TLC Newsletter 03.2025
So what is the D in DBT?
By: Lori Steffen PLMHP, PLCSW
If you have heard of DBT, or Dialectical Behavioral Therapy, you are probably most familiar with the skills that are taught. These include Mindfulness, Distress Tolerance (taking a break when trying to do anything could make things worse), Emotional Regulation (improving how emotions are handled), and Interpersonal Effectiveness (getting along with others). As you can probably guess by the name, dialectics are a key part of DBT. If you are thinking about joining a DBT focused group, or working with a DBT focused therapist, or referring someone for DBT focused treatment, it will be helpful for you to understand this concept. In DBT, “dialectical” refers to balancing apparently opposing concepts. The key dialectic is acceptance and change. For example, I am okay as I am, AND I need to improve.
As some of you know, DBT was developed by Marsha Linehan, Ph.D. She recognized that telling someone to think differently in order to feel differently does not always work. When a person who struggles with intense emotions is told to think differently, it can feel like nobody understands, like nobody CAN understand! Validating someone’s emotional experiences while still holding people accountable for their choices is a way of helping people survive so that they can have that chance to thrive.
Wise Mind Diagram
As I have worked to become more trauma informed in my work, I have seen where the dialectics of DBT can impact the effects of trauma. One of these is with the relationship between the Window of Tolerance and the pursuit of Wise Mind. Many of us have fairly wide windows of tolerance, which means most of the stressors that hit us day to day do not cause us to get overly emotional or to shut down–unless we have not gotten enough sleep, have not eaten, or have caught a cold, for example. Trauma, coming from neglect as well as violence, can narrow that window of tolerance long term. Developing a Wise Mind, the balance of emotion and reason which is the key goal of DBT, can help a person widen that window of tolerance. This helps us to reduce the frequency of overreacting, or shutting down, or both.
I have come to understand that DBT is largely about balancing client’s dialectical dilemmas while also maintaining dialectical balances of my own as a therapist. In Dialectical Behavior Therapy (Moonshine and Schaefer), they list some of the dialectical dilemmas that people can face, including:
“Don’t want to be in pain and don’t want to change.”
“Believe reality is out of their control, while continuing to engage in controlling behavior.”
“Want life to be easy and spend a lot of energy making it harder than it needs to be.”
“Want help and reject support.”
It is important to understand that people can be, and often are, doing these things at the same time. Therapy then involves balancing these opposing and often complex issues with that balance being continually monitored and adjusted as needed. For example, attending group meetings may be extremely difficult for someone, and yet helping someone to eventually attend group meetings may be key to addressing social anxiety.
As a DBT focused therapist, I need to intentionally balance additional dialectics. As discussed in Doing Dialectical Behavior Therapy: A Practical Guide, these include:
Consistently showing clients positive regard while not interfering with natural and logical consequences.
Encouraging self-efficacy and reminding clients that it is still okay to ask for help.
Developing problem solving skills and helping clients learn to accept some “problems” as part of life.
Many of us are dealing with the effects of culture and society, as well as the actions of people in our neighborhoods, communities, and families. Feeling heard, understood, and connected can help us make positive changes within ourselves and begin to address problems that may not have been caused by us, but are our responsibility to solve. Validation and acceptance are key in helping us create change.
References
Koerner, Kelly. Doing Dialectical Behavior Therapy: A Practical Guide. Guilford Publications, 2012.
Linehan, Marsha M. DBT Skills Training Manual. The Guilford Press, 2014.
Moonshine, Cathy, and Stephanie Schaefer. Dialectical Behavior Therapy, Vol 1, 2nd Edition: The Clinician's Guidebook for Acquiring Competency in Dbt. PESI Publishing & Media, 2019.