DBT Difference
An Evidence-Based Treatment

DBT is an acronym for Dialectical Behavior Therapy, a skills-building therapeutic approach developed by Marsha Linehan, PhD. and extensively supported by efficacy studies to be effective for treating a variety of disorders and problems. Clarify Counseling is a  Dialectical Behavior Therapy (DBT) practice for teens and adults based in Greenville, South Carolina.

DBT Critical Functions

Our DBT therapists focus  on problem-solving, skills acquisition, and acceptance and change-based strategies. The five critical functions of effective therapy are considered to be:

  1. Developing & maintaining clients’ motivation to change
  2. Enhancing clients’ capabilities
  3. Generalization of skills use in all relevant environments
  4. Structuring of the therapeutic environment & program to emphasize reinforcement of adaptive behaviors
  5. Maintaining the therapist’s motivation and capability to provide effective treatment

DBT therapy emphasizes balancing behavioral change, problem-solving, and emotional regulation with validation, mindfulness, and acceptance of the client.  Dialectical Behavior Therapists follow a detailed procedural manual.

DBT Components

Unlike traditional therapeutic approaches, standard or comprehensive DBT includes four researched and efficacy-proven components:

1.  Weekly individual therapy to address specific, customized goals for each client

2.  Weekly skills classes for learning effective coping strategies to replace ineffective behaviors such as:

  • Suicidal actions or thoughts
  • Non-Suicidal Self-Injury (NSSI) including cutting, burning, head-banging, punching things that result in self-harm, overtaking medications, etc.
  • Quality-of-Life-Interfering (QOL) Behaviors – The variety of QOL issues is extensive and customized based on each client’s goals. Some examples include problematic substance abuse, restricting food, binging or purging, losing temper and yelling or otherwise damaging important relationships, breaking things, shoplifting, sexual promiscuity that is problematic/dangerous, sleeping all day, isolating, etc.

3.  Coaching calls with a DBT Therapist as needed and initiated by the client to help use skills and not  use ineffective coping strategies such as those listed above.  Coaching is a part of the DBT program and there is no additional charge for these calls.  Calling helps clients achieve their goals faster by getting the skills out of the classroom and into clients’ lives.

4. Consultation Team – Marsha Linehan found that Dialectical Behavior therapists need support to do what is needed to help clients achieve change.  A consultation team is a required component of comprehensive DBT and is crucial to helping clients be successful in Dialectical Behavior Therapy. Clarify Counseling DBT participates in the Greenville DBT Collective, a community of Dialectical Behavior Therapists who meet weekly to consult and support each other.

DBT Participation

Participation in DBT is a bigger commitment than many traditional therapeutic approaches.  Though the setting feels familiar, the DBT approach can be somewhat surprising.

Program Participation

The decision to enter Dialectical Behavior Therapy is not just the client’s choice.  Prior to admittance into Clarify’s DBT program, two DBT therapists meet with the potential client (and caregivers of teens) to swap information.  Clients share their history and the therapists share information about the programs.  No decision is made at the the time of this first meeting.  Instead, the therapists bring the client’s information back to the weekly team meeting and the team determines whether they think DBT can be helpful for this client at this time.  Meanwhile, the client needs to decide whether they can commit to full participation in a DBT program at this time.

Attendance

Clients typically attend two sessions each week – one individual session addressing specific personal issues and one group session/class designed to teach and experience strategies for managing stress effectively. Unlike traditional process groups, which can be intense and personal, the skills classes focus on learning and intense personal discussions are discouraged to enhance the learning environment for all members.

Diary Cards

Clients fill out a daily “diary card” tracking emotions and behaviors.  The behaviors to be tracked are customized for each client according to their goals.

Session Agendas

In traditional therapy, clients usually decide what is to be discussed during the therapy session.  In Dialectical Behavior Therapy, the session agenda is driven by the client’s stated goals and what is reported on the diary card.  Successes and struggles during the past week are then addressed in order to focus on 1) how to decrease ineffective behaviors that interfere with progress toward goals; and 2) how to increase use of skills to do so.  This focusing of sessions can feel unusual or even uncomfortable to those who have attended therapy frequently in the past, but research has shown it to be effective.

Coaching Calls

Unlike traditional approaches, where a client has little contact with their therapist during the week unless there is an emergency, Dialectical Behavior Therapy clients are encouraged to call when they are struggling to use the skills they’ve been learning.  This access to the therapist speeds up the time needed to apply skills in daily life and achieve stated goals. Parents of teens are also encouraged to call for coaching to help them be more skillful in family transactions and support the teens' use of skillful behaviors. Clients can even call to resolve a problem with the therapist or to share good news! 

Radical Genuineness

Many traditional approaches discourage what is called self-dislosure, the therapist sharing their personal experiences.  DBT therapists practice what has been researched to be the highest level of validation, radical genuineness.  Instead of leaving clients guessing what the therapist may be thinking or experiencing, DBT therapists decide which experiences to share for the benefit of their clients.  Examples of struggles and skills use are common.

Direct Approach to Problems in the Therapy Process

Any behavior that interferes with the DBT therapist and client working together effectively is called a therapy-interfering behavior.  These behaviors can be things the client or therapist do that create tension in the relationship and get in the way of therapy progress.  In Dialectical Behavior Therapy, these behaviors are identified and time is spent resolving the problem together in a pragmatic, non-judgmental way. This process of problem-solving models how normal it is to experience hiccups in a relationship and builds the client’s confidence in their ability to experience interpersonal stress, approach someone to talk about difficulties, and be effective enough to feel good about the relationship again.