Dialectical Behavior Therapy:
An Introduction to the
Philosophy and Skills
Jancey Wickstrom, AM, LCSW
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Overview
• Philosophy based treatment
• Overall goal: creating a meaningful
life
• Skills are easily adaptable to variety
of situations, abilities, and interests
• Helps a wide range of behaviors
intended to regulate emotion
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Dialectics
• Middle ground
• From either/or to both/and
• Black or White thinking to Black AND
White thinking
• Emerged from repeated ineffective
interventions
• Counteracts rigidity
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Dialectic of DBT
• Acceptance
• Mindfulness
• Distress tolerance
• Change
• Emotion regulation
• Interpersonal effectiveness
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DBT Framework
• Four components:
– Skills training
– Individual therapy
– Telephone consultation
– Consultation group
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Consultation Agreements
•
•
•
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•
Dialectical Agreement
Consultation to the Client Agreement
Consistency Agreement
Observing Limits Agreement
Phenomenological Empathy Agreement
Fallibility Agreement
Assumptions in DBT
• Clients are doing the best they can
• Clients want to improve
• Clients must do better, try harder and
be more motivated to change
• Clients may not have caused their
own problems but must solve them
anyway
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Assumptions in DBT (cont.)
• Clients’ lives are unbearable as they
currently live
• Clients must learn new behaviors in
all relevant contexts
• Clients cannot fail in therapy
• Therapists need support
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DBT Principles
• People with problems regulating
emotion have:
– High sensitivity
– High reactivity
– Slow return to baseline
• Generally raised in invalidating
environments.
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DBT Principles (cont.)
• “Problematic” behaviors served a
purpose at one point, but are now
ineffective.
• Clients reward us for reinforcing old
ways of living and punish us for doing
DBT effectively.
• Only way to realize meaningful life is
through practice and more practice.
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Acceptance: Mindfulness
• Becoming aware of and present with
our thoughts and emotions
• Differentiating ourselves from our
thoughts and emotions- getting
“unfused”
• Practicing controlling our attention
• NEVER about controlling our thoughts -underlies every single aspect of DBT
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MINDFULNESS
Learning how to control your
mind/attention so it does not
control you.
Acceptance: Distress Tolerance
• Skills to help get through a crisis
situation without making matters worse
• Not intended to help clients feel better
• Anything can help tolerate the moment
• Willingness vs. Willfulness
• Mindfulness: practice going back and
back and back to skill being used
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DISTRESS
TOLERANCE
Getting through the moment
without making matters worse.
Change: Emotion Regulation
• Change our reaction to our emotions
• NOT changing/controlling emotions
• Learn to identify and use emotions as
allies not enemies
• Mindfulness: Very skilled at distancing
from emotions, must slow down and
practice this skill
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EMOTION
REGULATION
Not about changing or controlling our
emotions- instead is about changing
our reactions to emotions
Change: Interpersonal
Effectiveness
• How to get along with others more
effectively
• Helping clients get their needs met
(make requests and say no) in a way
respectful to both self and others
• “Manipulation”
• Mindfulness: being aware of reactions
to others as well as what goals are
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INTERPERSONAL
EFFECTIVENESS
Getting our needs met while
respecting both ourselves and
others.
Questions
Other Useful Resources
• Mindfulness resources: Jon Kabat-Zinn;
Sharon Salzberg; Pema Chodron; Tich
Nhat Hahn
• Dialectical Behavior Therapy Skills
Workbook: Practical DBT Exercises for
Learning Mindfulness, Interpersonal
Effectiveness, Emotion Regulation, &
Distress Tolerance (New Harbinger).
McKay, Wood, Brantley (also available in
teen version)
References
• Linehan, M. M. (1993). Cognitivebehavioral
treatment
of
borderline
personality disorder. New York, NY:
Guilford Press.
• Linehan, M. M. (1993). Skills training
manual for treating borderline personality
disorder. New York, NY: Guilford Press.
• Holmes, Paul. Contextual behavioral
approaches, personal communication.
Emotion Management Program, Orland
Park, IL.
Other Useful Resources
• Learning to Breathe: A Mindfulness
Curriculum for Adolescents to Cultivate
Emotion Regulation, Attention, and
Performance. Patricia Broderick
• Don't Let Your Emotions Run Your Life:
How Dialectical Behavior Therapy Can
Put You in Control (New Harbinger).
Spradlin (also available in teen version)
Thank you!
Jancey Wickstrom, AM, LCSW
Jancey.wickstrom@gmail.com
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