Dialectical Behavioural Therapy: History, Principles, and Pros and Cons

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This document provides an overview of Dialectical Behavioural Therapy (DBT), including its history, principles, and pros and cons. DBT is a type of cognitive behavioural therapy that focuses on identifying and changing negative thinking patterns and promoting positive behavioral changes. It is commonly used to treat individuals with suicidal and self-destructive behaviors. The document discusses the development of DBT, its basic principles and skills, and the benefits and drawbacks of the therapy. It also explores when and why DBT is best used for patients and who would likely benefit the most. References are provided for further reading.

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Running head: DIALECTICAL BEHAVIOURAL THERAPY
DIALECTICAL BEHAVIOURAL THERAPY
Name of the student:
Name of the university:
Author note:

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History of development of Dialectical Behavior therapy:
Linehan had survived a suicide attempt and then moved to Chicago to live at a YMCA
(Young Men’s Christian Association). Here, she became one of an ardent Catholic and then she
started to work and even took night classes at Loyola University. While she was praying one-day
at the campus chapel, she experienced an epiphany that changed her life profoundly and planted
in her the seeds that allowed her in developing DBT. She eventually earned a Ph.D degree in
social as well as experimental psychology in the year 1971. When she started working with
patients, she witnessed the importance of radical acceptance which had mainly formed the
bedrock principle of DBT. She created the DBT for highly suicidal patients who felt compelled
in harming their own selves or for those who were treated with BPD. This therapy incorporated
the principles of CBT (emotion regulation and reality testing) along with distress tolerance and
radical acceptance. Another principle of mindfulness, which was a Buddhist principle, formed
one of the basic principles of DBT.
The developer and founder of the therapy called the Dr. Marsha M. Linehan had three
major assumptions when she organized the principles in her approach towards psychotherapy.
One of them is the multiple foundations. The approach had its main basis on the foundations of
that of philosophy as well as science. Another major assumption was that change is inevitable
where the approach assumed that both the reality as well as truth constantly evolves. Another
assumption of the founder and developer was integration. She believed the everything is
connected with everything else. Only the one major constant in the universe was that change is
inevitable and that even what appear to be entirely opposing points of view can also be
successfully integrated.
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Basic principles or skills about Dialectical Behavior Therapy:
Dialectical behavioral therapy can be described as the type of cognitive behavioral
therapy. It mainly tries in identifying as well as changing negative thinking patterns and thereby
pushes the clients for positive behavioral changes. DBT is mainly used for treatment of issues
like individuals showing various kinds of suicidal as well as other self-destructive behaviors. The
term dialectical is mainly seen to come from the idea of bringing two opposite aspects in the
same therapy which are acceptance and change as both in combination manner have been found
to bring out a better result than either one or alone. One of the most unique aspect of this therapy
is that it is found to focus on the acceptance of the experiences of the patients as a medium for
the therapists in reassuring them and thereby balancing the work needed for changing the
negative behaviors in the clients. Some of the standard comprehensive aspects of the therapy is
the individual therapy, group skills training, phone coaching needed during the time of crisis
between the session as well as by consultation groups for the healthcare providers for staying
motivated and discussing patient care.
This therapy consists of individual therapy sessions as well as DBT skills groups. The
individual therapy sessions are seen to comprise of one on one contact with that of the trained
therapist ensuring that all the therapeutic requirements and needs of the clients are addressed
properly. It is found that the individual therapist would be helping the client for staying
motivated and thereby apply DBT skills within the regular daily lives and also address the
obstacles that might arise during the course of the entire treatment phase.
Another therapy method is the utilization of the DBT skill group participants where each
of the participants practice skills along with that of the others. Members of the group are seen to
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encourage others for sharing their experiences and thereby providing mutual support. These
groups are mainly led by one trained therapist who teach the skills and lead the exercises. The
groups members are then assigned their respective homework like that of practicing mindfulness
exercises. Each of the group sessions are seen to last approximately for about two hours and the
groups are seen to meet weekly for six months.
The approach of DBT mainly includes the utilization of three important components for
assisting in the treatment of clients in the therapy. One of them is the orientation towards the
individual. All forms of therapy have their own specialized principles that they follow but such
principles can never be applied in the same way with every individual. BDT mainly helps by
approaching the individual clients by helping them in indentifying their strengths to change and
also in developing their weakness in addressing to the problems that they are facing. Another
component is thinking and behaving. Studies are of the opinion that DBT is a form of cognitive
behavioral form of therapy and therefore, it uses both the cognitions as well as actions of the
individuals in recognizing of the problems of the clients and thereby developing solutions to
them. There approach is to understand how and why a client believes the way they do and how
they affect their actions. The third component is the using of the therapeutic alliances for
achieving the changes. By the work therapeutic alliance, it mainly refers to the working bond
that occurs between the therapists as well as the client in the therapy. Studies are of the opinion
that this bond mainly represents both the understanding as well as respect for the client as the
person and even the therapist as someone with an expertise who can help the client. This therapy
considers the therapeutic alliance to be one of the most important fostering mechanisms of
changes for the client. However, at the same time, the therapists using DBT also believes that the
support system of the clients outside the therapy also plays a significant role in addressing the

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issues of the clients. Hence, DBT therapists often try to include friends, family members, and
peers in group therapy, working associates and others in the treatment of the client. Therapeutic
alliance is considered to be one of the most important mechanisms that contribute to the success
of this therapy.
Review of literature shows that many other various principles, skills and techniques are
used in DBT. One of them is incorporating the concept of mindfulness. The concept of
mindfulness can be explained as the ability of the individuals in giving one’s undivided attention
to what is happening at the moment in a non-judgmental manner as well as experiencing the
moment as it occurs. This is a skill that is seen to need high level of practices and allows an
individual in reviewing the events as well as interpreting different events around them
objectively. In case of those individuals who have distressing problems, it becomes vital for them
in suspending their expectations as well as their biases so that they can understand others.
Another important principle is tolerating stress as well as distress which is also related to
the mindfulness approach. It should be known that DBT was developed mainly to address issues
that were conflicting. Individuals are seen to come to therapies so that they can alter stressful and
distressing situations like traumatic experiences, loss of loved ones and many others. However,
many of the studies are of the opinion that such changes are not always possible. In such
situations, this therapy helps clients in accepting such inevitabilities in a non-judgmental as well
as non-evaluative fashion. These allow the clients in accepting more positive approaches and
taking more positive actions in addressing issues that they can control. Individuals who have lost
their loved ones might not get back the person but DBT can help such individuals in learning to
manage the stress associated with it through stress management techniques.
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Another important principle of DBT is managing emotional regulation. Most of the
clients who are generally referred for DBT experience very extreme as well as emotional
stresses. DBT has developed many important approaches for understanding as well as regulating
the emotions of individuals. This is seen to incorporate a much structured procedure that includes
being able to identify emotions as well as reduction of one’s vulnerability to reactive behaviors
that may occur as the result of emotional states. This might also help the individuals by
identifying obstacles to changing emotions as well as in learning to take opposite actions a as
well as to apply tress management for stress distress tolerance.
Another aspect is the interpersonal effectiveness. This mainly comprises of techniques
that allow individuals in communicating with others in ways that is assertive and also helps in
maintaining self-respect and also helps in strengthening relationships.
Pro and Cons about Dialectical Behavior Therapy:
One of the pros of DBT is that it helps by treating the problematic behavior that are
developed by individuals and helps the individuals in coping with as well as giving temporary
relief to the situation. It also helps in enhancing and developing the capabilities of a person by
teaching them the behavioral skills that work and provide relief in both the long run as well as
the short term. It has been found to highly effective in providing significant improvements for
the chronically suicidal patients as well as self0-injuring individuals who suffer from borderline
personality disorder.
A number of cons are also seen to be associated with the therapy. One of the study has
found that in order to make DBT successful, the client first has to acknowledge the fact that she
might be suffering from BPD or similar others and that they want to learn about it and want to
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work hard to overcome the issues. If the individuals do not acknowledge it, then DBT cannot
provide much help to the individual. Secondly, these type of therapies are often termed as highly
costly and that they are not available in all directions. Third, DBT is found to be highly
demanding because there are daily forms and homework in filling out and even require higher
hours of therapy each week and constant motivation. Fourth, there are indeed studies which have
shown DBT reduces the number of suicidal thoughts and reduces the instances of self-harm but
there have been no studies which show that the therapy relieves depression and even makes a
person happier.
When and why it is best used for a patient and who would likely benefit most:
The desired outcome of DBT is effective resolution of different types of maladaptive
behaviors related to impulse control and emotional regulation, mainly for those behaviors in
individuals that might result in death as well as self-injury. Initially, it was mainly applied for
suicidal as well as para-suicidal behavior sand this had always remained the highest priority in
the hierarchy of the treatment for the different target population of BPD patients. However, now
the goals of DBT is mainly used in the reduction as well as the end of the para-suicidal behaviors
as well as the reduction of the other associated self-injurious behaviors like that of the substance
abuse and other eating traits, development of emotional regulation skills for allowing patients to
better process their feelings and even the development of social skills for helping clients in
maintaining healthy personal relationships. DBT is helpful for these individuals as it is support –
oriented and helps the patients in identifying and building on their own strengths for increasing
self-confidence. This treatment is suitable for the patients as they are cognitive based and it also
helps people in identifying patterns like their beliefs, assumptions and thoughts that make their

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lives more difficult. DBT is mainly collaborative as it encourages patients in working out their
issues in collaboration with their therapists.
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References:
Linehan, M. (2014). DBT? Skills training manual. Guilford Publications. ISBN-13: 978-1462516995
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