Psychologist Marsha M. Linehan founded dialectical behavior therapy (DBT) in the late 1980s. DBT was originally developed to treat severe cases of suicidal behavior, usually in individuals with borderline personality disorder (BPD). Having a basic understanding of BPD helps to put DBT into context. The theory underlying DBT reflects the features of BPD. A starting point of DBT is that some individuals are disposed to react in a far more extreme or intense manner to emotional situations and relationships compared to other people. The main characteristics of BPD include emotional swings and volatile personal relationships.
How DBT Developed
Today, Linehan calls the process she spontaneously underwent years ago as “radical acceptance,” and it’s part of the bedrock of DBT. Linehan believes that her personal healing, through radical acceptance, began when she stopped being angry at herself for feeling that she did not measure up to her parents’ expectations. Linehan, the psychologist, then translated this observation into a psychological theory that people can heal if they accept life as it is – not how they think it is supposed to be – and are willing to make personal changes in the face of that reality. The theory blended well with behaviorism, which was then emerging as a psychological theory that if people learned new healthier behaviors, over time, they could improve their emotions. To put her theory to the test, Linehan began to treat individuals with severe cases of suicidal behavior. Many of these individuals had a BPD diagnosis. In practice with these patients, Linehan helped to guide them to accept the symptoms, such as rage and acute loneliness, they experienced. Next, Linehan would guide these patients to accept that their reactions, such as self-cutting and suicide attempts, made sense in view of their feelings. Finally, Linehan would elicit a commitment to change from these patients. As the method continued to evolve, Linehan added teaching patients day-to-day emotional management skills. Today, all of these therapy components are collected under the theory of DBT.
DBT in Practice
- Any current self-injury or suicide behaviors
- Ways to decrease stress
- Behaviors that may disrupt therapy
- Addressing any post-traumatic stress
- Quality of life/lifestyle concerns
- Ways to improve self-image and self-respect
- Ways to improve day-to-day living
The National Alliance on Mental Illness states that the majority of DBT clients will experience significant long-term periods of symptom remission.
Self-Compassion in DBT
“A moment of self-compassion can change your entire day. A string of such moments can change the course of your life. – Christopher K. Germer, author of The Mindful Path to Self-Compassion.
Source: Christopher K. Germer
Self-kindness is a necessary balm to soothe a painful experience. A crisis or other difficult situation is a time for a person to step up and care for herself. However, the opposite reaction often happens. In difficult times, many people turn against themselves and are self-critical, judgmental, and even hateful. As self-compassion develops and expands, people who have a pattern of being harsh on themselves can recognize that personal imperfections, unmet expectations, and life difficulties are just part of the human experience.
The practice of self-compassion is cultivated in DBT, but it is always advisable for one to work on oneself outside of structured therapy. To that end, World of Psychology provides guidance on how to incorporate self-compassion into daily living. Simple strategies including treating oneself as well as others, noticing one’s language to ensure it’s not judgmental, comforting oneself with a physical gesture such as holding a hand over the heart to calm down, repeating some compassionate phrases (self-help expert Louise Hay provides numerous affirmations), and practicing self-compassion meditation. All of these approaches will complement DBT therapy.
DBT in Substance Abuse Treatment
 “What is DBT?” (n.d.). The Linehan Institute. Accessed June 23, 2015.  “BPD Overview.” National Education Alliance Borderline Personality Disorder. Accessed June 23, 2015.  Carey, B. (June 23, 2011). “Expert on Mental Illness Reveals Her Own Fight.” New York Times. Accessed June 23, 2015.  Ibid.  Ibid.  “An Overview of Dialectical Behavior Therapy.” (Jan. 30, 2015). PscyhCentral. Accessed June 23, 2015.  Ibid.  Ibid.  Ibid.  Ibid.  Baime, M. (n.d.). “Practicing Mindfulness.” PBS: This Emotional Life. Accessed June 23, 2015.  “Self-Compassion.” (n.d.). Self-Compassion. Accessed June 23, 2015.  Ibid.  Ibid.  Ibid.  Tartakovsky, M. (June 27, 2012). “5 Strategies for Self-Compassion.” World of Psychology. Accessed June 23, 2015.  Dimeff, L. & Linehan, M. (June 2008). “Dialectical Behavior Therapy for Substance Abusers.” Addiction Science Clinical Practice. Accessed June 23, 2015.  Ibid.  Ibid.