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  • Chad McCoy, M.A., LPC

What is DBT and how does it work?

Dialectical Behavior Therapy was first introduced as a therapy options for extreme behaviors such as suicide. The DBT Institute of OKC (http://www.dbtokc.com) explains that: "Dialectical Behavior Therapy combines the best of scientific psychology in the West with the beauty and wisdom of the East. DBT is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders."


Samantha Carlton is a licensed therapist in Central Oklahoma who is trained as a licensed marriage and family therapist who sought additional training in DBT. She was kind enough to sit down with me for a few minutes and explain, from her point of view, what DBT is and how it can help people.


C: Samantha, thanks for taking some time and speaking with me.


S: No problem! Thanks for the opportunity to speak about one of my favorite therapeutic models.


C: So tell us a little about yourself, your practice, and how you go about helping people that you see.


S: I'm a Licensed Marital and Family Therapist in private practice. I work with individuals, couples, and families of all ages and in all stages of life. My training was a hybrid of systemic family therapy and behaviorism. Systems theory views people as individual parts of a greater whole (think about a mobile hanging over an infant's crib: Each member of the family rests on an individual prong but when that individual piece moves, the whole family/mobile moves. That's systems theory!), while behaviorism considers the internal and external actions of individuals and their environment. I firmly believe the two dialectics can coexist and should be addressed together. This sparked a sort of professional identity crisis as a new clinician because I had not worked with providers who shared a similar outlook.


C: I’m sure that did cause a bit of a professional crisis. You know we learn a lot about therapy and what it could look like, the theories we can use to help people, and what those look like; but I don’t know we were ever prepared for that clinical crisis when we see that multiple approaches could help a client or a family. How’d you resolve that conflict for yourself so that you could help both individuals and the family?


S: Three words: Dialectical Behavioral Therapy. Dialectics was a word I had never used until I attended a basic training on Dialectical Behavior Therapy (DBT). The training was an absolute game changer for my practice and I have since dedicated a large portion of my career and resources to studying DBT. I discovered that DBT theory allowed me to combine systems and behaviorism the way I felt necessary. Dialectical Behavior Therapy is a life-changing, evidence-based therapeutic model for people with emotion dysregulation, depression, suicidal ideation and urges, self-harm, and more. The therapist helps the participant meet life-enhancing goals and reduce ineffective behaviors. DBT looks at two opposing forces, like acceptance and change, and attempts to find a synthesis between the two, which is basically the definition of “Dialectics”.


C: Marsha Linehan, in her original conception of DBT, had three components to the therapeutic approach: 1. Addressing risk taking behaviors and being mindful of their current emotional states; 2. Distress tolerance for the day to day negative emotions that they may experience, which is often tied to events; and finally 3. Strategies to cope and address intense emotions in their life. Now, if I'm not mistaken, there are four primary skills to DBT. is that right?


S: Comprehensive DBT is comprised of four parts: 1. Individual therapy where people meet weekly with their individual therapist; 2. Skills Training Class where participants meet in a group setting to learn DBT skills such as mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation; 3. Phone coaching that allows participants to contact their individual therapist outside of session for in-the-moment coaching; 4. Group consultation for the individual therapist.


The components you’re referring to are the four modules of DBT skills: 1. Core Mindfulness; 2. Interpersonal Effectiveness - skills designed to build/rebuild relationships and effectively get your needs met; 3. Emotion Regulation - skills to develop an acknowledgement of emotions, their purpose, and how to regulate them;, and 4. Distress Tolerance - learning skills to survive a difficult situation without making it worse.


C: It seems like those skills are necessary for anyone, but especially for those that are experiencing extreme distress in their lives. Thank you so much for taking a moment to speak with me and help me learn more about DBT. I feel like I know so much more now than before we spoke. Best wishes with all your professional endeavors.


S: Thanks, Chad. I'm glad I could share this and hopefully somebody can learn something from it.


If you'd like to talk to Samantha more about her practice or DBT, you can find her on Facebook at www.facebook.com/samanthacarltonLMFT.


If you or somebody you know are struggling in life and need help, you can contact me at 405-513-0282 or visit www.chadmccoy.com for more information.

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