There are so many different types of therapy out there. As a developing therapist, we undergo various types of trainings and supervision. A fundamental goal is to develop our own therapeutic style and approach. A therapist’s approach can be a very important factor when considering the client’s challenges and goals. Sometimes, therapists spend their entire careers developing their style and approach. I consider myself to be lucky, as I found my calling quickly. Let me explain how I fell in love with and why I chose to ground my life and practice in Dialectical Behavioural Therapy (DBT).
At the beginning of my clinical training, most of my clinical supervisors were theoretically grounded in Cognitive Behavioural Therapy (CBT). CBT is a therapeutic approach where thoughts, behaviours, and emotions are interchangeably connected. Changes in either one of the facets evokes changes in the others. CBT is commonly used with clients who are facing challenges such as anxiety, depression, obsessive-compulsive disorder, to name a few. The theory behind this modality made perfect sense to me and it was very easy to explain to clients. Furthermore, as a new therapist, it provided the structure I felt that I needed at the time.
I won’t lie, most of my clients, who at the time were children, adolescents, and their parents, loved CBT. Many clients found themselves making progress quickly. I would see positive changes in clients in as few as three sessions together. However, others were stuck and were become increasingly frustrated with the techniques used in standard CBT.
I will never forget one of my clients, a 14-year-old female, ripping her thought record sheet, yelling that she was sick and tired of documenting evidence for alternative thoughts and realistic outcomes. She broke down into tears and explained to me that her emotions were too intense to be able to think in a realistic manner. She was right. I started doing my own research and came across a different type of therapy that was based on CBT; Dialectical Behavioural Therapy (DBT).
What Is DBT?
DBT is an evidence-based approach that was developed to help people cope with extreme or unstable emotions and unhealthy or harmful behaviours. It started as a treatment for borderline personality disorder, however, research shows it may help with many different mental illnesses or concerns, particularly self-harm (2). DBT focuses on mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness, and the middle path (balanced thinking).
… AND SO THE AFFAIR BEGINS
From that moment, I knew I wanted to be trained in DBT. Fast forward a few months to when I started my doctoral internship at the Child and Adolescent Depressive Disorders Clinic at the Douglas Mental Health University Institute. In this program, I worked mostly with adolescents who had high levels of emotion dysregulation, suicidal thoughts and self-harm. Some had to be hospitalized for being at-risk of attempting suicide. The patients we worked with had received many forms of therapy in the past. This was considered the “last line” of service before being placed in an inpatient unit. We were six therapists in the unit and we each saw our own clients on a weekly basis. We also had two groups skills groups, one in English and one in French, for adolescents and their parents.
At the beginning of the treatment, I remember the adolescents being so pessimistic about the program, feeling forced to participate. We spent weeks learning DBT skills, sharing experiences, supporting parents through their difficult journeys. At the end of the program, the adolescents had made incredible progress. They learned how to manage their intense emotions and healthy ways of coping with them.
I will never forget some of my clients in the program who had a grocery-long list of unhealthy coping behaviours at the beginning of treatment. By the end of the year, they were no longer engaging in self-harm and no longer had the urge to end their lives. Some had even built strong relationships with their parents and other family members.
Spreading The Love
After my internship, I started to use DBT with my clients in private practice. Unfortunately, at the same time, they were no longer able to offer DBT groups at the Douglas Hospital (see more). Soon after, clients who were searching for the services once offered at the Douglas Hospital started to ask (some even plead for) me to run groups. They had heard that this was the treatment they or their children needed. I accepted the challenge and it has been incredibly rewarding watching clients who feel like they had hit rock bottom build a life worth living.
I enjoy seeing new clients who sit in my office jaw dropped and making comments about how they have never had sessions like this. I love how clients say that they have learned so much about themselves. I love seeing clients finally being able to cope with difficult situations in their everyday lives. I love leading groups and hearing therapists and clients using the same language. Throwing words around like “emotional mind”, “reasonable mind”, “wise mind”, “radical acceptance”, use your “PLEASE” skill. I love hearing my clients teach their loved ones and friends about DBT and the various skills. I love seeing the difference DBT makes in their lives and I love the psychologist that DBT has molded me to into.
My Personal Connection To DBT
In addition to using this framework in my clinical practice, I have also internalized DBT and apply it on the daily in my own life. As someone who can identify with the 14-year-old in my office a few years back, I myself was looking for some help beyond looking for alternatives to my negative thinking. In my own time of crisis, I decided to go off to California for a DBT training. This was so unlike me. Traveling at the last minute, alone? Everyone who knows me was shocked to hear it. The training was not just a learning opportunity, it was also soothing to be around people who loved DBT as much as I did. I came back emotionally stronger and ready to face my reality.
Over the years, DBT has taught me how to use balanced thinking, how to accept reality for what it is, and that my own (and others’) emotions are completely valid. I love the person that DBT has transformed me into and how it continuously pushes me to grow.
It’s Not For Everyone…
I would be lying if I said everyone that I came across in my practice loves DBT. Some people are simply not yet ready to make the changes that this type of therapy requires. Change can be scary. However, I truly believe that we are doing the best that we can right now, in this moment, with the tools that we have. Can we do better? Sure. Like how this sounds? Watch out, you might also be falling in love with DBT too.
Author: Melissa Stern