5 Hallmarks of Dialectical Based Therapy

5 Features of Dialectical Based Therapy

• Dual Approach
• Individual Counseling
• Group Skills Training
• Treatment Stages
• Team Meetings

Among the hallmarks of dialectical based therapy is the adherence to a comprehensive protocol. Clients engage in skill training, individual counseling, homework, keeping a diary, role-playing, episode analysis, and phone coaching during crises.

This therapeutic framework emerged in the 1980s, first developed to improve the prognosis for borderline personality disorder. Since then, treatments have markedly alleviated other severe mental health conditions. Here are the defining features of the dialectical model and its life-transforming benefits.

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1. Dual Approach

Dialectical behavior therapy (DBT) is a branch of psychotherapy empowering people to change harmful thinking and behaviors. Its intensive framework is well-suited to those prone to self-injury and scarred by psychological trauma. DBT teaches clients how to manage stress, moderate disturbing emotions, avoid destructive habits, and enjoy healthy relationships.

DBT successfully treats depression, anxiety, eating disorders, addiction, rage, suicidal thinking, attention deficit hyperactivity disorder, and post-traumatic stress disorder. Also eased are symptoms of impulsivity, bipolar disorder, and borderline personality disorder.

One of the hallmarks of DBT is its unique psychological approach, combining dialectics and cognitive behavioral therapy.

Dialectics

Essentially, dialectics means dual. Its key principle is balancing acceptance and change, two opposing goals of psychotherapy. DBT holds that suffering results from trying to control situations that can’t be altered.

When life is painful, people often seek relief in three ways — ignoring the source, fighting against it, or becoming numb to it through habits like drinking and taking drugs. However, these reactions are only temporary band-aids.

A healthier response is total or “radical acceptance,” letting go mentally and emotionally. A neutral stance lessens discomfort. Though pain may persist, people can learn to witness it, like a bystander. Or, they can switch their focus to pleasant or productive activity. Either way, distress softens.

Here’s an example of radical acceptance. A person is driving to an appointment, cruising along, when traffic suddenly halts. They can’t do anything to get the cars moving. Rather than stewing over the standstill, they listen to an audiobook or gaze at the gorgeous landscape around them.

Cognitive Behavioral Therapy (CBT)

CBT is a technique by which people develop a positive outlook. To achieve this, one must first recognize negative thinking patterns and the unhealthy behaviors they breed. Frequently, people with poor mental health have low self-worth, created by inaccurate opinions of themselves.

Through CBT, clients adopt a kinder stance toward their thoughts, feelings, and habits. By acknowledging their abilities and strengths, self-esteem grows. Becoming free of false beliefs and dark thinking promotes beneficial behaviors, and the harmful ones fade. CBT also corrects distorted views of situations that lead to catastrophic thinking, unfounded assumptions, and paranoia.

2. Individual Counseling

Per the DBT protocol, each client meets once weekly with a therapist, discussing problems that surfaced the prior week, as recorded by the patient on diary cards. Through daily entries, clients track undesirable responses to situations. As management skills are learned, clients also document their breakthroughs.

Sessions follow a treatment hierarchy. Priority goes to ending self-destructive behaviors. Following this are habits that don’t harm the client or others but do impede progress. Broached next are interpersonal conflicts.

Concurrent with addressing these issues, the therapist may focus on symptoms of a mental health diagnosis. Plus, if a crisis occurs between sessions, the client can call their therapist for brief coaching, lasting 10 to 20 minutes. Phone coaching is a unique hallmark of dialectical based therapy.

The goals of individual counseling are strengthening a client’s coping strategies, social skills, and self-respect. To this end, the therapist provides encouraging feedback, keeping their client motivated.

3. Group Skills Training

While group sessions are common to psychotherapy, with DBT, clients meet in a classroom setting to learn coping skills. This is another hallmark of dialectical based therapy.

Typically, training is given once a week for six months, each session lasting two hours. Group members practice the techniques with each other, role-playing and sharing insights. Each client also receives homework, for continued progress outside class.

Standard assignments include keeping a diary, practicing mindfulness, and chain analysis, identifying the factors leading to unwanted behaviors. By recognizing triggers, such as volatile thoughts and feelings, clients can work on changing their responses.

Generally, group sessions start with a mindfulness exercise, followed by homework review and learning a new coping strategy. By program completion, clients are fluent in four management skills — distress tolerance, mindfulness, emotion regulation, and interpersonal effectiveness.

• Distress Tolerance – To foster equanimity when troubled, clients can engage in self-soothing, distraction, or radical acceptance. Strategies for releasing tension include imagery, prayer, muscle relaxation, self-encouragement, and seeing something positive in a challenge.

• Mindfulness – This entails focusing in the present moment, slowing down and approaching a challenge calmly.

• Emotion Regulation – When negative thoughts and feelings arise, clients take steps to reduce their power. From Good Therapy, here’s detailed information on the skill of emotion regulation.

• Interpersonal Effectiveness – To improve communication, clients learn the art of negotiation, assertiveness when warranted, and ways to preserve self-respect. Also taught are tips for avoiding isolation, keeping friends, and ending toxic relationships.

From Johns Hopkins Medicine, here’s an inside look at group skills training for clients with a borderline personality disorder.

4. Treatment Stages

Another hallmark of dialectical based therapy is that treatment is progressive, consisting of four phases, building upon each other.

• Stage One – The client faces their harmful behaviors, such as cutting, using drugs and alcohol, or attempting suicide. Then, the therapist outlines steps for controlling adverse reactions and eliminating destructive habits.

• Stage Two – To understand the roots of current problems, past traumas are revisited. In this confidential setting, the client can safely express feelings, rather than repressing them or exploding.

• Stage Three – The client forms life goals while becoming more adept at coping and problem-solving.

• Stage Four – The focus is on honing communication skills and improving relationships.

5. Team Meetings

Since DBT clinicians treat severe mental health conditions, they’re vulnerable to emotional and mental fatigue, leading to clinical mistakes and poor outcomes. To help therapists stay motivated, patient, and effective, the DBT model includes weekly team meetings.

Topics visited are client challenges, regulating emotions, refining skills, problem-solving, and sharing successful treatment strategies. Through mutual support, therapists avoid burnout and stay aligned with the treatment protocol.

Radical Victories

Five hallmarks of dialectical based therapy are its twofold approach, group skills training, individual counseling with supplemental phone coaching, progressive treatment stages, and team consultations. Clients who complete one year of DBT are well-equipped to manage intense emotions, end destructive behaviors, gain self-esteem, and maintain healthy relationships.

DBT is rich in client victories!