What is Comprehensive Dialectic Behavior Therapy?

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Comprehensive Outpatient DBT is a distinct, evidenced-based treatment approach designed to treat complex and severe mental health disorders, and is particularly effective for those struggling with emotion dysregulation, suicidal behaviors, and non-suicidal self-injurious behaviors. 

Comprehensive Outpatient DBT is a distinct, evidenced-based treatment approach designed to treat complex and severe mental health disorders, and is particularly effective for those struggling with emotion dysregulation, suicidal behaviors, and non-suicidal self-injurious behaviors. 

There are four modes of standard outpatient DBT: Individual psychotherapy, DBT Skills training, in-the-moment phone coaching, and DBT Consultation Teams for therapists. This is different than many other psychotherapies that consist of just one mode or aspect of treatment, such as individual therapy.

Individual psychotherapy is a mode that serves two functions within DBT.

1. Enhance Motivation with Individual Therapy – DBT individual therapy is focused on enhancing client motivation and helping clients to apply the skills to specific challenges and events in their lives. In the standard DBT model, individual therapy takes place once a week for as long as the client is in therapy, and it runs concurrently with DBT skills training.
2. Structure the Environment with Case Management in Individual Therapy – Case management strategies help the client manage his or her own life, such as their physical and social environments. The therapist applies the same dialectical, validation, and problem-solving strategies in order to teach the client to be his or her own case manager. This lets the therapist consult to the patient about what to do, and the therapist will only intervene on the client’s behalf when absolutely necessary.

Problematic behaviors evolve as a way to cope with a situation or attempt to solve a problem. While these behaviors might provide temporary relief, they often are not effective in the long-term. DBT assumes that clients are doing the best they can, AND they need to learn new behaviors in all relevant contexts.

The function of DBT Skills is to help enhance a client’s capabilities. There are four skills taught in DBT:

• Mindfulness: the practice of being fully aware and present in this one moment
• Distress Tolerance: how to tolerate pain in difficult situations, not change it
• Interpersonal Effectiveness: how to ask for what you want and say “no” while maintaining self-respect and relationships with others
• Emotion Regulation: how to change emotions that you want to change

Skills training is frequently taught in groups during weekly sessions, and the full skills curriculum runs for 24 weeks. Group leaders assign homework to help clients practice the skills in their everyday lives. Briefer schedules that teach only a subset of the skills have also been developed for particular populations and settings.

DBT uses phone and other in-vivo coaching to provide in-the-moment support. The goal is to coach clients on how to use their DBT skills to effectively cope with difficult situations that arise in everyday life. Clients can call their individual therapist between sessions to receive coaching at the times when they need help the most.

A therapist’s work can be difficult for many reasons. The DBT consultation team is essential to help therapists monitor their fidelity to the treatment, develop and increase their skills, and sustain their motivation to work with high-risk, difficult-to-treat clients. Learn more about Consultation Teams here.