Dialectical Behavioral Therapy: What It Is, Theory, What It Is For And Techniques

Dialectical behavioral therapy was proposed by Marsha M. Linehan in 1993. The objective of the therapy is to address the main symptoms manifested by patients with borderline personality disorder that we will see below:

• Difficulty in regulating emotional response.
• Tendency towards impulsivity.
• Feelings and fear of abandonment.
• Interpersonal difficulty reflected in relational instability.
• Unstable identity.
• Self-destructive behaviors such as self-harm.
• Parasuicidal behaviors.
• Autolytic attempts.
• Toxic consumption.

In this sense, dialectical behavioral therapy seeks to make the patient take responsibility for their emotions and allow yourself to experience them without avoiding them to achieve a life worth living.

This type of therapeutic process emphasizes affective emotional self-regulation and the management and control of emotions, as well as cognitive and behavioral aspects. The duration of this therapy is at least 1 or 2 years.

Dialectical behavioral therapy comes from the cognitive behavioral paradigm and integrates aspects of third generation therapy such as the following:

• The importance of context.
• Active participation.
• The relationship and the therapeutic alliance.
• The importance of the function of behavior.
• Concepts of acceptance, emotional validation and commitment to change.

In the same way as acceptance and commitment therapy, Linehan’s dialectical behavior therapy introduces the normalization of discomfort as a natural aspect of human life. The objective is return to the patient the responsibility of integrating their experiences as just another event.

According to Vallejo (2011), ⁽¹⁾Third generation therapies like this return responsibility to the patient, since they place the weight of the decision on their experience and it falls on them to make decisions. This choice generates a commitment to change so that if the patient manages to synthesize and integrate the different polarities of his experience, he will be able to live fully and comfortably.

Dialectical behavior therapy is widely used in outpatients with borderline personality disorder. In fact, it is the most applied treatment for this mental illness. Although borderline personality disorder is the disorder par excellence with which to apply dialectical behavioral therapy, it has also proven to be effective with patients who present the following symptoms.

• High levels of impulsivity.
• Hopelessness.
• Autolytic ideation.
• Suicide attempts.
• Recurrent self-harm.
• Adolescent population with high levels of impulsivity.
• Juvenile delinquents.
• Eating disorder, especially with bulimia.
• Patients with addictions.
• Dual pathology.
• Posttraumatic stress.

The dialectical behavioral therapy intervention is carried out through four components, which are individualized psychotherapy, group training in social skills, urgent crisis telephone assistance and support calls, and periodic feedback and supervisions.

Individualized psychotherapy

Some of the strategies and techniques used in individualized psychotherapy of dialectical behavioral therapy are:

• Dialectical strategies that encourage acceptance and change with specific strategies such as paradoxes, devil’s advocate representation, stories and metaphors, magnification of the patient’s verbalizations, activation of the wise mind that integrates the emotional and the rational, change from the negative to the positive and dialectical evaluation.
• Core strategies for validation of the past and present
• style strategies combining reciprocal and irreverent communication, opposed to validation.
• Control strategies to act on the patient’s environment and how he or she relates to it.

Group training in social skills

The strategies to train social skills that are used in dialectical behavioral therapy are:

• Mindfulness.
• Exposure and detection of thoughts and feelings of emptiness and lack of self-knowledge.
• role playing.
• Modeling and modeling.
• Instructions and self-instructions.
• Validation of experience and suffering.
• Acceptance.
• Tolerance of emotions.

Therapist strategies in his attitude

Some of the strategies that therapists should apply regarding the attitude they show when applying dialectical behavioral therapy are:

• Initial directiveness.
• Coordination between professionals and teamwork in the different modules.
• Close, understanding attitude that generates security, trust and a solid therapeutic relationship.
• Non-evaluative attitude of acceptance and empathic validation.

This article is merely informative, at PsychologyFor we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

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