Kalamazoo DBT (dialectical behavior therapy) is a group of regional clinicians (Victoria Cane, Ph.D, LP; Gary Snapper, MA, LLP, LPC, NCC; Dawn Bouaouad, MA, LLP; Kim Yore, LPC, David Lawrence, MA, TLLP, and Cortney Modelewski, MA, LLPC) collaborating to provide evidence-based therapy. We all specialize in DBT and hold advanced training as well as 10 years of practice experience providing DBT. Additionally, we are all pursuing or have achieved credentialing in DBT through the founder's (Marsha Linehan) accreditation organization.
*What is DBT?
Dialectical Behavior Therapy (DBT) is a theoretical orientation and empirically-supported practice founded in the early 90’s by Marsha Linehan with the help of a research team. Marsha had been doing work with a population of clients experiencing high levels of difficulty tolerating and managing emotions and she found that "treatment as usual" was not effective with these clients for multiple reasons. A primary reason was that therapists tended to either over-focus on the client changing, (which feels invalidating) or over-focus on "just supporting" the client (supporting the status quo of misery). DBT was founded on the principle of "dialectics" where two seemingly incompatible truths can be held at the same time to arrive at a place of "synthesis". For example: *clients must be fully accepted and validated as they are concurrent with *clients must change in ways that bring them closer to their goals.
If you want to see a really short, concise, and fun video "What the Heck is DBT" (geared towards younger clients, but as with many things, adults sometimes prefer things geared towards younger folk)- it is linked at the end of this section.
Thus DBT was formed to treat extreme difficulty managing both emotions and certain behaviors. DBT teaches that no emotions are inherently "bad" and all serve a purpose and that accepting a full range of emotional experiences is essential to decreasing misery. When we can accept negative emotions there is a good chance of them decreasing and when we are less worried about how long a positive emotion will last, there is a good chance it will last longer.
The diagnosis most associated with the behaviors treated by DBT is Borderline Personality Disorder (BPD), characterized by mood lability (big swings in mood), impulsive behaviors (like eating disordered behaviors, self-harm, substance abuse, or sometimes suicidal behaviors), difficulty managing relationships, an empty sense of self, and an "all or nothing" style of thinking, among other criteria. DBT holds multiple assumptions about both clients and therapists including the following:
*clients are doing the best that they can
*clients need to do better, try harder, and learn new behaviors in all relevant contexts (meaning in all the places that matter, not just the therapy office).
*therapists are fallible (i.e they are human and make mistakes)
*therapists need support (this is the purpose of the DBT consult team).
Because learning new behaviors is so important in DBT, skills training (either individual or in group as available) is essential to the treatment. The skills taught in DBT are aimed at helping clients regulate emotion, tolerate distress, learn how to be more aware and attentive through mindfulness, and be more interpersonally effective.
DBT emphasizes the important working relationship between the therapist and client while integrating
principles of behavior as illuminated by B.F Skinner. DBT aims to help clients and their loved-ones understand ways that dysfunctional behaviors are sometimes
inadvertently reinforced (strengthened) which is key to helping learn how to extinguish those behaviors and reinforce other, more skillful ones.
DBT consists of individual therapy, skills training, between-session phone coaching, and ongoing consultation for the DBT therapist. The role of the consultation team is to provide support for the therapist while also promoting adherence to the treatment.
While in DBT, you agree to stop other psychotherapy elsewhere. DBT requires a solid team between client and therapists, much like the relationship between an athlete and their primary coach. More than one primary coach can lead to confusion and difficulty not only forming the therapeutic relationship but doing the difficult work of putting DBT concepts and skills into action. Once you have completed DBT, you are of free to return to a previous therapy if you choose. Clients in DBT continue to see other treatment providers like psychiatrists and other medical practitioners. Some clients also take part in other supportive services like twelve step and these services are not usually considered a conflict with DBT therapy.
DBT requires a commitment to learning and practicing new skills which takes time. We ask that you commit to at least 6 months of DBT to start. DBT also requires a commitment to reducing and eliminating self-harming behaviors. If you believe you are not ready to commit to this goal, DBT is likely not the therapy for you. We understand that motivation on this goal may waiver and it is our job to help increase motivation in this area but if a general agreement on this primary goal is missing then therapy will not be productive.
DBT requires participation and regular attendance. If you miss either 4 consecutive individual sessions or 4 skills sessions, you will have dropped out of DBT. If you would like a referral elsewhere, effort will be made to provide you with one.
As with most healthcare, we can't obtain reimbursement for missed sessions. Any individual session not cancelled with at least 24 hour notice will be charged at a fee of $35 (see separate policy on group misses). Because we limit the number of clients on our caseload, if it appears that sessions are frequently missed or cancelled, we will discuss this with you. You have the right to terminate your participation on the DBT team at any time. If you believe the treatment is not a good fit for you and you wish to terminate therapy, bring this to your therapist's attention immediately. You and your therapist may discuss other options for therapy at that time.
For more information on DBT see the DBT "Frequently Asked Questions" sheet and "DBT for Eating Disorders" sheet.
Below are some videos about the diagnosis of BPD and the treatment, DBT:
Here is a recent article published in the NY Times by Will Lippincott. He shares his experience struggling with depression and suicidal ideation- and how DBT helped him
use skills to change his life.