Dialectical Behavior Therapy (DBT)

Art of Counseling’s DBT Program Mission:

At Art of Counseling, we are dedicated to providing our clients with comprehensive DBT and other supportive therapies in a warm, nonjudgemental and collaborative environment. We meet clients where they are, accept their challenges and offer them tools to create and rebuild their lives.

What is Dialectical Behavior Therapy (DBT)?

Dialectical Behavior Therapy (DBT) is a comprehensive behavioral intervention designed to treat individuals with severe mental disorders and out-of-control cognitive, emotional and behavioral patterns. It has been commonly viewed as a treatment for individuals meeting criteria for Borderline Personality Disorder (BPD) with chronic and high-risk suicidality, substance dependence or other disorders. However, over the years, data has emerged demonstrating that DBT is also effective for a wide range of other disorders and problems, most of which are associated with difficulties regulating emotions and associated cognitive and behavioral patterns. It is also assumed that there are multiple causes as opposed to a single factor affecting the client. In Dialectical Behavioral Therapy, “dialectical” means, A synthesis or integration of opposites (aka- finding the balance between opposites). In DBT, the main “dialectical” tension, or balance, is between the opposite ideas of ACCEPTANCE and CHANGE. In this framework, DBT therapists balance treatment strategies of validation and problem solving.

Who can benefit from DBT?

  • Lost time when under stress, or feeling like you “blacked out” when stressed
  • Extreme emotional “ups and downs”
  • Feeling “empty” and having thoughts of: “Who am I?” or “Why don’t I know who I am?”
  • Challenges communicating with loved ones, coworkers, friends, or really ANYone
  • Not knowing how to make or keep friends
  • Not knowing how to get out of relationships with destructive people
  • A LOT of anger, and a fear of abandonment if anyone sees the “real” you
  • Confusion about why your emotions are so intense and won’t change
  • Impulsive urges, that are self-damaging, to get rid of pain or loneliness (i.e. using drugs, alcohol, food, shopping, shoplifting, gaming, sex, reckless driving, etc. to “numb out”)
  • Recurring suicidal thoughts, urges and behaviors
  • Thinking that self-harm is a good way to punish yourself or get rid of intense pain or just to feel something.
  • Symptoms of Borderline Personality Disorder, Dissociation, Addictions, Persistent and Major Depression, Social Anxiety, and General Anxiety

The 5 areas of instability that clients may experience in daily life*

  • Emotional Dysregulation
  • Cognitive Instability
  • Interpersonal Instability
  • Behavior Instability
  • Self Instability

*Cognitive-Behavioral Treatment of Borderline Personality Disorder, Marsha M. Linehan, 1993; p. 60

“My main goal for people who come into therapy is that they get out of hell…and that they stay out of hell…to build a life worth living.” Marsha M. Linehan, founder of Dialectical Behavioral Therapy (DBT) BehavioralTech.org

Why Choose Art of Counseling?

We offer a comprehensive and informed DBT dependent on the patient’s needs. Dialectial Behavioral Therapy is an evidence-based treatment, which means there is research to prove its effectiveness. (Art Therapy, AIR Network, EMDR, etc) Who are we?

Here are some other therapies to enhance the client’s treatment experience:

Adaptive Internal Relational (AIR) Network Eye Moment Desensitization and Reprocessing (EMDR)

Art Therapy and DBT – is used in conjunction by many art therapists. Art exercises provide an avenue for exploring personal experiences without judgment or the need to filter experiences through to the art therapist.

Art therapy also provides an avenue to engage in mindfulness art making to help regulate emotions and feelings of anxiety. As clients engage in art making they are developing creative skills that reinforce competence and personal connections that are not dependent on doing the art making ‘correctly’ or finding solutions to problems that may feel overwhelming at the time for the client.

Art therapy supports the important tenets of DBT by providing coping skills to clients. Coping skills help clients to identify emotions, implement grounding techniques, and use self-regulation strategies to reduce maladaptive behaviors.

The integration of art therapy and DBT can encourage clients to take a more fluid approach of connecting to their emotions which is then expressed through art. In this instance, DBT can help provide structure in treatment for those clients who are looking to develop a sense of security in therapy while also acknowledging the personal emotional experiences that originally brought the client to therapy.

Art therapists can implement structure in the art therapy process by establishing a series of protocols for working within the art room. Art therapists can also introduce clients to a series of art exercises that will help introduce clients to the use of art supplies and the creative process. By undertaking these steps the art therapist is helping to establish a sense of security in the art therapy process. This helps the client ground themselves and establish a feeling of safety in which they can further explore difficult emotions.

Art therapy has the advantage of connecting clients to their experiences through non-verbal expression that is not forced through potential censorship from the verbal mind that judges, criticizes, and over-analyzes.

4 stages of DBT
Intake/AssessmentStarting with the intake Focuses Contiunal assessment
PretreatmentFocuses on orienting the client to the structure and philosophy of DBT, beginning to using the Diary Card, creating values-based goals, and establishing therapy agreements between therapist and client. The Pretreatment phase ends when the client begins attending skills groups.
Stage 1Focuses on the client learning and using skills (skills acquisition) to target emotional dysregulation, Cognitive Instability, Interpersonal Instability, Behavior Instability and Self Instability. The client participates in a weekly skills group which covers 5 skills modules. This stage lasts for approximately 12-18 months – or until the client graduates from the skills groups.
Stage 2Focuses on PTSD/past trauma as client is ready. Once a client has a firm understanding of skills and is able to apply the skills to their lives, the therapist uses a variety of therapies, in addition to DBT, to resolve past trauma. If the client does not have past trauma, or has resolved trauma, Stage 3 begins.
Stage 3Focuses on resolving problems of living and client’s respect for self. If the client is still struggling to maintain self respect, a safe environment, and meeting values-based goals the therapist will help them balance acceptance and change skills to resolve these issues.
Stage 4Focuses on attaining sense of joy and freedom. This stage is sometimes a type of “maintenance” phase, and the parameters are established between the therapist and client to help them continue experiencing joy and freedom in their lives.
4 Components of Comprehensive DBT Treatment
1) Individual Therapy
Session length – 50 minute
Individuals will meet with a DBT-trained therapist at least once per week (additional frequency is determined with therapist).
2) Skills Training Group
Session length; 2 – 3 hours
The participant will attend each module of skills groups, twice. This process takes approximately 12 -18 months (6 months for Adolescents) to complete. Group skills sets are as follows: Distress Tolerance, Interpersonal Effectiveness, Emotion Regulation, and Mindfulness. Please see more details about group below.
3) Between-Session Phone Coaching
An as needed basis. Contact with the therapist is brief, focused, and target-oriented. 5-10 minutes.
Available to the participant when they are not in individual or skills group sessions. The coaching call is with the client’s individual DBT therapist. Telephone skills coaching is designed as a way to support the participant during the week in using their skills effectively. Therapists try to make themselves available for phone coaching outside of business hours. When phone calls are not possible, DBT participants have a safety plan to refer to in order to help themselves through crises.
4) Therapist Consultation Team A service for the therapist, between therapists, that is used to strengthen and continually improve the DBT therapists’ knowledge and experience in treating participants. At least once per week, DBT therapists meet together to provide consultation to each other on DBT therapy, on particular DBT skills, and as a support in providing excellent psychotherapy services to the Art of Counseling participant.

DBT Treatment Priorities, or Treatment Hierarchy, followed during individual therapy sessions

  1. Decrease Suicidal and/or Self-Injurious Behaviors
  2. Decrease Therapy-Interfering Behaviors
  3. Address Quality-of-Life Behaviors
  4. Skills Acquisition

*Cognitive-Behavioral Treatment of Borderline Personality Disorder, Marsha M. Linehan, 1993; p. 60

DBT Skills Groups

Skills Trainings Modules include: Core Mindfulness, Emotion RegulationInterpersonal Effectiveness and Distress Tolerance.

Skills training is delivered in a group format that meets one time per week for approximately 2 – 3 hours. Skills training is organized in two segments – 1) mindfulness practice, homework and dairy card review, and 2) teaching of skills and self reflection. The DBT skills group is not a processing group – meaning it is not a group where clients discuss and process individual challenges. It is a group that is led by a therapist and co-therapist, and is structured to teach clients behavioral skills to:

  1. Enhance an individual’s capability by increasing skillful behavior
  2. Improve and maintain a client’s motivation to change and be engaged with treatment
  3. Ensure generalization of change occurring through treatment
  4. Enhance the motivation of therapists to deliver effective treatment
  5. Assist the individual in restructuring or changing their environment such that it supports and maintains progress and advancement towards goals
When do we offer groups?
Day of WeekTimeAge Group
Monday
Tuesday10am-1pm
5 – 6:30pm (Part 1)
Adults 18+
Adolescence Only (in-person)
Wednesday
Thursday 5 – 6:30pm (Part 2)13-18 (+ caregiver online)
Friday

Inquiry About the Program:

For more information about DBT, watch this video: 

Read about DBT on BehavioralTech.org

Information About Diagnoses: