go through, and this helps make the skills approachable. Practice is the key to working with DBT, because each skill has to be practised in lots of situations if it is going to be something that a person can use in an emotionally challenging moment. Half of skills training is dedicated to talking about the homework and troubleshooting skills from the previous week.
4) The skills give people more choices – and even if one doesn’t work, another might
One of the things about people is that we vary. A lot. Something that is the best thing ever for one person, someone else will think is a waste of time. That is the case with DBT skills too. Some will be wonderful and accessible the first time through. Others may take some time to click. A few won’t work for us. The point is to equip yourself with more options – and to work out how to make effective choices between those options. I love how effective DBT is at doing that. For marginalised clients, especially those who struggle to find a therapist who understands their intersections of oppression, these skills offer a route to creating a life worth living in an invalidating world. They offer tools to work through situations that are difficult to explain to others – and ones that can be used really effectively with peers.
5) Skills groups can be made up of members of a marginalised community, which can be really validating
The first peer skills group that I set up was for disabled queer people. More recently I’ve worked with sex workers, queer people and disabled people in skills training groups. While the skills don’t require working with people that share experiences, doing so can make some of the homework easier to work through. It is often validating for people to hear about how others struggle with similarly hostile social environments or similar internal struggles.
If you’re interested in joining a DBT skills group, you can sign up to my mailing list here to find out when the next one is running. I’ll be running online groups on interpersonal effectiveness and distress tolerance starting the last week in May 2019.