What is Dialectical Behavior Therapy?
An evidence-based, skills-focused therapy for building emotional resilience and healthier relationships
Origins and Approach
DBT was originally developed by Dr. Marsha Linehan to support people navigating intense emotional pain and high-risk behaviors like suicidality and self harm. Today, DBT supports a wide range of emotional and relational challenges and patterns that hadn't responded to other forms of therapy. These include Borderline Personality Disorder (BPD), emotion dysregulation, impulsivity and shame cycles, mood disorders (anxiety, depression), relationship instability or sensitivity, eating disorders, trauma-related difficulties
In DBT the term dialectical refers to holding two truths at once and finding balance between them. In DBT, this often means balancing acceptance and change. You learn to understand and accept your thoughts and emotions without judgment, while also developing new responses that better support your goals and relationships. As a behavioral therapy, DBT focuses on noticing patterns in emotions, thoughts, or actions that cause distress, and helps you gently shape them into more effective responses. Rather than labeling behaviors as “good” or “bad,” DBT seeks to understand your behavior in the context of your history, while also helping you move toward choices that support your values and long-term wellbeing. DBT teaches practical skills that help you stay present, manage emotional intensity, communicate more clearly and respond to challenges without abandoning yourself or creating more suffering
What Skills Are Taught in DBT?
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Mindfulness
Skills for being awaren of your internal experience and staying grounded in the present moment
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Distress Tolerance
Skills for tolerating crisis situations without making them worse and for increasing your ability and willingness to accept difficult realities
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Emotion Regulation
Skills for changing unwanted emotions and increasing emotional resilience
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Interpersonal Effectiveness
Skills for making requests and setting limits in relationships, while still maintaining closeness with others and your self-respect
What’s Included in DBT?
Individual Therapy: Individual DBT therapy sessions are more structured than typical therapy. At the beginning of treatment, I will help you create a diary card to track daily emotions, thoughts, and actions. Based on your diary card, we set an agenda each session to address life threatening behaviors (suicidal and self-harm behaviors), behaviors interfering with your progress in therapy, and behaviors interfering with your quality of life. Sessions are highly interactive and collaborative. In the room, you are the expert in your own life, I am the expert in DBT, and we work together as equals to help you build a life that you experience as worth living.
Between Session Phone Coaching: The DBT model acknowledges that learning is context-dependent - it is one thing to learn a skill in the contained environment of a DBT skills group or discuss a skill in your individual session, and a very different thing to then use that same skill out in the wild. Between-session phone coaching offers you the opportunity to reach out to your therapist for support in using skills in your day to day context.
DBT Skills Group: Skills groups meet weekly for 90 minutes. These sessions are organized like a didactic class - two group leaders guide the group though a mindfulness activity, homework review, skills lessons, and application activities. At the end of session, homework is assigned for the following week. It takes 6 months to complete the full DBT skills curriculum in this format.
Therapist Consultation Team: For a therapist to offer comprehensive DBT, they must be part of a DBT consultation team that meets weekly. This consultation meeting provides DBT therapists the opportunity to discuss cases, refine their skills, and ensure that the treatment you are being provided adheres to the key principles of DBT.
Frequently Asked Questions
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DBT blends emotional insight with concrete skills in a format that is more structured than your typical therapy session. With its structure comes flexibility - you are in charge of setting your treatment goals, and the treatment is tailored to support you. Overall, DBT focuses on both understanding your inner world and building tools you can use in real time.
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Comprehensive DBT is a ~year long program where the client is receiving individual therapy, groups skills sessions (covering mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness), and between-session phone coaching, while their therapist is receiving support via a DBT consultation team.
Any deviations from that format make it “DBT-informed therapy”, rather than comprehensive DBT. While the research on the effectiveness of DBT has been done on DBT treatment that adheres to the full, comprehensive model, many clients also benefit from certain components of DBT, whether it is standalone skills training in a group or one-on-one setting, or individual sessions infused with DBT skills practices tailored to each client’s needs.
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The research on outpatient DBT is typically done with clients in 12-18 months of treatment. That said, many DBT programs are structured around a 6- to 12-month format, with pacing depending on your goals and needs. Meaningful change takes time, and we move at a pace that supports growth and stability.
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Not always. Some people benefit from comprehensive DBT (individual therapy, skills group and coaching), while others do well with DBT-informed individual therapy. We will explore the right level of support together.
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No! DBT was originally developed for BPD, but it is now widely used for anxiety, depression, trauma-related symptoms, emotional sensitivity, relationship struggles, and impulsive or self-protective behaviors that feel hard to shift.
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Many people do! You do not have to feel ready or be fully confident to begin. We take things step by step, at a pace that feels safe and grounding. Reach out for a free initial consultation, and I am happy to answer any questions and discuss what DBT options would be a good fit for you!