What is DBT, and who can it help?
I’m going to avoid copying from Wikipedia here, and offer my own definition of DBT as I understand it so far.
DBT Is a practical therapy focussing on changing or reframing emotions, behaviours, and goals. It aims to reduce emotional distress, and teach the client/patient to respond differently to their distress. In DBT literature there is a lot of emphasis on not making things worse (I like this), and on something called the Middle Path, which is about holding opposites in mind, and accepting both.
DBT makes most sense when you understand who it was developed for. In psychiatric diagnostics there is this unfortunate term - Borderline Personality Disorder. I made a couple of visits to psychiatrists 30 years ago at Friern Barnet, a sprawling, crumbling hospital with amazing grounds. It’s now a luxury housing development. Anyway, although they didn’t formally diagnose me with BPD, I always felt I had been, and it seemed almost the worst diagnosis you could come away with. In this article from 2018, psychologist Jay Watts comments that BPD has “been known as the ‘dustbin diagnosis’ since the 1970s…It positions everything about the person as disordered, which is why so many people describe it as the ultimate character slur”:
Over time, whilst reading more about DBT, I’ve come to accept that I fit well within the borderline category. And meanwhile, because of the success of DBT, and the generalising of DBT to a range of emotional difficulties, it now seems a less worse label to have. And yes, I know I've diagnosed myself, and no, I'm not a psychiatrist (though I did have a five year relationship with one, and he sure had his own issues), but there’s a certain relief now in recognising a lot of me in the BPD literature. I finally know what I've got to grapple with so that I can live as well, and as productively as I can.
It has also helped to read more about why the features of BPD (difficulty in regulating emotions, strong reactions, suicidal feelings, suicide attempts, inability to bear feelings, and so on) fit so badly with established psychotherapies. Linehan has written in detail on how poorly those with a borderline setting can fare in conventional therapies - ‘the emotional state of both the patients and the therapists seemed to deteriorate when these individuals entered therapy.’ This will need more unpacking later, but now is a good time to mention that I’ve always been surprised that therapists who clearly cover issues like abuse, neglect, suicidality, self-harm and knitting in their training, and who are most probably aware of DBT, make so little attempt to work some of the key ideas on these subjects into their therapies.