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DBT Center

Dialectical Behavioral Therapy

DBT® Diary Card

Dialectical Behavior Therapy (DBT®) is an evidence-based treatment for persons struggling with emotion regulation issues (e.g., rapid mood changes, intense and debilitating emotions, etc.). It was developed by Dr. Marsha Linehan and colleagues at the University of Washington (The Linehan Institute and Behavioral Tech). Since its creation in the early 1990’s, DBT® has been shown to be effective for a broad range of issues from severe suicidal thoughts to problems in maintaining relationships. The standard DBT® protocol consists of once weekly individual therapy and once weekly skills training class, which is a weekly scheduled group. DBT® is provided by a team of therapists who meet weekly for consultation on how to improve their skills as therapists adhere to the treatment principles and protocols. Our DBT® Team has participated in extensive specialized intensive training provided by The Linehan Institute and Behavioral Tech, creators of DBT®.

The overarching goal of DBT® is to obtain “a life worth living” by providing skills to manage emotions, to tolerate distress and to improve relationships. DBT® has been shown to be effective in reducing suicidal behaviors, hospitalizations, and problems with anger, depression, and hopelessness. DBT® treats multiple modes of dysregulation including emotion dysregulation which is defined as a combination of extreme emotional vulnerability with difficulty in regulating emotions once they are aroused. DBT® clients learn an array of skills to manage their emotions and the impulsive and almost automatic behaviors that often accompany strong emotions. In individual therapy each client works on:

  1. A highly personalized plan to reduce the behaviors getting in the way of attaining their goals
  2. Increasing their use of skillful behaviors. Clients who enter DBT® are asked to make a six month commitment to attend both individual therapy and skills training class. In six months of treatment with hard work from both the client and the DBT® team, most clients can see significant improvement in their lives.

Is DBT® right for me?

This question is best answered in an interview with an intensively trained DBT® therapist. However, to get a general idea of the kinds of problems DBT® treats you can read through the nine questions below. Consider each question carefully and decide if it is 1) mostly true or 2) mostly not true about you. If you find that you answer “mostly true” to several of these items, then DBT® may be right for you.

  1. Do you have mood swings and rapidly changing emotions? Do you find that little
    things tend to cause emotions to flare and that the emotions are extreme and sometimes long-lasting?
  2. Do you either over-express or under-express anger? Does anger cause a lot of
    problems in your life?
  3. Are you somewhat impulsive? Do you have a tendency to do things under the influence of emotion that you later regret, such as drink too much, spend too much money, eat to excess or engage in inappropriate sex?
  4. Are you confused about who you really are? Do you wonder, for example, whether you really like yourself at all, what your values are, or whether or not you are a “worthy” person?
  5. Are your relationships often filled with conflict, or do you have few or no lasting relationships?
  6. Do you find that when an important person in your life is upset with you or wants to leave a relationship that you feel overwhelmed with fear of abandonment as if you cannot survive without that person? Does this feeling really frighten you?
  7. Do you find that sometimes, when you are really upset, that you want to hurt yourself, or think you would like to be dead? Do you ever harm yourself intentionally or consider killing yourself?
  8. Do you ever feel empty or numb for long periods of time?
  9. When you are really, really upset, do you sometimes have thoughts that people really want to harm you or are hurting you on purpose even though later you might realize this isn’t true? Do you ever lose track of where you are, or of time, or feel paralyzed when you are very emotional?

What can I expect?

DBT® is a therapy which requires a serious commitment from both the client and the therapist. Your therapist will help you clarify your goals and will ask for specific commitments from you, which will help you reach your goals. You and your therapist will develop a collaborative relationship which will seek to reduce any problems that get in the way of your therapy and will also identify behaviors that you most need to change in order to achieve your goals. Individual therapy and skills training will be weekly and you will have homework for each. You will also have access to between-session coaching contact. DBT® is a very active and directed process, where you and your therapist delineate a clear path toward your goals and focus on the steps needed to reach them. Your effort will be a huge factor in your progress.

The first four sessions of DBT® will focus on orientation, assessment and commitment. There are formal and informal assessment procedures. During the early sessions you and your therapist will establish your relationship and treatment plan, including making a diary card. Attendance at group usually begins within four to six weeks after entering therapy. The minimum commitment is usually six months and the full treatment protocol is to complete 2 rounds of the 6 month skills class.