Balancing Opposites: An Introduction to Dialectical Behavior Therapy

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At first consideration, the concepts of “acceptance” and “change” seem diametrically opposed. Acceptance implies that something is suitable or satisfactory, whereas the need for change indicates that something is inadequate or lacking in some way. Yet these two opposite components form the core of dialectical behavior therapy.

What is Dialectical Behavior Therapy?

Dialectical behavior therapy (DBT) is a type of modified cognitive behavior therapy (CBT) that was originally developed by psychologist Marsha Linehan to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). Research has shown that it is also effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder and eating disorders.

The term “dialectical” is commonly used in philosophy to indicate a type of logical argumentation or discourse between two opposing points of view. As it relates to DBT, it indicates a synthesis or integration of two opposites: acceptance and change.

DBT’s Balancing of Opposites

Carefully balancing the opposites of acceptance and change within a therapeutic context requires what could be called a skillful dance between these components. For example, therapists must accept clients as they are while also acknowledging the clients’ need to change in order to reach their goals.

All of the skills and strategies taught in DBT are also balanced in terms of acceptance and change. For example, DBT utilizes four skill modules, which include two sets of acceptance-oriented skills (mindfulness and distress tolerance) and two sets of change-oriented skills (emotion regulation and interpersonal effectiveness).

The methodology of DBT assumes that people are doing the best they can (acceptance), but they are either lacking the skills needed or are influenced by positive or negative reinforcement that interferes with their ability to function appropriately (change).

The Power of Acceptance in DBT

The primary difference between DBT and traditional CBT lies in DBT’s emphasis on validation. Under the guidance of a trained therapist, this is a powerful tool enabling the client to accept uncomfortable thoughts, feelings and behaviors instead of struggling with them.

Once an identified thought, emotion or behavior has been acknowledged and accepted, the process of change no longer appears impossible, and the goals of gradual transformation become reality.

The Four Skills Training Modules of DBT

While carefully maintaining the balance between acceptance and change, dialectical behavior therapy employs four primary skillsets, which are taught to the client:

  • Mindfulness (focusing skills): The practice of being fully aware and present in the moment—not a matter of explaining or solving but of experiencing and describing.
  • Distress Tolerance (crisis survival skills): Guidance on how to tolerate pain in difficult situations, not to change it.
  • Emotion Regulation (de-escalation skills): Training on how to change emotions that the client wants to change.
  • Interpersonal Effectiveness (people skills): Helping clients build skills to ask for what they want and to say no, while maintaining self-respect and relationships with others.

As a result of numerous studies, (3) there is increasing evidence that DBT skills training is a promising intervention for a wide variety of both clinical and nonclinical populations.

Dialectical behavior therapy is effective at producing significant and long-lasting improvement for people experiencing a mental illness. It helps decrease the frequency and severity of dangerous behaviors, uses positive reinforcement to motivate change, emphasizes the individual’s strengths and helps translate the things learned in therapy to the person’s everyday life.

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