Dialetical Behavorial Therapy
Dialectical Behavior Therapy (DBT) can be highly effective for treating clients with substance abuse issues. DBT does not require a client to “hit bottom.” Instead, this therapy draws its energy from the client’s own stubbornness to face fears or pain. DBT accepts clients as they are in the moment versus demanding that the patient change this very instant. This is not to say that DBT lacks challenge, commitment or client responsibility. To the contrary, DBT focuses therapeutic energy on challenging a client’s point of view while simultaneously acknowledging and accepting it. Demands for change are balanced by support. This two-sided nature of the therapy is why it’s called dialectical.
At Morningside Recovery, DBT is most often used with clients suffering from Borderline Personality Disorder (BPD). BPD individuals are often hypersensitive to any perceived criticism while lacking the skills needed to regulate emotions. This perfect storm of emotional maladjustment has proven very resistant to therapy because clients don’t want to listen and think they know best. Therefore, DBT seeks to draw strength from clients’ hypersensitivity and ability to pick up emotional cues. It recognizes that individuals will react quickly, especially to negative cues, and react so strongly as to disrupt cognitive processing. In other words, clients with BPD will shut-down or react so angrily that they can’t think straight. That is why a therapist doesn’t tell clients what their goals “should” be, or what they “should” put up with. DBT accepts the fact that a client can be powerless to take direction. Thus, therapy is directive only when appropriate and to show clients thinking skills to get what they want. This would seem to be counterproductive since many clients, especially BPD clients, may seek to maintain their original mood state and a heightened state of arousal. This is commonly called being “addicted to chaos.” DBT seeks to address this by recognizing that it is the emotional regulation system itself that is disordered. DBT takes into account the biased memory and biased interpretations of BPD individuals, which contribute to their outsized emotional responses of fear, anger, or shame while also experiencing intense and unregulated positive emotions such as love, or obsessions with work, hobbies, sports.
Practical and Proven Effective
Therapeutic approaches that demand client conformity are often experienced by the client as a rejection of his or her life experience. Traumatized clients often either lack the motivation or the skills to adopt the new behavioral requirements quickly enough to experience relief. This leads to relapse or dropping out of treatment. To combat this, DBT explores the interrelated nature of human functioning and reality as a whole, always asking, “What do we really know about this?” This lack of certainty replaces the rigid, “always/never” responses characteristic of severely dysfunctional individuals who say to themselves “I have to…” Ambiguity and change are viewed as inevitable aspects of life.
This uncertainty hits on a central aspect of DBT, in that therapy seeks the known facts of a particular situation. For example, a client may be angry about something when, in fact, the situation isn’t like he or she thinks it is. So why waste time getting angry about it? This is part of the inductive method that encourages clients to look at their thoughts as being hypotheses or guesses that can be questioned and tested. And if new information makes a hypothesis incorrect, then the client changes his or her thinking to address the reality of the situation. Clinical progress is reinforced and any current maladaptive behavior is not reinforced, rather than punished. According to therapist Fouzieh Nikzad, the focus is on acceptance of current conditions while teaching a broad range of behavioral skills. The goal is to increase skillful coping behaviors, including distress tolerance and emotional regulation.
DBT is also helpful with many other disorders such as anxiety and depression. The empirical nature of treatment focuses on patterns of thinking that are causing pain. For example, a client who is depressed may say to himself, “I’ll never get a job.” The Morningside Recovery therapist doesn’t argue with the depressed client, but instead asks him to view such a belief as a hypothesis rather than a fact and to test out his belief by running an experiment. Moreover, a depressed or anxious client is encouraged to monitor and log thoughts that pop into his or her mind to determine what patterns of biases in thinking may exist and to develop more positive alternatives.
The Right Environment
Morningside Recovery provides the right environment for DBT. If a person’s lifestyle continues to reinforce problematic and borderline behaviors, clinical progress is impossible. Conversely, if a client’s environment is highly artificial, far away from any city, then treatment gains may not be maintained once treatment is ended. Therapy and the treatment environment work together to help the client develop optimal clinical gains. The treatment atmosphere at Morningside is a constant backstop against relapse and an encouraging force for therapeutic progress. DBT also features family sessions and consultation meetings with other therapists.
Generally, Dialectical Behavior Therapy requires intensive individual therapy with sessions twice a week. People who seek DBT can expect their therapist to be active, problem-focused, and goal-directed. DBT is most fundamentally based on validation, which means seeing and responding to the patient as a person of equal status and value. DBT core strategies require the balancing of validation with problem solving. Validation consists of listening empathetically, reflecting accurately, and identifying any undesired behaviors that are due to chemical imbalances or past learning history. Validation also targets behaviors that are valid because they fit current facts or match the client's long term goals.
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