Dialectical Behavior Therapy (DBT) is a therapeutic approach that was developed by Marsha Linehan to help individuals with borderline personality disorder and other conditions that involve intense emotions and difficulty regulating behavior. DBT is a form of cognitive-behavioral therapy that emphasizes the balance between acceptance and change. It is based on the idea that individuals with these conditions have a biological vulnerability to intense emotions, and that this vulnerability is exacerbated by an invalidating environment. DBT aims to help individuals learn to regulate their emotions and behaviors, and to gain more control over their life.
DBT is composed of four main modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
DBT is a comprehensive therapy that is typically delivered in a group format, with weekly individual therapy sessions, and regular phone coaching. It requires a high level of commitment from the patient and therapist, and typically takes several months to complete. It has been shown to be effective in treating a wide range of mental health conditions, including borderline personality disorder, post-traumatic stress disorder, and substance abuse disorders.
DBT has been adapted to be used in treating Dissociative Identity Disorder (DID) by providing a structured and consistent approach to managing the symptoms associated with DID. DBT can be used to help individuals with DID to:
DBT can be integrated with other therapeutic approaches, such as psychodynamic therapy, and EMDR, which can be effective in treating DID.
--Above created with assistance from ChatGPT.
One challenge with DID folk working in DBT groups is that they're often expected to present as singular in group settings. Some professionals who run DBT groups seem to think that presenting as plural, or different headmates fronting during groups (and sometimes in 1:1 adjunct therapy) is undesirable "Dissociative" behavior and counter to the goals of DBT. Thus for some plural or DID systems, we're forced to be inauthentic or mask during DBT groups.
This idea comes from the thought that conflates switching in itself as dissociative (and thus maladaptive) behavior. When a system becomes increasingly co-conscious, they continue to switch without dissociation symptoms such as disorientation, amnesia, feeling distant or detached, or losing time. It may help for plural & DID systems to seek out DBT from more knowledgable practitioners — unfortunately sometimes we have to take what we can get. Other options include joining plural-only DBT peer-run practice groups or discussing DBT internally with one another as a system i.e. having a DBT group internally while working in an external DBT group.