How It Works, What It Helps, and More

Here’s what you should know before starting DBT.

What’s a Dialectical Behavior Therapy Session Like?

A DBT appointment is structured to address each person’s unique needs and challenges. “No two DBT sessions look fully alike, as they’re tailored to meet your individual goals and your concerns,” explains Shah.

Lorandini adds that some DBT programs offer virtual therapy, which may be helpful if a person lives in a remote area or has certain responsibilities that make in-person therapy challenging.

She says it’s important to think about the pros and cons of virtual therapy. “There are also many benefits to being in person, including fewer distractions, the implicit reinforcement of dedicated self-care, and often, an increased bond with your therapist,” she says. “The important part is that you go.”

While the structure and style of the therapy may vary, DBT usually includes four types of sessions, according to Cleveland Clinic:

1. DBT Pre-Assessment

During a DBT pre-assessment, therapists explain how DBT works and ask each patient questions to determine whether DBT might be an appropriate and effective treatment for them.

2. Individual Therapy

Individual therapy usually involves weekly sessions with a therapist that last typically up to an hour. The goal is to help patients address problematic behaviors and learn new coping skills to replace those behaviors.

Lorandini notes that all patients are encouraged to fill out a weekly “diary card,” which is a self-monitoring chart used to document urges, behaviors, emotions, and skills.

“Then, in session, clients and therapists discuss the record to gain a better understanding of thoughts and behaviors, identify patterns, and develop more effective ways of increasing skillful behaviors and decreasing unskillful ones,” she explains.

3. Skills Training in Groups

This type of session is run like a classroom. The therapist teaches skills in a group setting and assigns homework as a way to practice new strategies.

“A key component of learning about emotions and facilitating their effective expression and management includes interacting with other people, which is why group therapy is so important,” says Lorandini.

The groups usually meet once a week for about 2.5 hours, according to the University of Washington. Group members learn the core DBT skills, which include:

• Mindfulness This practice encourages people to focus on the present moment rather than fretting about the past or future.
• Distress Tolerance This technique involves effectively withstanding emotions in stressful situations without reacting with destructive behaviors.
• Emotion Regulation It means being able to manage one’s emotions and changing emotional responses to certain situations.
• Interpersonal Effectiveness This method involves learning how to ask for something while setting healthy boundaries.

Other important skills you may learn are called middle path skills. According to Lorandini, middle path skills are designed to help patients balance acceptance and change, so they can recognize that there’s more than one way to solve a problem.

4. Telephone Crisis Coaching

Patients can call their therapists during an agreed-upon range of times to receive coaching between sessions. This telephone crisis coaching is done on an as-needed basis. The calls are typically short in length. They are usually made when patients have an immediate crisis or need some advice on how to implement DBT skills.

How to Prepare for a Dialectical Behavior Therapy Session

There are a few helpful ways you can prepare yourself for your first DBT session, says Shah. First, it’s important to manage your expectations and bear in mind that therapy is typically not a quick fix.

“Don’t expect to walk out of your first therapy session feeling better immediately,” says Shah. “It takes a lot of work and is a long-term process to develop from where you are to where you want to be.” You may want to spend a few moments beforehand to collect your thoughts and think about your reasons for seeking a therapist, she adds.

Know that your first DBT session will most likely be about gathering background information about you, such as your current day-to-day life, your mental health history, what symptoms or issues brought you to therapy, and your goals for therapy, Shah says. Your therapist may also review some DBT tools and resources that you might use in future sessions.

Shah adds that you may want to spend a few moments beforehand to collect your thoughts, contemplate your reasons for seeking a therapist, and jot down any concerns you have before your first DBT session.

If your appointment is virtual, it can also help to make sure you’re in a quiet space free from distractions, and that you turn off any notifications or pop-ups on your computer or phone.

Keep in mind that DBT usually involves working between sessions. “DBT sessions don’t exactly end when the client leaves the office, so the preparation is ongoing,” says Lorandini.

She explains that patients are often assigned prompted activities, such as filling out a diary card or practicing mindfulness strategies. The homework depends on each person’s particular needs and what they want to work on.

“It can be very helpful to bring a short agenda to your DBT session,” adds Shah. “Tracking your emotions and behaviors and bringing those concerns to session can help make your therapy as effective and helpful as possible.”

How to Find a DBT Therapist

Finding a DBT therapist can sometimes be challenging. Some research suggests that a shortage of available therapists is a major barrier to implementing DBT.

ABCT’s Therapist Directory is one resource people could use to find a DBT clinician.

“You can also find referral lists at your local hospitals, with your health insurance, or many other therapists will have referrals to DBT therapists that they keep on hand,” says Shah.

Lorandini adds that it’s important to check with your insurance provider first to see if they cover DBT. She recommends that if you do have to pay out of pocket, ask potential therapists if they offer a sliding scale fee, a payment structure with rates based on your ability to pay.

Who Shouldn’t Try Dialectical Behavior Therapy?

According to Cleveland Clinic, it’s very difficult for DBT to work if:

• You’re not fully committed to making positive changes, attending all therapy sessions, or doing the homework assignments that come with DBT.
• You don’t feel comfortable or able to do therapy in a group setting.
• You don’t feel comfortable focusing on your past in therapy.