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Dialectical Behavior Therapy in the Private Practice Setting

Dialectical behavior therapy (DBT) has become a popular treatment for various client populations. Initially developed to treat individuals diagnosed with Borderline personality disorder, DBT has become helpful for treating individuals managing a spectrum of challenges and symptoms that result in personal suffering. Through the program, clients benefit from development and implementation of specific life skills organized into four modules—mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness—to address deficits in identification and management of painful emotions, and change the maladaptive behaviors employed to address them.

In its traditional design, DBT consists of group skills training, 1:1 psychotherapy, coaching calls between client and therapist, and therapeutic consultations among the DBT team members. Individuals and their therapists identify target behaviors, such as cutting, binge eating, substance use, etc., and use assessment tools to track a reduction to these behaviors through application of learned skills. DBT programs leaders typically require their participants to commit six to 12 months to treatment, which allows time for each of the four modules to be introduced and practiced two times.

For individuals who seek to participate in DBT treatment, it can sometimes be challenging to access available programs. Although it has become a popular therapy, locating a program that meets a client’s logistical needs is often difficult. And because skills groups is a non-rolling, closed style, a candidate may be required to wait weeks or months before being admitted. Lastly, and perhaps most simply, the time commitment to the program, both in its length and the frequency of required sessions, may be a detractor for some individuals.

However, the value of DBT and its core principles transcends its traditional treatment paradigm and therapists can utilize elements of the therapy in their practices with a piecemeal method. In keeping with the spirit of DBT, in which clients are encouraged to make positive changes while simultaneously accepting and acknowledging their pain—this is a dialectic—therapists should introduce skills in session that may be helpful to address identified challenges. The clinician supports the client in learning how to conceptualize and, eventually, practice these skills in real life situations.

As with the traditional program design, when using DBT in a private practice setting, the therapist may ask the client to keep a record, called a diary card, to track how target behaviors are affected by use of learned skills. This tool is an important part of the therapy, as it allows both the clinician and the client to observe changes—or lack thereof—across a treatment continuum. Live record-keeping also helps reduce reliance on memory to communicate client experiences, questions, or problems to the therapist.

It is important to note that target behaviors need not be parasuicidal in nature—for example, a therapist and client may identify avoidance as a target behavior because the consequences are undesired and destructive. Further, one need not be struggling with life-threatening symptoms in order to benefit from DBT. If deeply ingrained, maladaptive behavioral patterns have made it difficult for a client to experience meaningful change, the structure of DBT—even informed in nature—and its various skills may be successful in treating intractable symptoms that have been previously resistant to modification when addressed through other therapeutic methods.

DBT or DBT-informed treatment may be right for you if:

1. Your painful emotions are managed through negative or harmful coping mechanisms

2. Boundaries are difficult for you to implement and observe

3. Your relationships are consistently stormy or unfulfilling

4. You desire a better life—a life worth living


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