Dialectical Behavior Therapy: A Critical Analysis Report

This report critically analyzes Dialectical Behavior Therapy (DBT), a treatment approach initially designed for borderline personality disorder, but also applied to other mental health issues like depression and mood disorders. The analysis explores DBT's therapeutic strengths, such as its effectiveness in managing BPD and key problematic behaviors, improving emotional regulation, and reducing self-harm and suicide risks. It also acknowledges limitations, including the need for pharmacological treatment in some cases, the potential for diminishing effects over time, the high cost and time commitment required, and the need for highly qualified therapists. The report emphasizes the importance of racial, cultural, religious, and gender sensitivity on the part of the therapist, discussing how to accommodate clients from diverse backgrounds. Finally, it explores the implications of DBT for future mental health practice, highlighting its potential in managing chronic relapsing disorders and the need for further research on its efficacy in various conditions.

Running head: DIALECTICAL BEHAVIOR THERAPY 1
Dialectical Behavior Therapy
Name
Institutional Affiliation
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Introduction
Dialectical behavior therapy is a treatment approach first designed to manage borderline
personality disorder. The therapy can also be used in the treatment of other mental problems,
such as depression, suicidal ideation, as well as mood disorders among other disorders. DBT
provides individuals with skills necessary to handle negative emotions and reduce conflict in
relationships (Ivey, Ivey & Zalaquett, 2016). The therapy enables people to regulate their
emotions by equipping them with coping skills. The following paper is based on a critical
analysis of dialectical behavior therapy (Carmel et al., 2016). Besides, the paper will highlight
the strengths and limitations of the treatment approach. The racial, cultural, religious, and gender
sensitivity required on the part of the therapist will also be discussed. Furthermore, the paper will
provide a discussion of the implications of the approach to future mental health practice.
Therapeutic Strengths and Limitations of Dialectical Behavior Therapy
Strengths
One of the strengths of DBT is that it is a practical treatment approach for BPD. BPD is a
severe psychiatric problem that was difficult to manage before the introduction of DBT (Ivey,
Ivey & Zalaquett, 2016). Besides, the therapy is well-received by individuals, and treatment
compliance is high among the clients with BPD. Hence, clients presenting to therapists with BPD
can be managed successfully using the DBT. To illustrate this, a group of researchers performed
a clinical trial study to determine the effectiveness of DBT in managing BPD (Wetterborg et al.,
2018). Thirty men with BPD and antisocial behavior participated in the study during which the
researchers evaluated 12 months of DBT. The researchers found out that DBT was effective in
decreasing the risk of negative behaviors associated with BPD which included criminal insults,
aggression, and self-harm. The risk of negative behaviors was reduced by 60% after the therapy.

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(Wetterborg et al., 2018). Manifestations related with depression and BPD were significantly
reduced. The researchers concluded that DBT is an effective treatment approach for BPD.
Furthermore, therapy is used in managing key problematic behaviors.
Besides, DBT enhances clients’ ability to accept the current situation. Also, the clients’
tolerance of negative emotions is improved instead of them trying to avoid it (Carmel et al.,
2016). The clients are also equipped with skills of managing intense feelings that have result in
problems in individuals’ lives. The therapy also enables clients to communicate effectively by
focusing on self-respect and assertiveness.
DBT is effective in the management of severe mental health disorders including
suicidality, self-harm, posttraumatic stress, BPD as well as depression among other disorders. To
illustrate this, studies have proved that DBT sessions provided for one year reduce chances of
self-harm among clients at a higher rate when compared to other modalities (Corey, Corey &
Corey, 2016). Furthermore, a study revealed that DBT decreases risks of committing suicide by
50% among clients, which is a higher rate when compared to other approaches. Another study
performed by a group of researchers aimed to determine the effectiveness of DBT in managing
PTSD (Steil et al., 2018). Twenty-one women who experienced PTSD after sexual harassment
participated in the study. The study revealed that the percentage of women presenting with self-
harming behavior reduced from 72% to 15.6% (Steil et al., 2018). The researchers concluded that
DBT is effective in decreasing symptoms that arise due to PTSD. Furthermore, therapy is used in
managing key problematic behaviors. Therapists use motivational improvement skills to
decrease problematic behaviors that may adversely influence the quality of life (Chen et al.,
2015). During the therapy sessions, counselors ask clients to have diary cards filed every week as
a way of encouraging self-monitoring preventing tendencies of self-destructive behaviors.

DIALECTICAL BEHAVIOR THERAPY 4
In addition, counselors who provide DBT receive support and motivation from their team
of therapists. This is achieved thoroughly weekly meetings during which the counselor’s
challenges are addressed to prevent burnout (Winter et al., 2017). In most cases, it is exhausting
to manage clients with BPD and other severe mental health problems hence creating the need for
the motivation of the counselor.
Limitations
Dialectical behavior therapy is useful in the management of severe mental health
disorders. However, the treatment approach has some limitations that affect the desired outcomes
(Coyle, Shaver & Linehan, 2018). For instance, DBT needs to be provided alongside
pharmacological treatment to improve the management of certain disorders such as anxiety and
depression as well as enhancing compliance.
Additionally, the efficacy of DBT may not last long. In some instances, the desired effects
get weaker six months after treatment (Linehan et al., 2015). The desired results fade over time,
which creates the need for clients to receive maintenance management to avoid relapse. Hence,
clients will be required to attend other sessions some months after the scheduled therapy.
Moreover, the provision of DBT is expensive because individuals are needed to go for
therapy sessions every week for several months. Also, the need to see a therapist every week
requires the clients to spend a lot of time. Besides, the therapy is very demanding as clients are
required to participate in two separate sessions, including group therapy for two hours and
individual therapy for one hour (DeCou, Comtois & Landes, 2019). In addition to that, the
therapist assigns homework to the clients every week for several months. The counselor is also
required to be available every day to provide emergency therapy.

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Another limitation is that only highly qualified therapists are required in providing
therapy to patients. The therapists are also required to attend meetings for consultation that last 2
hours each day for supervision and further learning. This results in problems with the utilization
of resources (Linehan et al., 2015). Also, multiple researchers have tested the effectiveness of
DBT during the first stage only, which is the most crucial. There is no sufficient evidence to
indicate the effectiveness of the other stages of DBT.
Racial, Cultural, Religious and Gender Sensitivity needed on the Part of the Therapist
Therapists offering DBT deal with clients from various backgrounds. The clients may
come from various backgrounds, including differences in races, culture, religion, and gender.
Hence, therapists need to be sensitive when providing therapy to clients (DeCou, Comtois &
Landes, 2019). The therapist needs to have cultural sensitivity when assisting clients. The
counselor can achieve this by understanding the patient’s belief system, ethnicity, and cultural
background. The counselor needs to assimilate cultural sensitivity in their practice to
accommodate clients from various cultures (Eisner et al., 2017).. Besides, the counselor offers
DBT needs to respect differences in attitudes, values, and opinions of various cultures. The
therapists also need to be culturally competent by having a proper understanding of their cultural
values and determine how they affect their interaction with patients (Linehan et al., 2015). For
instance, some cultures require the therapist to share some information about themselves for the
patients to be free and develop trust in the counselor. Hence, the client will be able to share his or
her emotions with the counselor to promote regulation and management.
In addition, therapists need to be culturally sensitive by appreciating the client’s values
and incorporate the use of appropriate communication skills during the individual and group
sessions that clients with BPD are required to attend (Eisner et al., 2017). Also, the therapists

DIALECTICAL BEHAVIOR THERAPY 6
need to vary the DBT approach depending on a person’s culture to achieve desired outcomes.
For instance, the weekly assignments and diaries, which are part of self-monitoring required
during DBT, can be varied depending on patients’ cultural backgrounds.
Racial sensitivity is also needed on the part of the therapist providing DBT.
Acknowledgment of differences in races and ethnicities enables counselors to deliver effective
care to their clients. Besides, racial sensitivity is of benefit to clients from racial minority groups.
Therapists are required to make adjustments to their work when providing care to clients,
including the ones from minority groups (Linehan et al., 2015). For instance, therapists are
required to adopt teaching skills that focus on respect for authorities and sustaining of harmony
in relationships when providing DBT to Asian clients. Additionally, the counselors are required
to modulate interpersonal effectiveness skills to promote tolerance of distress when providing
DBT to individuals from the Black race (Wilks et al., 2016). Furthermore, therapists may achieve
better health outcomes for their clients when they communicate to them using their primary
language, which varies according to race and culture (Goldstein et al., 2015). For instance, a
study revealed that Spanish clients presenting with mental disorders prefer to be assessed using
the Spanish language when receiving DBT from therapists.
Religious sensitivity is also essential and required on the part of therapists providing
DBT. The therapists can achieve this by making several adjustments to their work when handling
clients from various cultural backgrounds. For instance, therapists are required to make
adjustments to mindfulness focused interventions, which is one of the goals of providing DBT to
clients (McCredie, Quinn & Covington, 2017). Religious sensitivity enables counselors to
understand the purpose of religion in their lives. The therapists are required to assist the clients in
connecting with various aspects of their spirituality, which will assist in controlling negative

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emotions (Niedtfeld et al., 2017). For instance, therapists working with Muslim clients may
incorporate prayers and use of scriptures from the Quran to reinforce emotional control
(Niedtfeld et al., 2017). Besides, Christians clients may change and avoid self-destructive
behaviors when therapists base part of their sessions with clients on Biblical texts. This assists in
reducing the risk of self-harm and suicide.
Gender sensitivity is vital and a feature that therapists should possess when providing
DBT to clients. For instance, some clients presenting with BPD and other mental illnesses
requiring DBT may have a preference for specific gender identity (Wilks et al., 2016). Fulfilling
the request of the client to be attended by a therapist of a specific gender enables the client to feel
comfortable and relate well with him or her. Besides, during the sessions, the client may find it
easy to share their emotions with counselors of a specific gender (Perepletchikova et al., 2017).
Moreover, therapists need to address all clients equally without discrimination based on gender.
This includes forming group sessions that include clients from both genders. Additionally,
women may be exposed to oppression and violence, which leads to depression or self-harm
behaviors (Wilks et al., 2016). Therapists need to address the emotional needs of such women
who are the weaker gender in society. Moreover, the therapy needs to person-centered and
address the specific emotional needs of people.
Implications of Dialectical Behavior Therapy to Future Mental Health Practice
DBT has proved to be successful in the management of individuals with BPD.
Additionally, the therapy can be used in managing chronic relapsing mental disorders that are
difficult to manage using pharmacological treatment (Perepletchikova et al., 2017). For instance,
medication may assist in managing mood changes in suicidal patients; however, the symptoms
tend to reoccur. Hence, DBP can be relied upon in preventing relapse of symptoms in suicidal

DIALECTICAL BEHAVIOR THERAPY 8
clients. There is sufficient evidence indicating the effectiveness of DBP in treating BPD
(Uliaszek et al., 2016). BDP has increased healthcare expenditure on mental health because of
the higher rate of hospitalization. DBT assists in reducing healthcare expenditure since therapists
can assist patients in regulating their emotions, which results in a reduced rate of hospitalization.
Further research is required to improve the effectiveness of BPD and accompanying disorders
such as substance abuse and Axis 1 mental issues. Besides, DBT is more effective in eliminating
symptoms related to depression among elderly individuals. As a result, research is being carried
out to establish the effectiveness of DBT in managing individuals presenting with major
depression.
Furthermore, there are studies underway that are aimed to confirm the effectiveness of
DBT in the treatment of eating disorders (Wilks et al., 2016). Future studies should seek to
establish the efficacy of DBP in the management of eating disorders such as binge eating
disorders and bulimia nervosa (Valentine et al., 2015). At the moment, the therapy is effective in
treating anorexia nervosa among adolescents. A study was performed to compare the
effectiveness of DBT and CBT in the management of individuals with anorexia nervosa
(Navarro-Haro et al., 2018). Out of the 90 participants, 62 of them were them were able to avoid
dysfunctional eating habits after therapy (Navarro-Haro et al., 2018). Besides, the study revealed
that DBT was more effective than CBT in managing the eating disorder. Hence, further studies
will improve the management of such mental disorders.
There are also positive indications that DBT can be used in managing individuals with
personality disorders such as risk-averse and perfectionistic disorders. Furthermore, there is a
case which revealed that DBT was effective in eliminating symptoms associated with paranoid
personality and obsessive-compulsive personality disorders (Linehan et al., 2015). The outcomes

DIALECTICAL BEHAVIOR THERAPY 9
lasted for three years after the therapy was provided. Therefore, researchers should perform
further research to establish the efficacy of DBT in the management of other personality
disorders.
Conclusion
Dialectical behavior therapy was initially designed to manage BPD. Currently, the therapy
is effective in the management of other conditions, including self-harm behaviors, suicidal
thoughts as well as depression, among other disorders. There are several therapeutic strengths
and limitations related to DBP. The strengths of DBP include its effectiveness in managing BPD,
enabling clients to accept the current moment, tolerance of negative emotions, and management
of intense feelings. Moreover, DBP is effective in managing problematic behaviors and
counselors who provide DBT receive support and motivation from their team of therapists. The
limitations of the therapy include the need to combine the therapy with medical treatment in the
management of specific mental disorders, including anxiety and depression, to achieve desired
outcomes. In addition, the desired effects of the therapy may not last for long after termination of
DBT. Also, DBP is an expensive and time-consuming therapy. Therapists need to be racial,
cultural, religious, and gender sensitive when providing DBP. They need to understand and
appreciate the clients, cultural and religious values. Besides, therapists need to honor clients’
requirements, such as a preference for specific gender identity. There are several implications of
DBP to future mental health practice. To illustrate this, DBP can be used in managing chronic
relapsing disorders that cannot be managed using medical treatment. Further research is required
to establish the effectiveness of DBP in managing eating disorders, other personality disorders as
well as substance abuse.

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References
Carmel, A., Comtois, K. A., Harned, M. S., Holler, R., & McFarr, L. (2016). Contingencies
create capabilities: Adjunctive treatments in dialectical behavior therapy that reinforce
behavior change. Cognitive and Behavioral Practice, 23(1), 110-120.
Chen, E. Y., Segal, K., Weissman, J., Zeffiro, T. A., Gallop, R., Linehan, M. M., ... & Lynch, T.
R. (2015). Adapting dialectical behavior therapy for outpatient adult anorexia nervosa—
A pilot study. International Journal of Eating Disorders, 48(1), 123-132.
Coyle, T. N., Shaver, J. A., & Linehan, M. M. (2018). On the potential for iatrogenic effects of
psychiatric crisis services: the example of dialectical behavior therapy for adult women
with borderline personality disorder. Journal of consulting and clinical
psychology, 86(2), 116.
Corey, MS, Corey, G & Corey, C (2016), Groups: process and practice, 10th edn, Thomson
Brooks/Cole Publishing Company, California
DeCou, C. R., Comtois, K. A., & Landes, S. J. (2019). Dialectical behavior therapy is effective
for the treatment of suicidal behavior: A meta-analysis. Behavior therapy, 50(1), 60-72.
Eisner, L., Eddie, D., Harley, R., Jacobo, M., Nierenberg, A. A., & Deckersbach, T. (2017).
Dialectical behavior therapy group skills training for bipolar disorder. Behavior
therapy, 48(4), 557-566.
Goldstein, T. R., Fersch-Podrat, R. K., Rivera, M., Axelson, D. A., Merranko, J., Yu, H., ... &
Birmaher, B. (2015). Dialectical behavior therapy for adolescents with bipolar disorder:
results from a pilot randomized trial. Journal of child and adolescent
psychopharmacology, 25(2), 140-149.

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Ivey, AE, Ivey, MB & Zalaquett, CP (2016), Intentional interviewing and counseling: facilitating
client development in a multicultural society, 9th edn, Thomson Brooks/Cole Publishing
Company, California.
Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., ... &
Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high suicide risk in
individuals with borderline personality disorder: a randomized clinical trial and
component analysis. JAMA psychiatry, 72(5), 475-482.
McCredie, M. N., Quinn, C. A., & Covington, M. (2017). Dialectical behavior therapy in
adolescent residential treatment: Outcomes and effectiveness. Residential Treatment for
Children & Youth, 34(2), 84-106.
Navarro-Haro, M. V., Botella, C., Guillen, V., Moliner, R., Marco, H., Jorquera, M., ... &
Garcia-Palacios, A. (2018). Dialectical behavior therapy in the treatment of borderline
personality disorder and eating disorders comorbidity: A pilot study in a naturalistic
setting. Cognitive Therapy and Research, 42(5), 636-649.
Niedtfeld, I., Schmitt, R., Winter, D., Bohus, M., Schmahl, C., & Herpertz, S. C. (2017). Pain-
mediated affect regulation is reduced after dialectical behavior therapy in borderline
personality disorder: a longitudinal fMRI study. Social cognitive and affective
neuroscience, 12(5), 739-747.
Perepletchikova, F., Nathanson, D., Axelrod, S. R., Merrill, C., Walker, A., Grossman, M., ... &
Mauer, E. (2017). Randomized clinical trial of dialectical behavior therapy for
preadolescent children with disruptive mood dysregulation disorder: feasibility and
outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10),
832-840.

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Steil, R., Dittmann, C., Müller-Engelmann, M., Dyer, A., Maasch, A. M., & Priebe, K. (2018).
Dialectical behaviour therapy for posttraumatic stress disorder related to childhood sexual
abuse: a pilot study in an outpatient treatment setting. European journal of
psychotraumatology, 9(1), 1423832.
Uliaszek, A. A., Rashid, T., Williams, G. E., & Gulamani, T. (2016). Group therapy for
university students: A randomized control trial of dialectical behavior therapy and
positive psychotherapy. Behaviour Research and Therapy, 77, 78-85.
Valentine, S. E., Bankoff, S. M., Poulin, R. M., Reidler, E. B., & Pantalone, D. W. (2015). The
use of dialectical behavior therapy skills training as stand alone treatment: A systematic‐
review of the treatment outcome literature. Journal of clinical psychology, 71(1), 1-20.
Wetterborg, D., Dehlbom, P., Långström, N., Andersson, G., Fruzzetti, A. E., & Enebrink, P.
(2018). Dialectical Behavior Therapy for Men With Borderline Personality Disorder and
Antisocial Behavior: A Clinical Trial. Journal of Personality Disorders, 1-18.
Wilks, C. R., Korslund, K. E., Harned, M. S., & Linehan, M. M. (2016). Dialectical behavior
therapy and domains of functioning over two years. Behaviour research and therapy, 77,
162-169.
Winter, D., Niedtfeld, I., Schmitt, R., Bohus, M., Schmahl, C., & Herpertz, S. C. (2017). Neural
correlates of distraction in borderline personality disorder before and after dialectical
behavior therapy. European archives of psychiatry and clinical neuroscience, 267(1), 51-
62.