What does individual DBT therapy look like?

Dialectical Behavior Therapy, or DBT for short, is a type of therapy originally created for use with borderline personality disorderAnyone could potentially benefit from DBT, however, due to its skill/analysis structure. DBT is a solution focused therapy modality that requires a specified agreement between the therapist and the client (the person seeking therapy). In DBT, the client and the therapist agree to work, as equals, through scenarios in the client’s life by chain analysis. There is a contract that outlines what each person is willing to do to make the relationship work, including a no harm pact and honest, open communication. The therapist is there to help, without judgement, regardless of content. Some of the behaviors discussed in DBT can be embarrassing or shameful in the client’s eyes. In this way, chain analysis allows a judgement free, clinical perspective of the behavior. 
 Chain Analysis  Chain analysis is a meticulous procedure of laying out any and every observable aspect of a situation that has previously occurred to determine what happened, what was good, what was not so good, and what can be changed. The purpose of this activity is to increase the identifiable areas of change that will result in more acceptable, appropriate, or less distressing behaviors. It may seem like a huge time suck, but individuals seeking out DBT have behaviors that destroy relationships, cause significant distress, or have resulted in legal issues. In an effort to increase the quality of life for that person, chain analysis steps in to practice the art of mindfulness, one of the main tenets of DBT. Once the pivotal moment of change is found, the client will be able to recognize if and when this happens again and change the outcome of the situation. For example, if a client is chaining a particularly violent outburst, the client can identify the emotion that led to this outburst and then the trigger for that emotion. The client is then able to understand where they lost control in the situation and change something before that moment. 
 The Diary  In addition to chain analysis, the client will be given a diary. Throughout their counseling experience, which typically starts at a year long commitment, the client uses the diary to keep track of suicidal thoughtsself harm, moods, substance use, and skills use. There is a page for cataloging how and when each skill was used as well as noting how effective it was. This allows the client to keep a running log of the work they are doing in DBT and the application of that in their life outside therapy. This log is addressed or reviewed at the beginning of each session. 
 Individual Sessions  Speaking of DBT sessions, it may seem like this is something that takes a very long time to do. Each session, however, is 50 minutes long and broken down by segments. The first few minutes are a check in. Then the diary card is reviewed. These two things should take 15 minutes of the session. There is typically a point in the past week where the client has noted an issue that they need to address, such as a conflict at home or work. This is then introduced into the behavior chain analysis, which should take 15 minutes of the session. In the beginning, this will dominate the session, but over time, the client will begin to do some of this behavior chaining on their own using handouts from therapy or DBT skills group. The rest of the session is a check in on skills, learning a new skill, and/or any questions that need to be addressed - another 15 minutes. The last 5-10 minutes is used for a final check in and any administrative questions, like scheduling or payment, that the client may wish to bring up. It is important to note that these time frames are not rules, but guidelines to manage time well. The client and the therapist will flow through the session in a dynamic way that may look different from session to session. This is dependent on what the client is needing during that time, which may include processing. 
 Skills Training  Due to the fact that DBT is a skill based model and that the purpose is to teach the skills to the client over time, clients will also need a DBT group. Now, this may turn some people away, but it’s important to note that only working on DBT 50 minutes a week may not be successful in the one year time frame. The client does have quite a few options here, as DBT groups are offered online and in person. In addition, there are several self help books that the client can learn DBT skills from while waiting to get into a DBT group. In an ideal world, the therapist would have a DBT group lined up and ready for this client, but this is not an ideal world and clients need options that benefit them and are workable with their personal schedule. 
 Putting it all together  DBT is a solution focused therapy program that offers structure and non judgmental collaboration to improve the quality of life for an individual. While the program was originally created for (and is amazingly successful for) Borderline Personality Disorder, any individual can learn skills for navigating life with DBT. It is a highly skills oriented type of therapy with a large emphasis on behavior and mindfulness. Chain analysis, skills review, and diary check ins are done at nearly every individual therapy session, but each session is tailored to what that client needs at that time. Skills can be learned through a variety of group therapy options. Through DBT group and individual weekly sessions, a client can learn ways to manage difficult emotions and distress/crisis in a way that does not involve self harm, suicideharming others, substance abuse, or illegal activity.