Assumptions in Dialectical Behavior Therapy (DBT)

Assumptions in Dialectical Behavior Therapy (DBT)
Dialectical behavior therapy (DBT) is a cognitive-behavioral therapy (CBT) originally developed to treat women with a history of chronic suicidal behavior who meet criteria for borderline
personality disorder (M Linehan, 1993). According to Marsha Linehan, Standard DBT includes multiple modes of treatment, including weekly individual therapy, weekly group skills training, and as-needed phone coaching to address skill and motivational problems common in people diagnosed with BPD.
The original manualized DBT program consists of four group skills training modules
a) Group skill training of mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance modules,
b) individual counseling,
c) telephone crisis coaching, and
d) a therapist consultation team
The DBT components became popular because it address skills deficits (via group skills training modules and phone coaching), in addition to issues related to motivation for change through individual therapy.
Typically, DBT skills training aims to teach skills to reduce dysfunctional behavior and facilitate the adoption of new behavioral, emotional, and thinking patterns through (but not exclusively delivered in) a group format(Linehan, 1993).
Four modules address skills deficits associated with BPD:
(a) core mindfulness skills center on ways to strategically deploy attentional control;
(b) emotion regulation skills teach clients to identify and influence emotions elicited by the
environment;
(c) interpersonal effectiveness skills help clients to learn to respond effectively to
interpersonal demands and conflicts; and
(d) distress tolerance skills teach clients to identify crisis situations and experience strong negative emotions while inhibiting dysfunctional behaviors that could serve to make the situation worse (Linehan, 1993)
Every therapy operates with a certain set of basic assumptions. These are sets of hypotheses’, facts or statements that are taken for granted. They are not always articulated, but they are acted upon as rules and guidelines for treatment.
DBT is no different. It too operates with a certain set of assumptions. In DBT, however, the assumptions are clearly articulated.
About Clients
People are doing the best that they can.
People want to improve
People must learn new behaviors both in therapy and in the context of their day-to-day life.
People cannot fail in DBT
People may not have caused all of their problems, but they have to solve them anyway.
People need to do better, try harder and be more motivated to change.
The lives of people who are suicidal are unbearable as they are currently being lived.
About Treatment
The most caring thing a therapist or treatment provider can do is help people change in ways that bring them closer to their own ultimate goals.
Clarity, precision and compassion are of the utmost importance.
The treatment relationship is a real relationship between equals.
Principles of behavior are universal, affecting clinicians no less than clients.
Treatment providers need support
Treatment providers can fail.