This week I attended a workshop on how to use Dialectical Behaviour Therapy (DBT) with difficult clients. I thought it might be valuable to share some of the strategies presented. Most people in the mental health field know DBT as a therapy for individuals with Borderline Personality Disorder. Although DBT was originally created to work with Borderline Personality Disorder, and has undergone 11 empirical studies with clients who have the disorder, the therapy has also been empirically validated for populations including eating disorders, suicidal teens, and depression in the elderly. However, based on the information in the workshop it was clear that the skills taught in DBT are transferable to multiple client issues.

 DBT evolved out of traditional cognitive therapy and incorporates cognitive techniques with mindfulness and acceptance strategies and Zen practices. The therapy focuses not only on changing maladaptive behaviours, but balancing change with acceptance of things that cannot be changed. In order to achieve acceptance of things that are not under the client’s control, DBT teaches a number of skills. These skills include distress tolerance skills, mindfulness skills and emotional regulation skills. The therapist’s role is not only to teach, process, and model the skills with the client, but to thoroughly understand, validate and accept that the behaviours being exhibited by the client have served a function in the client’s life despite producing maladaptive consequences. The goal is to balance the position of the therapist (the thesis) with the position of the client (the antithesis) and to find a middle ground.

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