Dialectical behavioral therapy was at first developed by Dr. Marsha Linehan, an adjunct professor of psychology and psychiatry at the University of Washington in Washington State, at the Seattle campus. Linehan got a lifetime achievement award for writing the book on dialectical behavioral therapy where she layed out the new therapy that she had developed to help her patients and others like them alter they way they act in difficult situations. Linehan also has an individual practice and is researching how to develop therapies that treat and give hope to those with serious mental health disorders.

Dialectical behavior therapy, or DBT, is a cognitive behavioral treatment that focuses in on individual therapy as as a means of behavioral shift, well as group therapy skills training sessions. Linehan originally designed DBT to treat her patients who had borderline personality disorder, one of the serious mental health disorders that can have the side effect of a patient having chronic suicidal thoughts. Indeed, DBT has become the most useful and best in class standard psychological treatment at top rated drug rehab centers for those with chronic suicidal ideation, especially who suffer from BPD. Dialectical behavior therapy does not stopped there. Linehan’s research and development treatment has changed the lives of those struggling with various disorders in so many different ways. There are  a myriad of diagnosis that find the use of dialectical behavior therapy invaluable:

  • Those with dual diagnosis substance abuse
  • Depression
  • Generalized Anxiety Disorder
  • Post Traumatic Stress Disorder, or PTSD
  • Eating Disorders
  • ETC


The Four Stages of Dialectical Behavior Therapy

  • Discovery Institute1st Stage of DBT: In the first stage the therapy is built to address a patient who is experiencing utter chaos. Their behavior is chaotic and their emotional landscape probably also feels like it is in a state of chaos too. Simply put, the patient is and feels out of control most of the time when they are approaching DBT for the first time. This first stage is usually met by the patient with persistent suicidal ideation or perhaps the idea is new to them and their expression, this desire to end their life perhaps is what brought them to the therapy to begin with. Or perhaps, the new patient is coming to DBT not because they want to die but because they are engaging in self harm, maybe by cutting themselves, overworking themselves, or by abusing an addictive substance, whether it is an illicit drug, prescription medication or alcohol. The most important thing in the first step of DBT is that the client moves from being or feeling out of touch to being able to control behavior.
  • 2nd Stage of DBT: Even as the person struggling with whatever chaos they bring to the table has become more proficient at withstanding the urge to react in an inappropriate way or to act in a destructive manner, they may still be and will likely feel desperate, hopeless and alone when they come to the 2nd step of DBT. This continued suffering could well be because of some sort of trauma or childhood neglect that has remained unprocessed up until now. This kind of quiet desperation cannot go unmonitored or eased otherwise it could lead directly back to the tendencies of self harm that the patient was going through at the beginning of the dialectic therapy process. Step 2 is characterized by the goal of taking a patient from a place of silent despair  where they are living to a more free space where they are allowing themselves to feel all of their emotions in spite of any fear that may come along with the emotion.
  • 3rd Stage of DBT:  Now that the patient who approached the first stage of therapy is no longer living in a dangerous chaos of the heart and mind and have begun to have control over their own behaviors and habits – now that they can start allowing themselves to experience all of their emotions that they are feeling and they are able to fully experience every moment even as they are still behaving in the way they want to. Now that they have control,  it is time for the patient to begin rebuilding their life. They will use these new understandings of themselves and the tools they built through their DBT homework and therapy sessions to make goals and lead a more healthy everyday life while they are able to deal confronting both pleasant and more difficult situations as they come.
  • 4th Stage of DBT: Not everyone engages in the fourth stage of DBT, however some patients find that the therapy can play an important role in a spiritual experience that perhaps they need. Dr. Marsha Linehan created the fourth step to allow for the patient who is struggling to have a goal of spiritual fulfillment.

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Reviewed for Medical & Clinical Accuracy by Dr. Jeffrey Berman, MD

Dr. Jeffrey Berman, MDDr. Jeffrey Berman is a psychiatrist in Teaneck, New Jersey and is affiliated with Robert Wood Johnson University Hospital. He received his medical degree from State University of New York Upstate Medical University and has been in practice for more than 20 years. He also speaks multiple languages, including French and Hebrew.

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