DBT 101: What is Dialectical Behavior Therapy?

At Pacific DBT, we offer Comprehensive Dialectical Behavioral Therapy as part of our services. If you’ve ever come across the term “DBT” but the various acronyms, treatment components, and inundation of online information has left you scratching your head, fear not– we are here to make the treatment clear! 

Quick Definition

In short: Dialectical Behavior Therapy (DBT) is a structured, evidenced based-therapy that teaches skills to manage intense emotions, reduce harmful behaviors, create more meaningful relationships, and ultimately build a life worth living. 

The History Behind DBT

This treatment model was originally created in the 1980s by Dr. Marsha Linehan, a psychologist and researcher from the University of Washington, as part of her dissertation on preventing death by suicide. Dr. Linehan’s own painful experiences with Borderline Personality Disorder informed her creation of the DBT treatment; at that time (and often still today), treatment would often inadvertently invalidate client’s experiences and even add to the layered stigma around BPD. Dr. Linehan did not reinvent the wheel, by any means; instead, she took components of existing treatment models such as Cognitive Behavioral Therapy and Mindfulness to create a treatment format that emphasized both acceptance (validation, mindfulness) and change (cognitive modification, behavior analysis, contingencies, problem solving). Although the treatment was originally designed to treat Borderline Personality Disorder, it is now recognized as a treatment for a variety of mental health conditions. 

Let’s Break Down the Acronym: DBT

Dialectics

In simple terms, dialectics means that two truths can be present at the same time. More specifically, it suggests that two seemingly opposing truths can exist in any given moment. For example: you can be mad at somebody, and still love and respect them; you can be capable, and need support. Dialectics helps us transform the rigidity and black-and-white nature of an “either/ or” statement into a flexible, “both/and.” The core dialectic in DBT is balancing the opposites of acceptance and change; it recognizes that when talking about change we automatically talk about acceptance. In order to have change, we need to accept that we have a problem. In order to accept something, it means changing to allow for the acknowledgment of a problem. This balance, and expanding a rigid mindset into a dialectical one, is at the core of DBT. 

Behavior

DBT has its origins in Radical Behaviorism, a philosophy developed by psychologist B.F. Skinner. What this means is that the treatment draws from behavioral principles such as contingency management, reinforcement, and shaping. In simple terms, a behavior is defined as anything we can increase or decrease; this includes thoughts, emotions, actions, and sensory input. Essentially, everything that we attribute to being human can count as a behavior. DBT emphasizes understanding why we do the things that we do, and DBT therapists help clients figure out which behaviors are or aren’t working to move clients closer to their goals and values.  For example, a DBT therapist may prescribe “increasing validation behaviors” in relationships to foster increased sense of connection and intimacy–after all, being understood by others goes a long way in relationships.

Therapy 

This is the space and relationship where the treatment is delivered. This is the most important ingredient in DBT therapy. Without a strong relationship with your primary therapist, doing any sort of therapy is impossible. DBT therapists practice principles of radical genuineness; we don’t see ourselves as blank, neutral slates, but rather as a human in the room alongside our clients. What this means is that sometimes, DBT therapists may respond differently than clients are used to– DBT therapists may be irreverent, use self-disclosure, and hold limits. This is always done in service of the client; after all, a therapeutic relationship is a real relationship, and  DBT is a relational therapy. DBT therapists explore with their clients the way relational dynamics playing out in the therapy room may also be playing out in a client’s life. 

So there you have it: D-B-T. 

Let’s Break Down what it means when we say, Comprehensive DBT

The Core Components of DBT

"Full" DBT treatment, or Comprehensive DBT, includes four components: individual psychotherapy, weekly skills group, telephone coaching, and the DBT consultation team. Any therapy that does not include all four of these components is not full DBT, thought it may be considered “DBT-informed.” At Pacific DBT, we offer DBT-informed therapy, full protocol, or, comprehensive DBT, skills group, and other evidence-based psychotherapies. 

1. Individual DBT Psychotherapy

The individual therapy component of DBT is the space where a client can really dig into their behaviors and emotions to better understand themselves. DBT individual therapy is more structured than traditional talk therapy; it includes the use of certain tools, such as the Diary Card, to help clients and therapists get a clear picture of a client’s week-to-week experiences. Individual therapy may also include in-session behavior rehearsal in order to practice the new skills a client is learning. In this way, the individual therapy helps clients generalize new skills. A DBT therapist will spend time orienting the client to the treatment, building commitment and motivation for change, and helping the client get an idea of what their treatment goals are (for example, wanting to increase or decrease certain behaviors). In this way, the therapist and client are creating the roadmap for treatment; the “Life Worth Living” goals are the compass that guide both the therapist and client. 

2. Skills Training Group

The weekly skills group is where clients learn the specific DBT skills. The skills are taught in four modules: Mindfulness skills (staying present and aware), Distress Tolerance skills (surviving crisis without making it worse), Emotion Regulation skills (understanding and managing emotions), and Interpersonal Effectiveness skills (asserting needs and setting boundaries while maintaining relationships). The skills group is less like a traditional group therapy setting and much more akin to an educational class, with a new weekly lesson and weekly practice assignments. Clients can expect to participate in sharing how they practiced the weekly skills, learning new concepts, and expanding their repertoire of coping skills. 

Home Practice

Because DBT is a more intensive therapy than traditional talk therapy, clients are expected and encouraged to take what they are learning and apply it outside of the therapy room. This means DBT clients are completing weekly practice assignments, for both the skills group and their individual therapy. The goal of these out-of-session practice assignments are to help clients practice their skills across different situations, so that they can learn to rely on new ways of coping. After all, rehearsal is what helps the new behaviors stick! 

3. Phone Coaching 

A component of full DBT therapy that sets it apart from traditional talk therapy is access to 24/7 phone coaching with their primary therapist. Phone coaching is a brief, 5-15 minute conversation outside of session time, and is offered 24 hours a day, 7 days a week. There are several reasons why phone coaching is important (and useful!) part of DBT. Phone coaching teaches clients how to ask for help, particularly before a full-blown crisis actually occurs; the idea is to intervene and get support before a crisis builds into something unmanageable. Phone coaching also provides assistance if a client is having trouble coping or integrating the use of skills into their daily lives, or is struggling to use the skills rather than engage in unhelpful behaviors. Phone coaching also provides opportunities for relationship building; sometimes, clients want to share success with their therapist, or repair the therapeutic relationship, and phone coaching allows them to do this without waiting until the next full session. Phone coaching is an incredibly useful tool, and clients can find comfort in knowing that their therapist is truly with them during their therapy journey, every step of the way. 

4. Consultation Team

The final component of full-protocol DBT is one that clients wouldn’t notice as much during their usual treatment, but is an essential part of DBT; that is the Consultation Team. Every DBT therapist sits on a DBT team, and participates in a weekly meeting that includes supporting one another and providing consultation on clinical cases. This team meeting is like “therapy for the therapists;” it helps DBT clinicians avoid burn out, and builds motivation to continue to deliver effective treatment. It also helps ensure that DBT therapists are maintaining fidelity to the treatment model; in other words, staying true to the principles of DBT as it was researched in order to maintain high standards of care. Because of the DBT consult team, clients have access to not only their individual therapist, but they also benefit from indirect access to the expertise of the entire team. At Pacific DBT, we are a community of therapists that are invested in all client’s success, even if we don’t see them directly. Through our consultation team, we support one another to stay present and effective with our clients. 

So, how does this all work together? 

As a client, it might feel overwhelming to see so many details about a potential treatment. Lets walk through an example of how all these different components work together, so you can imagine what DBT might look like for you. 

Laura is a 28 year old who has been working a corporate job for the last few years. She has been struggling with managing her emotions, which can become very intense and overwhelming quite quickly. To cope, Laura sometimes drinks more than she intends to, and on occasion, the emotional intensity has led her to scratch or punch her legs. These difficulties have also created conflict in her relationship with her girlfriend, Susan, who has a hard time understanding Laura’s emotional experiences. 

Laura decided to try full DBT therapy after it was suggested to her by a psychiatrist. In individual therapy, she worked with her therapist to identify her “Life Worth Living” goals—such as marrying Susan, traveling, and returning to school—and to recognize the behaviors that were getting in the way, including difficulty managing her emotions, self harm behaviors, alcohol misuse. Together, they tracked her behaviors and emotional patterns, especially during high-intensity moments, helping Laura increase awareness and insight.

In weekly DBT skills group, Laura learned and practiced new coping strategies in the areas of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These skills gave her concrete tools to use when things felt hard—for example, choosing a distress tolerance skill over self-harm or substance use.

Throughout the week, Laura also used phone coaching to get real-time support. One night, during an escalating argument with Susan, she called her therapist to figure out which skill might help de-escalate the situation and communicate more effectively.

Behind the scenes, Laura’s therapist received guidance and support from their DBT consultation team—ensuring the therapist stayed effective, focused, and grounded throughout Laura’s treatment.

After a year of DBT and two rounds of skills group, Laura saw a significant improvement in her ability to regulate emotions, manage conflict, and reduce impulsive behaviors. She no longer engaged in self-harm and had brought her drinking under control, allowing her to move closer to the life she envisioned.

We at Pacific DBT are here for you, contact us today to get started on your DBT journey. www.pacificdbt.com/contact