BLOG: Dialectical Behavior Therapy Skills
Author: Fiona Smith, Taproot Therapy Clinical Trainee
Dialectical Behavior Therapy (DBT) is a skills based therapy founded by Dr. Marsha Linehan that is oriented around the idea of dialectics: the existence of opposites. We can accept where we are, while also acknowledging that we need to change certain things. The dialectical aspect of DBT addresses the integration or synthesis of two opposing points.
One core component of DBT is its effort to educate the participant. DBT believes that participants show greater levels of improvement when they comprehend the mechanisms behind their actions, thoughts, and feelings. The education aspect of DBT puts the power in the participants’ hands and provides a reason for why we are focusing on certain skills. DBT investigates the underlying reality of a situation through a compassionate lens and an understanding that life is complex and ever evolving. It helps us to recognize negative patterns of thinking and unproductive behaviors.
DBT is effective in treating a wide range of life’s stressors. The skills taught within a DBT group or DBT-informed therapy can be applied to various circumstances and help us to deal with overwhelming emotions, unexpected life events, difficult relationships, anxiety, depression, and rocky transitions, and more. Though there is no “one size fits all” method of therapy that works in every scenario, DBT skills are useful to have in our back pockets as we navigate life.
Pulling from ancient spiritual traditions, these techniques help to focus us in the present moment and ground through the body. These skills encourage us to slow down and use our “wise mind.”
These set of skills teach productive and healthy coping mechanisms and self soothing techniques for when we are feeling upset or any intensity of emotion. Crisis survival skills are a key element in this module, as are reality acceptance skills.
This module offers ideas for reducing the intensity of strong emotions and learning to ride the wave instead of reacting or acting out. It helps us to better understand and navigate our feelings.
These skills address relationships and effective ways of ensuring our needs are met. Key elements in this module include self respect and respect of others, effective listening and communication techniques, learning how to deal with challenging individuals, knowing when to say no, and repairing relationships.
Author: Luke Fox, Taproot Therapy Clinical Trainee
The pressures of being a parent are numerous. It seems that the tasks are endless, sleep can be unpredictable, and efforts often go unappreciated. And these things don’t exist in a vacuum, they are mixed in with various other daily stressors. In times of exhaustion or heightened stress, parents might find they are reacting to their children in a way that is not as attuned, understanding, and supportive as they’d like. This awareness can be followed by feelings of guilt and shame about not being the perfect parent. This is where the concept of rupture and repair can be helpful. Ruptures in relationships are inevitable and there is no such thing as a perfect parent.
In a study with infants and their parents, Tronick and Gianino found that the pairs were in sync about one third of the time.1 This results in mismatches that can be stressful for the child and parent. Both child and parent attempt to correct this mismatch and repair the communication. This attuned effort toward repair helps the child develop self-regulation and resilience. It can be helpful to remember that closeness and attunement are the key factors in fostering repair and growth. Shaming oneself for not being the perfect parent can have the opposite effect. Shame often decreases our self-worth and leads to isolation and distance from others. Understanding that parents make mistakes, and that efforts to repair the relationship are key, it might be possible to move away from shame toward self-compassion. And through repetition of this repair process, children learn that they are worth being understood, that conflict can be resolved, and that they can manage uncomfortable feelings.
From a place of self-compassion, it is easier to practice mentalization. Mentalization is the “human ability to interpret the meaning of others’ behavior by considering their underlying mental states and intentions, as well as the capacity to understand the impact of one’s own affects and behaviors on others”2. When we are stressed and not grounded, we tend to focus less on the intentions of others and more on their behaviors, especially the frustrating aspects. Being grounded increases our ability to see beyond behaviors and consider the world of thought and emotion that influences these behaviors. While we can never know what someone else is thinking, curious exploration tends to increase patience, attunement, and the child’s sense of being understood. And mentalization also means understanding what is driving our behaviors and how we are experienced by others. Acknowledging and accepting our own experience helps us to better understand ruptures and conflict cycles and move towards repair.
1Tronick, E., & Gianino, A. (1986). Interactive mismatch and repair: Challenges to the coping infant. Zero to Three, 6(3), 1–6.
2Fonagy, P., & Target, M. (1996b). Playing with reality: I. Theory of mind and the normal development of psychic reality. The international journal of Psychoanalysis
Author: Fiona Smith, Taproot Therapy Clinical Trainee
A central pillar of Dialectical Behavior Therapy (DBT) is the concept of Radical Acceptance. This DBT skill is featured in the distress tolerance module and encourages the complete and unrestrained being at peace with unwanted events, problems, or emotions. Instead of resisting, we are encouraged to accept that the unwanted situation is occurring. Depending on the scenario, total acceptance can be enormously difficult to achieve.
DBT posits that pain - emotional or physical - is a sign that something is off. It’s your body’s natural way of alerting you to this. Accepting a painful event or emotion does not mean you condone it, like it, or approve of it. Rather, the acceptance of it in your mind, body and soul - that it did happen or is present in your environment - eliminates the mental struggle against it. It frees up your energy to move forward skillfully. Radical Acceptance is built on the idea that changing one’s reality first requires acknowledgement of what that reality truly is. Rejection of reality morphs pain into suffering and thus, prolongs that uncomfortable sensation.
An important facet of Radical Acceptance is that practicing of this skill does not mean we tolerate or stand for any unhealthy or abusive behavior. Rather, it is a framework for acknowledging the reality in which we find ourselves.
The first step is to simply observe. Ask: am I telling myself “it shouldn’t be this way.” “Am I denying the fact that things turned out differently from how I wanted them to?” Am I ruminating: “If only it had turned out differently.”
Practicing Radical Acceptance in daily life can feel like embracing the flow of each day as it comes. Let’s say you missed your train to work and now you’re going to be late because they only stop at your station every thirty minutes. Rather than resisting the reality of this scenario (that you will not be on time), Radical Acceptance instructs us to release any resistance to how things are and seek an alternate solution. In this case, one next step might consist of consulting the train schedule and planning ahead by texting your boss or colleagues that you will arrive later than expected. There is no problem too small or too large for this skill.
This skill is not an easy one. It requires persistence in order to fully incorporate it into your reflexive mindset, but once mastered, it is a comforting and freeing perspective through which to view life.
Have you practiced dialectics in your daily life? What has or hasn’t worked for you? What have you found challenging? What has come naturally to you?