Common Misconceptions about Dialectical Behavior Therapy (DBT) - Debunked

As DBT therapists, we often hear all kinds of misconceptions about DBT as a treatment. From the idea that DBT is only about skills, to the notion that DBT is a rigid or protocol-driven therapy, there are a lot of myths about it that float around. It is very understandable that people may have a misunderstanding about what this treatment modality is all about– there is so much information out there, and full DBT treatment has several components that can make it feel confusing. Some people may have even had an invalidating or negative treatment experience that was said to utilize DBT. In this blog post, we hope to clear up the misconceptions about DBT and demonstrate how our team at Pacific DBT Collaborative, understands and practices this highly effective therapy.

Misconceptions #1: DBT is only for Borderline Personality Disorder.

It's true that DBT was originally researched and validated for clients experiencing Borderline Personality Disorder. Marsha Linehan, the founder of DBT, struggled with BPD herself, and had a deep understanding of what it is like to live in a world that does not seem to understand your experience. Linehan pulled from existing treatment strategies such as cognitive restructuring and problem solving, but balanced it by emphasizing the need for validation, authenticity, and radical genuineness in the therapy room. So, DBT was born, and yes– it is very effective in treating BPD! However, BPD is not the only mental health challenge that can benefit from DBT therapy. DBT has shown to be effective for a wide range of mental and behavioral challenges, including anxiety, depression, PTSD, OCD, and more. There is DBT for children, DBT for substance use, DBT-PE for trauma, and Radically Open DBT for over control. So, DBT can be effective for many people. Many people find the skills taught in DBT very helpful, regardless of the severity of your mental health challenges. DBT is especially helpful for those people who are struggling with emotional dysregulation; DBT is not just for a label.

Misconception #2: DBT is rigid or "robotic"

While DBT has a structured format (skills group, individual therapy, coaching), it is meant to be flexible and tailored to an individual’s needs. In fact, DBT specifically emphasizes warmth, validation, and therapeutic connection. It encourages therapists to be human in the room with their clients, and treat them as equals. The more structured parts of the therapy (such as following a treatment hierarchy that prioritizes targeting life threatening behaviors above all other issues in a session) are meant to help ground both the therapist and client, particularly in moments when life becomes especially chaotic or a client is experiencing multiple crises at once. Still, within the container of comprehensive DBT, flexibility is needed and encouraged. We want to meet a client where they are at, and while DBT has several treatment strategies, it is at its core a principle-driven treatment rather than a protocol-based therapy. 

Misconception #3: DBT is cold and punitive 

DBT is a behavioral therapy, and as DBT therapists we focus on helping clients understand why they do the things they do, and how to make meaningful change especially in regards to unhelpful behaviors. Because of the focus on behavior change and accountability, some people might misinterpret DBT as a cold, harsh, or punitive kind of therapy. In reality, DBT is deeply compassionate– and for DBT therapists, the most caring thing we can do for our clients is help them change in ways that bring them close to their goals. Sometimes, this might mean going where 'angels fear to tread', as DBT therapists put it– in other words, pointing out to clients ways in which their behaviors or habits are unhelpful to their lives. This is always to be done in a compassionate, collaborative, and kind manner– we want to work with our clients to help them make meaningful change in their lives. Clients are not punished for struggling; instead, a therapist will explore why an unhelpful behavior happened, while validating the understandable reasons a client may have engaged in said unhelpful behavior. DBT therapists work to empower our clients, because we understand and validate their suffering while also honoring and reminding clients of their capacity for change. 

Misconception #4: DBT is skills only

Skills are a very important part of DBT, and one of the four components of comprehensive treatment alongside individual therapy, phone coaching, and the DBT consultation team. The DBT skills themselves have become quite popular, and sometimes clinics or programs will offer a shortened version of a DBT skills group, or a therapist may incorporate some of the skills or worksheets into their individual sessions. However, comprehensive DBT treatment is much more than just a set of skills to learn. DBT involves several treatment components including individual therapy, and has some unique tools and strategies that set it apart from other types of modalities. For more information, see our DBT 101 blog post that gives an overview of DBT therapy. Overall, DBT is a therapy that is all about helping clients understand why they do the things that they do, gain control over unhelpful behaviors, and move toward a life worth living. The DBT skills are one small part of that! 

Misconception #5: DBT is too solution oriented 

At its core, DBT focuses on balancing the dialect of acceptance and change. Change strategies and problem solving are certainly a large part of DBT, and we help clients make changes in their lives to live more towards their goals and values. And, part of that process involves acceptance of what is– sometimes, acceptance is the skill we must start with to make change at all. 

Misconception #6: DBT only helps people who are in crisis or suicidal 

DBT has been shown to be an effective intervention in treating suicidal thinking or self harming behaviors. However, you do not have to be struggling with those things or even be in crisis to benefit from DBT. Alongside behavioral control of life threatening behaviors, DBT also aims to treat problems in living, which can look like a range of issues– from skipping work due to depression to avoiding conflict due to anxiety,  anything that might be interfering with a person’s quality of life is considered a treatment target in DBT. 

DBT can be a powerful intervention– and, the reality is therapy is not one-size-fits-all. Often the most important part of therapy is finding a therapist you trust and work well with– regardless of the modality they use. If you are someone who has experienced invalidation from DBT, or found the treatment ineffective, that experience is real and valid. Sometimes, clients report that they have found DBT invalidating, unhelpful, or excessively rigid– and, the truth is, perhaps they were in a program or working with someone who was invalidating, unhelpful, or excessively rigid, even if that provider did not mean to be. Finding the right fit can be a tricky process, and at Pacific DBT, our goal is to listen with care to what our clients need– and sometimes, they might not need DBT!

It can be helpful to remember that if you had a negative experience with a DBT therapist or a DBT program, it might not mean that DBT as a whole is “bad” or unhelpful. Goodness of fit can mean so many different things, and a therapeutic relationship that feels unsupportive or just not your cup of tea might mean that the therapy isn’t going to be helpful, even if the modality is “supposed” to work for you. What's important is to not judge yourself for feeling that it isn’t working, and if possible, bring up your concerns to your therapist. DBT therapy is meant to encourage an open and active collaboration between client and therapist, and if you feel dissatisfied, it's important to let your therapist know, if you feel safe and comfortable to do so.

At Pacific DBT, we want our clients to feel that they can be honest with us about what is and isn’t working, so we can adjust the treatment to meet our clients where they are.