Dialectical Behavior Therapy
MIND WELL
Dialectical Behavior Therapy is widely researched and empirically based theoretical model and type of therapy. An intensive treatment program and model. It was created by Marsha Linehan to treat people with borderline personality disorder and specifically for people who have exhibited self-destructive-self-injurious behaviors and have attempted suicide.
DBT is a model of the third wave of cognitive-behavioral therapies. It comes from behavioral therapy, learning theories, and cognitive behavioral therapy. In addition, it borrows elements from philosophical systems and theories of the East and the West.
The term “dialectical” represents the dialectical dilemmas experienced by the person with borderline personality disorder. These are 3 basic dialectical dilemmas, where the individual exhibits behaviors that move between 2 opposite poles/extremes: a) emotional vulnerability vs. self-invalidation, b) active passivity vs. apparent competence, and c) unrelenting crises vs. inhibited grieving. The state of emotional distress is created whenever the person is at one of the two poles which leads to go from one pole to the other. This shift in behavior is a kind of emotional pendulum with the result that the balance does not come. One of the main therapeutic goals is to achieve balance/calm in this emotional pendulum and for the person to overcome the dichotomous way of thinking (black and white) that perceives situations in order to reach synthesis, that is, the dialectical way of thinking and behavior.
The therapeutic course is divided into 4 stages with individual goals.
- Preparatory stage: assessment, commitment to treatment, therapeutic contract.
- 1st stage: changing dysfunctional behaviors, acquiring and increasing skills, reducing suicidal and self-destructive behaviors, reducing behaviors that hinder treatment and the person’s quality of life.
- 2nd stage: treatment of post-traumatic stress and symptoms and/or other co-occurring disorders.
- 3rd stage: improving quality of life, achieving personal life goals and building up your self-esteem.
- 4th stage: self-awareness and spiritual fullness.
Therapeutic progress and skill acquisition is monitored through the completion of weekly logbooks. Homework exercises are an element that also characterizes DBT. All goals are determined through the cooperation of the psychologist with the patient, while the necessary time is given to achieve the goals. The 1st stage lasts 1 year or more, depending on the case, while for the remaining stages the duration of the treatment is determined after mutual consultation according to the goals, progress and needs of the patient.
Η θεραπευτική πρόοδος και η απόκτηση δεξιοτήτων παρακολουθείται μέσα από τη συμπλήρωση εβδομαδιαίων ημερολογίων καταγραφής. Οι ασκήσεις για το σπίτι είναι ένα στοιχείο που χαρακτηρίζει και τη ΔΣΘ. Όλοι οι στόχοι καθορίζονται μέσα από τη συνεργασία του ψυχολόγου με το θεραπευόμενο, ενώ δίνεται και ο απαραίτητος χρόνος για την επίτευξη των στόχων. Το 1ο στάδιο διαρκεί 1 χρόνο και παραπάνω, ανάλογα με τη περίπτωση, ενώ για τα υπόλοιπα στάδια η διάρκεια της θεραπείας καθορίζεται ύστερα αμοιβαία συνεννόηση ανάλογα με τους στόχους, τη πρόοδο και τις ανάγκες του θεραπευόμενου.
2. Skills training: Skill acquisition takes place within groups and in some cases it is also done on an individual level, i.e. with one person. The group has a psycho-educational character, it is not psychotherapeutic, it takes place once a week and lasts 2 hours. The instructors and responsible for the conduct and operation of the group are 2 psychologists. The group is held in circles. Each cycle lasts 6 months and the individual is trained in the following modules/skills: mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance
4. Consultation team for the therapists: once a week a group meeting is held to ensure the correct application of the DST model and to support the therapists.
The Basic Purpose of therapy, according to Marsha Linehan, is for the client to achieve a life worth living.
Dialectical Behavior Therapy is widely researched and empirically based theoretical model and type of therapy. An intensive treatment program and model. It was created by Marsha Linehan to treat people with borderline personality disorder and specifically for people who have exhibited self-destructive-self-injurious behaviors and have attempted suicide.
DBT is a model of the third wave of cognitive-behavioral therapies. It comes from behavioral therapy, learning theories, and cognitive behavioral therapy. In addition, it borrows elements from philosophical systems and theories of the East and the West.
The term “dialectical” represents the dialectical dilemmas experienced by the person with borderline personality disorder. These are 3 basic dialectical dilemmas, where the individual exhibits behaviors that move between 2 opposite poles/extremes: a) emotional vulnerability vs. self-invalidation, b) active passivity vs. apparent competence, and c) unrelenting crises vs. inhibited grieving. The state of emotional distress is created whenever the person is at one of the two poles which leads to go from one pole to the other. This shift in behavior is a kind of emotional pendulum with the result that the balance does not come. One of the main therapeutic goals is to achieve balance/calm in this emotional pendulum and for the person to overcome the dichotomous way of thinking (black and white) that perceives situations in order to reach synthesis, that is, the dialectical way of thinking and behavior.
The therapeutic course is divided into 4 stages with individual goals.
- Preparatory stage: assessment, commitment to treatment, therapeutic contract.
- 1st stage: changing dysfunctional behaviors, acquiring and increasing skills, reducing suicidal and self-destructive behaviors, reducing behaviors that hinder treatment and the person’s quality of life.
- 2nd stage: treatment of post-traumatic stress and symptoms and/or other co-occurring disorders.
- 3rd stage: improving quality of life, achieving personal life goals and building up your self-esteem.
- 4th stage: self-awareness and spiritual fullness.
Therapeutic progress and skill acquisition is monitored through the completion of weekly logbooks. Homework exercises are an element that also characterizes DBT. All goals are determined through the cooperation of the psychologist with the patient, while the necessary time is given to achieve the goals. The 1st stage lasts 1 year or more, depending on the case, while for the remaining stages the duration of the treatment is determined after mutual consultation according to the goals, progress and needs of the patient.
- Individual Therapy: 1 time per week. The individual therapist is responsible for the treatment issues.
- Skills training: Skill acquisition takes place within groups and in some cases it is also done on an individual level, i.e. with one person. The group has a psycho-educational character, it is not psychotherapeutic, it takes place once a week and lasts 2 hours. The instructors and responsible for the conduct and operation of the group are 2 psychologists. The group is held in circles. Each cycle lasts 6 months and the individual is trained in the following modules/skills: mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance
- 24-hour telephone intervention: the client calls the individual therapist with the goal of preventing self-destructive behaviors, preventing suicide, and using/enhancing skills in practice and when they are most needed.
- Consultation team for the therapists: once a week a group meeting is held to ensure the correct application of the DST model and to support the therapists.
The Basic Purpose of therapy, according to Marsha Linehan, is for the client to achieve a life worth living.
Frequently asked questions
What is psychotherapy?
Psychotherapy is the treatment of psychological issues and mental disorders carried out mainly through discussion and communication between the therapist and the patient, rather than through the use of pharmaceuticals or other medical and biological methods. There are different types of psychotherapy: individual, group, couple and family. Psychotherapy is a systematic approach to understanding mental health problems and a method of dealing with psychological problems and difficulties. It is based on clinically proven theories, good clinical practice with the application of specific techniques and interventions to address the causes of psychological problems, and is supported by empirical data. According to the British Psychological Society, psychotherapy is considered an additional qualification for someone already working as a psychologist or psychiatrist. To specialize in psychotherapy, training in a specific psychotherapy model is necessary. There are different approaches to psychotherapy for a psychiatrist and a psychologist (e.g. psychoanalytic, cognitive-behavioral, systemic, etc.).
What is the difference between a psychiatrist and a psychologist?
Many people confuse and equate the role of a psychologist with that of a psychiatrist, since both are mental health professionals. However,there are significant differences. A psychiatrist is a doctor, that practices the medical specialty of Psychiatry and can prescribe medication to relieve discomfort and treat mental health disorders, whenever it is required. Psychiatry is a specialized category of medicine that includes the prevention, diagnosis, treatment and research of mental disorders. Psychiatry differs from psychology in that it approaches emotional and behavioral problems using a medical model. A psychologist is not a doctor and cannot prescribe psychotropic medication. However, in many cases the two specialties can work together and help to deal with psychological difficulties.
Is there a possibility that I might need medication?
There is a possibility that, after the evaluation and in the context of the therapeutic planning, the therapist could also propose collaboration with a psychiatrist for the administration of medication. The answer to the question: “Is there a possibility that I might need medication?” is not simple. Prescribed medication is necessary in specific disorders and is useful in cases where the person is in a period of exacerbation of a certain problem. Cognitive Behavioral Therapy is combined with pharmacotherapy in specific cases for better therapeutic results and until there is a remission of the unpleasant symptoms. Medication is not helpful in personal difficulties that are not due to the existence of a mental disorder and in functioning problems that exist in the personality level.
Will treatment help me?
There is a possibility that, after the evaluation and in the context of the therapeutic planning, the therapist will also propose collaboration with a psychiatrist for the administration of medication. The answer to the question: “It may be normal to have some misgivings about whether to start treatment because there are doubts about the prospect of improvement and fears about the process and the impending change. That’s why some clients go into the process of postponing (“It’s not the right time”) or avoiding altogether. The truth is that you cannot be sure in advance whether the treatment will help you. There is no such thing as a “right time”, and any delay can exacerbate any difficulty. However, it is worth giving yourself the opportunity to try and do something that can bring about a significant change in your life, as this is a highly effective treatment that has helped many people. Finally, if you have decided that that the desired changes are not there, you can stop.
Can I stop before the treatment is completed?
Some people stop treatment without completing it. This can be due to several reasons. For example, some patients stop treatment when initial goals have been met and they feel better, or conversely, when they believe there is no improvement and they are not doing well enough. Improvement is gradual and comes with time and effort. Changes occur upon completion of the treatment. When there are similar concerns and thoughts it would be beneficial and helpful to discuss them in therapy.
What happens when there is a lack of improvement?
There is also the possibility that a long period of time may pass without progress (no change in your thoughts and mood). In this case it will be necessary to: investigate the possible problems that may have arisen within the therapeutic relationship, deal with the behaviors that hinder the therapeutic process, review the interpretation and the plan for each case, and choose different techniques and interventions that best meet your specifics.
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