Dialectic behavioral therapy (DBT) is utilized to treat those who suffer from conditions such as borderline personality disorder (BPD), bipolar disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), suicidal tendencies, and substance abuse. Psychologists are learning to help treat some of these more difficult mental problems, as affected individuals are learning that they can be helped and are seeking therapy in growing numbers.
Men and women with BPD, bipolar disorder, PTSD or OCD will often have other psychological issues, like suicidal traits, substance abuse, depression and anxiety episodes. One problem these individuals seem to share is a lack of proper coping mechanisms to enable them to manage the daily pressures of everyday life. This complex challenge for all these individuals often also keeps them from responding to more traditional strategies of psychological counseling, or cognitive behavior therapy (CBT). Modifications have been incorporated into DBT that have been shown to be much more powerful with these patients, teaching them coping strategies for special difficulties.
Marsha Linehan, Ph.D., first came up with dialectic behavioral therapy after observing the minimal success rate of CBT with adult women suffering from BPD. Her studies showed that clients were often pulling out from treatment or growing angry and unengaged. She also found that professionals regularly backed off when pushing for a change in behavior if patients became upset or emotionally withdrawn. On the other hand, patients would reward counselors with warmth or engagement if they were permitted to change the subject to something they wanted to focus on.
In order to correct this failure to promote change, acceptance techniques were included so clients could feel better understood by their counselors. Instead of pressuring a patient to alter all their actions, making them feel invalidated, several behaviors were praised as highly appropriate, allowing the person to realize that not every action or response was inappropriate. They were also helped to recognize that the current behavior was typical for their psychological condition, but was also treatable with cooperation between therapist and patient.
This not only keeps people from feeling separated from their therapist and wanting to quit treatment, but it also dramatically improves their relationship. It helps clients understand they have solid judgment and prepares them to know how and when to trust themselves. Rather than focusing on the need for change, DBT reinforces when patients make decisions that will result in change.
In order to weave in acceptance with change, Linehan also included a third set of strategies known as dialectics. In DBT, therapists and clients attempt to balance change with acceptance, two forces that may at first seem to counteract one another. But by maintaining and combining them, both parties avoid becoming caught in rigid ideas and behaviors.
OCD and bipolar individuals learn invaluable coping abilities in the course of three components of DBT: one-on-one therapy, skills groups and phone instruction. During individual therapy, patients receive a one-hour weekly appointment with the psychologist. They also attend a two-hour weekly skills group to develop the four key skill sets: mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance. And unlike other treatments, DBT maintains the presence of the therapist. Patients are advised to phone their individual therapists for skills coaching prior to potentially harming themselves. The therapist then emphasizes alternatives to self-harm or suicidal behaviors.
It is not uncommon for DBT to be utilized together with medications. This is especially true for people with bipolar disorder, who may rely on such medicines to handle severe depression, and to help stop the extremes in mood shifts.
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