By Nicole Roder, LCSW-C, DBT-LBC

When people experience intense, overwhelming emotions and suicidal behaviors, they might find it difficult to make progress in traditional psychotherapy. This is often the point when they begin to ask “How do I find DBT therapy near me?” or look for a DBT therapist

 

DBT Basics: What Is Dialectical Behavior Therapy (DBT)?

Dialectical Behavior Therapy (DBT) is a comprehensive behavioral therapy used to treat people with out-of-control emotions and behaviors. It is based on decades of research that shows it to be an effective treatment for borderline personality disorder (BPD), suicidal and self-harming behaviors, post-traumatic stress disorder (PTSD), substance use disorder, depression, anxiety, and other mental health conditions that involve intense emotional dysregulation.

Dr. Marsha Linehan, the founder of DBT therapy, often says that there are an enormous number of psychological treatments that don’t have any evidence to back them up, and there are an enormous number of mental health conditions that don’t have any evidence-based treatments. As a behaviorist, she believes that it is vitally important that if we are going to provide a treatment, we must have evidence that it actually works. 

That is why she spent so many years conducting clinical trials using DBT therapy–to make sure it worked. Since that time, other researchers have picked up the baton to continue Marsha’s research and learn how to effectively deliver DBT to many diverse populations. You can find links to a large body of evidence here.

This therapy can be life-changing for clients and therapists alike. “DBT has helped me improve my relationships with my three daughters,” says Danely Johnson, LCSW-C, one of Gladstone’s talented DBT Therapists in our Frederick, Maryland office. “Interpersonal effectiveness skills and distress tolerance skills remind me that my short term goal (getting them to accomplish a task “now”) is not as important as my long term goal (maintaining or improving our relationships). DBT skills guide me on how to ask, when to ask, and to negotiate if needed. It’s a balance!”

 

What Does “Dialectical” Mean?

Marsha wrote in her memoir that when the seeds of DBT were first planted in her mind, she had never even heard the word “dialectical.” So what does this mysterious word mean? 

Dialectics is the art of logical discussion. In DBT, it involves identifying the contradictions in a person’s position and working to find the synthesis between them. In other words, we are asking the question, “what is being left out?” We are also acknowledging that there are many opposites that can be true at the same time. 

The most fundamental dialectic in DBT is acceptance vs. change. We must accept people as they are, including all of the problems they are experiencing. People must accept that their problems are what they are. In addition to that, clients want to change their problems and we want to help them do that. 

 

How Does DBT Therapy Work?

In DBT therapy, there are four modes of treatment:

  • Individual sessions with a primary DBT therapist, usually once a week.
  • A DBT skills group that meets for two hours, once a week.
  • Telephone coaching with the primary therapist, available 24 hours a day, for crisis situations and guided skills practice.
  • A DBT consultation team that acts as “therapy for the therapist,” to ensure that providers always deliver the highest quality of care. Clients do not attend consultation team meetings.

 

 

 

DBT is divided into stages.

Pretreatment

We call the first four sessions of dialectical behavioral therapy “pretreatment.” During this stage, the DBT therapist assesses the new client to determine if they are likely to benefit from DBT. We also orient the individual to how the treatment works and ask them to commit to the full program (1 year for adults, 6 months for adolescents). People do not “officially” join the DBT program until they have signed their commitment.

 

Stage 1

In stage 1 of DBT, the therapist helps the client to get their behaviors under control. We prioritize life threatening behaviors first, like suicidal ideation and self-harm. We also work on any behaviors that interfere with therapy, like not showing up for sessions, and behaviors that interfere with the client’s quality of life, like using drugs or fighting with loved ones. 

Stage 1 is also when the individual joins their skills group. This is where they learn the skills they need to avoid those destructive behaviors. The skills are taught in 4 modules:

  • Core mindfulness
  • Distress tolerance
  • Emotion regulation
  • Interpersonal effectiveness

DBT groups are an effective, evidence-based way for people to learn these necessary skills without taking attention away from their individual work on specific problems they face in their lives.

 

Stage 2

Once the individual has gained some behavioral control, they are ready to move onto stage 2. During this stage of treatment, people work on experiencing their emotions in a healthier way, without avoiding them. This is also when people can work on trauma therapy if they have PTSD. The goal is to reduce suffering and restructure those thoughts and beliefs that are causing painful emotions.

 

Stage 3

In stage 3 DBT, people work on “ordinary” happiness and unhappiness, and set out to accomplish life goals. This is also a time for increasing self respect and maintaining the progress of the previous two stages.

 

Stage 4

Stage 4 DBT is something that just about anyone could strive to achieve. In this stage, people have resolved most of their larger problems and are now working towards spiritual fulfillment and expanded awareness.

 

DBT vs. CBT: What’s the Difference?

One of the most common questions we receive from new clients is about the difference between DBT and CBT therapy. They sound so similar. Are they?

CBT stands for cognitive behavior therapy. It is based on the idea that our thoughts, emotions, and behaviors are all connected. Therefore, if you change the way you think, you can also change how you feel and behave. 

The focus of CBT is mainly on challenging irrational thoughts and beliefs. For example, people with social anxiety might walk into their doctor’s waiting room and automatically think that everyone else is looking at them and judging them. A CBT therapist would challenge those thoughts and help the individual to understand that, most likely, the other people in the room aren’t thinking about them at all.

In DBT, there is some focus on challenging thoughts. However, DBT techniques put a lot more emphasis on helping people to regulate emotions, change behaviors, and learn new skills. It is especially important for DBT clients to learn mindfulness and acceptance. 

In addition, CBT is usually conducted with individual therapy only. This is in contrast to DBT’s four modes of comprehensive treatment.

Who Benefits from DBT Therapy?

Like we mentioned above, dialectical behavioral therapy has been proven effective in treating a number of mental health conditions. If you often find emotions overwhelming and intense, struggle to maintain relationships, and wish you could stop engaging in destructive behaviors, DBT can help. 

Some of the issues DBT treats include:

  • Suicidal thoughts and attempts
  • Self-harm
  • Frequent psychiatric hospitalizations
  • Intense emotional expression
  • Rapid mood swings
  • Low tolerance for distress
  • Addiction
  • Emotional dysregulation
  • Intense anger
  • Binge eating
  • Overspending
  • Avoiding responsibilities, people, or events
  • Numbing or “shutting down” in response to fear, anger and pain
  • Trauma and PTSD

Working with a DBT therapist can help you to integrate the skills into every area of your life and empower you to build a life worth living. 

 

How Do I Find DBT Therapy Near Me?

If you are looking for DBT therapy in Maryland and you have CareFirst Blue Cross/Blue Shield insurance, check out Gladstone Psychiatry and Wellness. 

“We are passionate about providing high quality DBT at Gladstone”  says Rebecca Blake, LCSW-C, DBT-LBC, Co-Director of Gladstone’s DBT Program.  “Our mission is to be a pioneer in making high quality, full-fidelity DBT accessible to those with commercial insurance. Our DBT Program is in network with CareFirst.” 

Rebecca also points out that Gladstone is one of only two DBT programs in the state of Maryland to be certified by the Linehan Board of Certification. “This means that our program has been independently evaluated by the Board and found to have a high level of fidelity to the DBT model as prescribed by the creator, Marsha Linehan,” says Rebecca. “We also have three clinicians who are DBT-LBC certified. And all of our clinicians have been trained in DBT-Prolonged Exposure for the treatment of trauma.”

  • Our comprehensive program is a DBT-Linehan Board of Certification, Certified Program™.
  • Three of our DBT Therapists are DBT-Linehan Board of Certification, Certified Clinicians™, including both program Co-Directors.
  • We have offices in Hunt Valley, Columbia, Bethesda, and Frederick. 
  • Our DBT clinicians see adolescents age 11 and up as well as adults. 
  • Telehealth and in-person sessions are available.
  • For adolescents and their families, we have in-person and virtual multi-family skills groups available.
  • Adult skills groups are telehealth only. 
  • We are in-network with CareFirst Blue Cross/Blue Shield.
  • We offer DBT-Prolonged Exposure for the treatment of trauma and PTSD.

Contact us at dbt@gladstonepsych.com or 443-689-7740 to ask about our program. You can also fill out an application, which is available on our website.