Dialectical Behavior Therapy

DBT is an empirically supported treatment developed by Marsha Linehan, Ph.D. DBT is designed to apply dialectical strategies, which blend acceptance and change through cognitive behavioral therapy (CBT) and mindfulness.


DBT is a treatment designed specifically for individuals who have difficulty regulating emotions and engage in self-harming behaviors such as:

  • Cutting and other forms of self injury
  • Suicidal Ideation, urges and attempts
  • Substance Abuse
  • Disordered Eating
  • Other impulsive behaviors

Many clients in DBT suffer from one or more of the following:

  • Borderline Personality Disorder (BPD)
  • Depression
  • Bipolar Disorder
  • Post-Traumatic Stress Disorder (PTSD)
  • Obsessive Compulsive Disorder (OCD)
  • Other Anxiety Disorders
  • Anorexia, Bulimia, and Binge Eating Disorder
  • Substance Abuse and Addiction

“Dialectic” means ‘weighing and integrating contradictory facts or ideas with a view to resolving apparent contradictions.’ In DBT, therapist and clients work hard to balance change with acceptance, two seemingly contradictory forces, which help both the therapist and the client get “unstuck” from extreme positions or from emphasizing too much change or too much acceptance. These strategies keep the therapy in balance, moving back and forth between acceptance and change in a way that helps the client reach their ultimate goals.
Mindfulness skills have emerged as an important focus of several empirically supported treatments. DBT, mindfulness-based cognitive behavioral therapy for depression, and mindfulness-based stress reduction. The roots of mindfulness practice are in contemplative practices common to both eastern and western spiritual disciplines and to the emerging scientific knowledge about the benefits of “allowing” experiences rather than suppressing or avoiding them.

Mindfulness in its totality has to do with the quality of awareness that a person brings to everyday living, learning to control your mind rather than letting your mind control you. Mindfulness as a practice directs your attention to only one thing, and that one thing is the moment you are living in. When you recognize the moment, what it looks like, feels like, taste like, sounds like-you are being mindful. Further, mindfulness is the process and a window to acceptance, freedom, and wisdom.

DBT organizes treatment into four stages with targets. Targets refer to the problems or goals being addressed in treatment.

Stage I: Moving from Being Out of Control of One’s Behavior to Being in Control

Target 1:Reduce and then eliminate life-threatening behaviors.
(Suicide attempts, suicidal thinking, intentional self-harm).

Target 2: Reduce and then eliminate behaviors that interfere with therapy.
(Non-attendance, incomplete homework, hospitalization).

Target 3:

  1. Decreasing behaviors that destroy the quality of life.
    (Depression, phobias, disordered eating).
  2. Increase behaviors that make life worth living.
    (Satisfying job, friends, going to school, stable income).

Target 4:Learn new behaviors (skills).

  1. Control focus; increase awareness in the “present moment”.
  2. Form new relationships, improve current relationships, and end destructive relationships.
  3. Understand emotions, how they function, and how to experiencing them with less intensity.
  4. Tolerate pain without acting impulsive/self-destructive.
  5. Think dialectically without “getting stuck” in extreme views.

Stage II: Moving from Emotionally Shut Down to Experiencing Emotions Fully

Target 5: Experience feelings without dissociating, avoiding life,or (PTSD).

Stage III: Building an Ordinary Life, Solving Ordinary Problems

Target 6: Work on marital problems, job dissatisfaction, career goals, etc.

Stage IV: Moving from Incompleteness to Completeness/Connected

Target 7: Existential or spiritual concerns, feeling empty or incomplete.