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Dialectical behavioral therapy

Anya’s story


Perched on a blush-colored, tufted velvet chair, an ivory blanket cascading over slender legs wrapped in white denim, Anya looks at this moment every bit a poised, polished woman without a single insecure or anxious bone in her body. The owner of a small advertising agency, Anya is warm, welcoming and magnetic. In her late 30s, she’s a self-described “business owner, mother, fashion lover, and a bookworm, totally not in that order,” she says with a laugh.


“If you’d asked me who I was before DBT, I would have said, ‘I’m a mess, chaos personified, broken and I’d even say dead inside except I hurt too much and hurting definitely means I’m not dead.’”


For all her grace and elegance, Anya admits she isn’t completely what she exudes on the outside. She says she’s suffered from  depression and  anxiety since as early as the age of 16; she guesses it may even have been earlier. Two years ago, she was diagnosed with borderline personality disorder.


Anya is no stranger to trauma, which her therapist has suggested is the reason for her numerous mental disorders. At six or seven, Anya estimates, an older cousin sexually assaulted her. It continued for a number of years until her father got a job in another state and the family moved. It had never occurred to Anya it was molestation or assault because it had been “almost playful, like just a game little kids play,” she remembers matter-of-factly. “And it probably wasn’t until I was 33, when I started seeing a  therapist, that I even thought to unearth this factoid, that I was molested as a little girl.”


As a teenager, Anya says she was awkward, a thin, crooked-toothed drama class enthusiast who never quite knew what to say around boys and who never really quite fit in with the girls either. Any attention she might have gotten from members of the opposite sex was often due to some embarrassing fumble, so she shied away from boys while other girls her age started to learn how to flirt, go on dates, and “play the game.” For Anya, high school was a nightmare. Lunches were spent alone in the corner of the library, and bus rides home were sometimes intolerably lonely. Still, she watched how the other girls assumed damsel-in-distress roles, or fell into giggles at the sight of boys, and watched carefully how the boys responded.


In college, things began to turn. Anya learned to put on makeup and turn her frizzy hair into an enviable glossy black mane. She learned that flirtation, and then distance from men actually made her attractive. She learned how to have a sense of humor. She learned how to befriend women (and how to make them envy her). Under the guise of improving who she was, what Anya was actually doing was learning how to manipulate her personality into whatever other people wanted or imagined her to be.


This pattern resulted in years of overlapping relationships, destructive friendships, and a life built on multiple lies. Anya mourned having no solid female friendships, and lamented loves lost. Sometimes she prided herself on her sexuality and her prowess; other times she wept at night for feeling as if she had no soul, no authenticity.


“I really started hating myself,” admits Anya. “There’s a growing support of women out there who are dating openly and admitting to being sexual creatures, but I was always afraid of being framed as a slut. But looking back, yeah, I was really promiscuous. I was seeking validation from everywhere but myself. Even if I wasn’t physically or emotionally attracted to a guy, I would go after it anyway, because it was the only way I could prove to myself I was worthy of something, of love.


“The more I fell into my depression, the more attention I would seek, which would sink me deeper into depression,” Anya continues. “It was this never-ending cycle. I was miserable. But I didn’t know how to stop.”


And then Anya fell truly, legitimately in love, with a man who recognized her behaviors and symptoms as abnormal. Even in the early stages of their relationship, even as he discovered her infidelities, he stayed close by, and encouraged her to seek mental help.  Tips on how to communicate efficiently


“(My boyfriend) went through heartache after heartache with me, and honestly I have no idea why or how anyone could have stayed with me through everything I did to him,” she says. “He didn’t know either, but he said to me, ‘Anya, this isn’t normal. This can’t really be who you are.’


“And for the first time, I considered the same thing… like, ‘Oh my God, this isn’t normal. I so fear being abandoned and rejected yet here I am doing everything I can so that anyone who dares to get near me has to abandon me and reject me, because I treat them – and me! – so horrifically.”


Anya’s therapist at first suggested cognitive behavioral therapy, designed to help patients understand the thoughts and feelings that influence behaviors. After several months, however, her therapist suggested a different approach: dialectical behavioral therapy.

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Dialectical behavioral therapy


Dialectical behavioral therapy, developed by Dr. Marsha Linehan in the late ‘80s, is a form of cognitive behavioral therapy. Specifically designed for patients with borderline personality disorder, DBT is derived from a process called dialectics, the concept that everything is composed of opposites. Change, according to Dr. Linehan and her associates, can only happen when one opposing force is stronger than the other. They believed that all things are interconnected, that change is constant, and that opposites can be integrated to get to a closer form of the truth. Basically, DBT is intended to work this way: the patient and the DBT professional would work together to resolve any contradictions between self-acceptance and change. If done successfully, the patient will experience positive change.


Validation is a powerful technique used in DBT; it’s believed that when patients’ actions are validated (if the therapist agrees that the person’s actions actually make sense given his own personal experiences, even if they’re not necessarily the best approach to solve whatever problem they’re going through), patients are much more likely to move toward change.


How does DBT work?


DBT is performed in one of three settings: in a classroom, one-on-one, and over the phone (between sessions).


Whether the sessions are conducted over the telephone, in person one-on-one or in a group, DBT’s characteristics are shared the same way. A person will discover the following:


Support. The DBT patient is asked to think about and recognize his or her strengths and positive attributes. They’re encouraged to acknowledge them, develop them, and use them.


Cognitive. Because DBT is based on CBT, it’s important that the patient really focus on changing his or her thoughts, beliefs, actions and behaviors that have historically not been effective.


Behavioral. A patient is asked to consider how they’ve dealt with analyzing and then dealing with problems in the past (and the answer will probably include very destructive methods). While in DBT, the patient will consider new, healthy behaviors and think about how they might be applied on a regular basis.


Skill sets. The DBT patient will be provided with new skills that will support all the things discovered during DBT, skills they will be able to use long after they’ve stopped attending sessions.


Acceptance and change. The DBT patient will eventually learn to accept life as it is, not as they have imagined it is. The patient will learn how to accept his or her emotions with the positive skills taught during DBT sessions, and by doing so will experience positive changes in their behaviors, and how they interact with others.


Collaboration. Finally, instead of living on an island and feeling alone, the patient will learn how to collaborate and communicate with other people in a healthy, effective manner.


What are DBT strategies?


There are four main strategies taught to DBT patients, and they include core mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation. More on those topics in upcoming blog posts.


Who is DBT for?

DBT, although designed initially for people with borderline personality disorder, has actually been found to be helpful for those with ADHD, generalized anxiety disorder, suicidal ideation, PTSD, bipolar disorder, major depressive disorder and even eating disorders.


If you’ve struggled with any of the above disorders, or any other mental health issue, you may want to consider seeking out a licensed DBT professional. For more information, visit us at  www.hopetherapyandwellness.com for a confidential consultation. 


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