Why DBT?

What is DBT?

Dialectical Behavior Therapy, or DBT for short, is a comprehensive psychotherapy treatment that is extremely effective for helping people become more mindful as they simultaneously work on improving relationships, tolerating distress, and regulating intense emotions. A comprehensive DBT program offers individual therapy, group skills classes, phone coaching, and a consultation team. This means that when you commit to DBT, you’re getting not just one therapist but a team of providers who are there to support you every step of the way. Check out this helpful video from UCSF to learn more.  

What I love about DBT

What initially drew me to DBT was its development by someone who herself struggled with severe emotion dysregulation problems. Dr. Marsha Linehan, the creator of DBT, shared that when she was psychiatrically hospitalized as a young adult while struggling with suicide and self-harm, she made a pledge that if she got better, she would devote her life to helping others get out of this same hell. The lived experience that drove Dr. Linehan to develop DBT really spoke to me because I believe it’s critical to have treatments developed by and for the communities they serve.

DBT is a little unorthodox compared to many traditional types of therapy. We use humor, irreverence, and self-disclosure to create a real relationship between equals. I love that as a DBT therapist I don’t have to pretend to be anything other than who I am. DBT focuses not just on keeping people alive but continuing to live in misery. Instead, it helps people create lives that are worth staying alive for. That’s powerful.

DBT fits naturally with an anti-racist lens which is an approach that’s critical to my work. That means that we’re not simply helping someone cope better with the realities of an oppressive society, instead we’re also helping them advocate for themselves and push for a more inclusive society. I love that DBT is also explicitly trauma-informed because we know that trauma is often what brings our clients to therapy in the first place, whether that be physical or sexual abuse, experiences of racism, transphobia, homophobia, or sexism, or a growing up in an invalidating household.

One skill from DBT I use regularly

DBT therapists practice what we preach. I use DBT skills every day and one of my favorites is alternate rebellion. Everyone has the urge to rebel sometimes whether it's against your family, your symptoms or diagnosis, an institution, conformity, boredom, or something else entirely. Rebellion may take the form of thoughts like “don’t tell me what to do” or “f*** you”. There are lots of good reasons that you may want to rebel, but unfortunately we sometimes choose to do so in ways that come with consequences for us in the long-term, such as by getting drunk or using drugs heavily, screaming at someone or starting a fight, self-harming, or isolating ourselves from others. Instead of trying to suppress our natural urge to rebel, alternate rebellion focuses on ways you can still feel like you’re breaking the rules but that doesn’t come with negative long-term consequences for you. This skill reminds us that rebellion can be really fun, and there are plenty of ways to do it safely. Here are some ideas:

•   Sleep in or wake up early (whichever is the opposite of what I would normally do)

• Make a mess and don’t clean it up

•   Get a piercing

•   Change your hairstyle

•   Say “no” to someone

•   Participate in a protest

•   Play loud music and dance around

•   Speak up rather than staying quiet

•   Dress in a way that feels rebellious

•   Debate someone about politics

•   Pee in the shower

•   Make up my own language and speak it

•   Give people strange looks

•   Show up late or early to something (whichever is the opposite of what I would normally do)

•   Turn all the cans of tomato sauce backward in the grocery store

How might this form of rebellion work out better for you than some of your less healthy coping strategies?

References:

Linehan, Marsha. DBT Skills Training Manual, 2nd Edition. New York: Guilford Press, 2015.

Mullen, Maggie. The Dialectical Behavioral Skills Workbook for Psychosis. Oakland, CA: New Harbinger, 2021.