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Dialectical Behavior Therapy (DBT)

/Dialectical Behavior Therapy (DBT)

Looking for Dialectical Behavior Therapy (DBT)?

Perhaps you’ve heard about Dialectical Behavior Therapy (DBT) from your doctor, a previous therapist, are in a DBT skills group right now or have been in one in the past, and are looking for a therapist who uses this approach in Centennial, CO, near the Denver Tech Center, Greenwood Village, or Englewood. If so, you’ve come to the right place to learn more about DBT.

What Issues does Dialectical Behavior Therapy (DBT) treat?

Are you struggling with trauma, depression, chronic pain, mood or emotional issues, or chronic relationship problems?  Have you been a victim of abuse, or a difficult family history Dialectical-Behavior-Therapy-Counselorthat might have involved substance abuse or mental illness? Perhaps you’ve even been suicidal in the past or even attempted suicide? Do you have issues with self-harm, such as cutting, or hair pulling (trichotillomania), or self-destructiveness in general? Does you sometimes feel empty, like you don’t know who you are or what you want, and that it’s hard to find meaning in life? Or do you always feel like people will abandon you, that you’re on your own, and can’t trust anyone? Do you sometimes have problems with out-of-control rage, and need help with anger management? Perhaps you’ve even been diagnosed with Borderline Personality Disorder  (BPD), or another personality disorder, and haven’t found many types of therapy very helpful.

These issues can seem very overwhelming, and leave people feeling isolated, hopeless, and like there’s no where to turn. Friends and family often have grown tired of trying to help, and despite the chaos that is being created, we feel powerless to stop our behaviors because we don’t know that there’s any other way to live. We sometimes find solace in high risk sexual behaviors, alcohol or substance abuse, or other addictions, but that creates its own problems on top off the turmoil we’ve already been facing.

The good news is that life doesn’t have to be this way.

Dialectical Behavior Therapy (DBT) Can Help You!

Dialectical Behavior Therapy is a proven, effective treatment for all these issues; in fact, it’s the gold standard of treatment for many of the most serious mental health issues, including feeling suicidal. DBT has a tremendous amount of research behind it that shows that it helps people recover from many of these issues. DBT is frequently used in inpatient and outpatient mental health settings, and is a great addition to other therapy treatments.

Even if you’re issues aren’t as serious as some of the ones described here, DBT provides a tremendous amount of skills and concepts that can change your life. I know; I use DBT skills myself all the time. They’re not just therapy concepts; they are ways of living and being that are life affirming and transformational.

DBT teaches skills and new ways of being for people who have come out of all kinds of difficult scenarios; child abuse (physical, emotional, or sexual), domestic violence, constant relationship conflict, families with substance abuse or mental illness, poverty, trauma, etc. If the household you grew up in had these kinds of issues, chances are DBT is a therapy approach that can help you.

What is Dialectical Behavior Therapy (DBT) and How Does it Work?

At it’s core, DBT melds many of the principles of cognitive-behavioral therapy (CBT) with a philosophy routed in Eastern mindfulness traditions, all within a cohesive theoretical philosophy.  It is considered one of the more recent and innovative versions of CBT, sometimes called “third wave“. The term dialectical in this case refers to a systematic reasoning, exposition, or argument that juxtaposes opposed or contradictory ideas and usually seeks to resolve their conflict.  DBT is primarily interested in resolving the conflict between being able to change what we can in life while being able to radically accept what we cannot. On one hand, it challenges us and empowers us to take action and do things differently in our lives, and on the other, it shows us the wisdom of being able to tolerate what is.

In many ways, DBT shows us the specifics (the “how-to”) of the classic Alcoholics Anonymous Serenity Prayer:

“God grant me the serenity 
to accept the things I cannot change; 
courage to change the things I can;
and wisdom to know the difference.”

DBT has four core content areas, known as modules. These are both skill areas and conceptual ideas that can create a more stable, livable life.

  1. Mindfulness

    1. Learn to focus attention on the present moment and become aware of your thoughts, feelings, and urges.
    2. Learn how to  use “Wise Mind”, a state of clarity and calmness with which you can most optimally function.
  2. Interpersonal Effectiveness

    1. Learn how to manage and improve relationships.
    2. Learn how to say “No” to unwanted requests, or ask for things you need in a way that is likely to get you what you want.
    3. Learn how to get relationship needs met in a healthy way, and end unhealthy relationship behaviors.
  3. Emotional Regulation

    1. Learn to identify your emotions and know when they are becoming a problem for you.
    2. Learn skills and strategies to regulate your mood, whether to decrease overwhelming, difficult emotions or increase positive emotions needed to live life.
  4. Distress Tolerance

    1. Learn how to survive crisis and events that seem unsurmountable.
    2. Learn how to use actions that are helpful instead of turning to behaviors that will ultimately make the situation worse.

Sounds good, but . . . 

I’ve been like this for a long time. Is it possible to really change?

DBT was specifically developed for people with chronic, even life-long issues. It’s multi-pronged approach of a skills group and individual therapy was designed specifically to help people make real, lasting changes. Sure, it takes time, effort, and practice, but the skills and theory behind DBT are targeting the areas and issues that psychotherapy researchers have identified as have tied to measurable, tangible, and identifiable improvements; for example, creating stable, secure relationships, or being able to stop behaviors that are destructive. These are the skills and ideas that we all wish someone had taught us from a young age, but didn’t. DBT is delivered in such a way that change is going clearly be the option that makes the most sense for creating the life you really want, and going back to old habits is no longer going to work the way they once (kind of) did. We’re going to to replace ineffective struggling with effective action.

I’ve done therapy before, and it didn’t help. How will this be different?

There are many approaches to therapy that are valid and helpful. Unfortunately, many well-meaning therapists that work primarily with therapy clients who are high functioning are not sure how to handle people whose lives are in states of constant crisis. Don’t get me wrong; there are wonderful approaches to personal growth, even serious problems like depression and anxiety that can do wonders for people that I also use and enjoy, but often those approaches were not designed for people that are really, really struggling. Therapy approaches need to meet the current states of clients where they are, and DBT does just that. It is one thing to meet an otherwise healthy person who has run into a challenging time in their life; it is quite another to help someone for whom life has always been difficult, painful, and confusing.

The founder of DBT, Marsha Linehan, a theoretical psychotherapist, struggled herself with a chronic mental health issues; including a 26 month stay in a psychiatric hospital that was ill equipped to help her stop hurting herself.  Through her exploration of many styles of therapy and eastern philosophy, she was able to not only change herself, but to create the very approach that similar mental health institutes now use for their most serious cases like hers; that is, DBT.

Do I have to join a DBT group in addition to individual therapy? Or can I  just do individual therapy?

This is a great question. The real, researched based DBT model is to use both. Joining a skills group is a wonderful thing, but without the support of a individual therapist, it can be an overwhelming experience. When I coordinated a DBT program, we had strict rule; no one could join a DBT group without also concurrently being in individual therapy, and preferably with a DBT informed therapist. Conversely, it is possible to begin DBT work (including utilizing material from the skills group) with an individual therapist and then add a DBT group when one is available and you and your therapist have determined you are ready. If you had to start with one, begin with a therapist who know DBT and add the group later.

There are a lot of therapists in my area. Why should I choose you?

I have trained and been individually supervised with one of the top DBT experts in Colorado and led multi DBT groups under his direction. I found the instructional nature of DBT a good fit for my background in education; I like to teach things.  Later, I coordinated an entire DBT program, overseeing and assisting other therapists facilitating 4 weekly DBT groups, helping new DBT clients join groups, and helping develop administrative and structural support for our therapists. This was an invaluable experience in understanding the ins, outs, and pitfalls of DBT that forced me to have a deep relationship with the model and utmost trust that it could transform lives.

Perhaps more importantly, I was not first introduced to DBT as a therapist; I was introduced to it as student of mindfulness who was curious about understanding how and why mindfulness as a core concept could transform a human life. DBT is known as one of several “mindfulness-informed” psychotherapy approaches, and an essential experience of DBT’s transformational power is working with a therapist who understands mindfulness; not just a conceptual idea, but who has a dedicated mindfulness practice, skills, and instructional background. Unfortunately, mindfulness is not easily learned and not even covered that much in instructional material for DBT facilitators, sometimes leaving DBT missing its center. (Some more mindfulness-informed  therapists jokingly call this “DBT-lite”.) I’ve been teaching studying and teaching mindfulness for nearly a decade, and have studied it in intensive residential retreat settings with master teachers from a variety of mindfulness tradition; including Zen, Vipassana, and the Shambhala Warrior Tradition. Basically, these retreats was doing mindfulness meditation in silence for 8-12 hours a day for weeks at a time with lots of instruction and help from the teachers, a not easy experience which changed my life in ways I would not have considered possible until it occurred. This is some of the hard earned wisdom I bring to my sessions and DBT work. Mindfulness is the core of my therapeutic identity, and it really makes DBT come to life in my individual therapy and skills groups.

Want to Learn More?

Contact me to find out about my current DBT offerings. I’m always available as an individual therapist, and sometimes offer DBT groups. Call me for a free consultation so we can determine how DBT or other therapeutic approaches might benefit your life.

You can contact me via email or by phone: (303) 748-4730.  Any inquiries made are always confidential, and I return calls Mon-Fri within 24 hours, usually sooner!

I look forward to speaking with you about DBT and am happy to answer any additional questions about how I might help you!

-Robin Ruscio, MA, LPCC, NCC

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