Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is organized around four skill modules, each addressing a different dimension of the emotional and relational challenges that drive DBT-indicated presentations. Mindfulness is the foundational module — teaching the ability to observe and describe one's experience with awareness and without automatic judgment, and to participate fully in life without being hijacked by automatic reactions. Mindfulness is the foundation on which all other DBT skills rest, because the ability to observe one's own mind in real time is prerequisite to making different choices in charged moments.

Distress Tolerance skills provide tools for surviving emotional crises without making them worse — the skills needed for the moments when emotion is so intense that problem-solving is not yet possible. Emotion Regulation skills go deeper, teaching clients to understand their own emotional system — identifying emotions, understanding their function, reducing emotional vulnerability, and changing unwanted emotional states. Interpersonal Effectiveness skills address the relational dimension — how to ask for what one needs, how to set limits and maintain self-respect, and how to preserve important relationships while also honoring one's own values and needs. Together, these four modules provide a comprehensive skills curriculum for emotional and relational wellbeing.

Comprehensive DBT is a structured treatment program that typically includes individual therapy, group skills training, phone coaching between sessions, and a therapist consultation team. In standard comprehensive DBT, the individual therapy and group skills training work in parallel — the group provides the skills curriculum and the individual therapy addresses how to apply skills to the client's specific life challenges. Phone coaching provides real-time support during crises between sessions, helping clients apply skills in the moment when they are most needed. The consultation team supports therapist competence and adherence to the model.

LC Psych offers DBT-informed individual therapy — drawing extensively from the DBT skills curriculum and the core therapeutic principles of the approach — as a powerful and clinically effective format for clients who need DBT's framework but for whom the full comprehensive DBT program structure is not accessible or appropriate. Your clinician will be clear about what format of DBT-informed care is being provided and what it includes, and will work with you to determine whether referral to a full comprehensive DBT program is indicated for your specific needs.

DBT was originally developed by Dr. Marsha Linehan specifically for Borderline Personality Disorder, and it remains the most evidence-based treatment for that condition. However, subsequent research has validated DBT for a considerably broader range of presentations. DBT is highly effective for individuals who struggle with intense, rapidly shifting emotions that feel overwhelming and uncontrollable, self-destructive or self-harming behavior that functions as an emotion regulation strategy, eating disorders (particularly bulimia nervosa and binge eating disorder), substance use driven by emotional triggers, treatment-resistant depression, and chronic interpersonal conflict driven by poor emotion regulation and interpersonal skill deficits.

The common thread across these presentations is emotional intensity and dysregulation — the experience of having emotions that are more intense, more rapidly activated, and more difficult to modulate than those of most peers. If this description resonates with your experience — if you often feel like you are feeling things more intensely than everyone around you, and that your emotional responses drive behavior you later regret — DBT may be the approach best matched to your needs.

DBT treatment is organized in stages that address the most urgent and life-threatening concerns before moving to less immediately pressing ones. Stage 1 focuses on achieving behavioral control — specifically addressing life-threatening behaviors (suicidal and self-harming behavior), therapy-interfering behaviors, and quality-of-life-interfering behaviors, in that order of priority. Stage 2 addresses the residual emotional suffering that remains once behavioral stability has been achieved — processing trauma and building a full emotional life. Stage 3 focuses on self-respect, connection, and the pursuit of a life worth living. This staged approach ensures that treatment always addresses what matters most, in the right order.

DBT requires genuine active engagement: clients are asked to complete diary cards tracking emotions and skill use between sessions, to practice skills consistently in everyday life, and to bring real, recent situations to sessions for collaborative skills application. This is demanding — but the outcomes it produces for clients who fully engage are among the most transformative in all of psychotherapy. The combination of validation and change that is DBT's defining dialectic creates the conditions for genuine growth that feels both deeply accepted and genuinely empowered.

DBT-informed therapy sessions at LC Psych begin with a brief diary card review — checking in on skill use, emotions, and significant events since the last session — and identifying the agenda for the session based on what has come up and what is most important to address. Sessions balance validation (being genuinely heard, understood, and accepted as one is) with change strategies (skills teaching, behavioral analysis, and problem-solving). Your therapist will be warm, direct, and actively engaged — DBT therapists are not passive or neutral; they bring genuine care and clinical authority to the work.

The experience of DBT-informed therapy is often described by clients as the most challenging and the most transformative therapy they have engaged in. The skills are genuinely powerful, the approach is compassionate and validating, and the changes it produces — in emotional experience, in relationships, in self-destructive patterns — are real and lasting for those who commit to the process with full engagement.