What Is Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy, usually called DBT, is a structured form of psychotherapy that combines individual sessions with skills training, coaching between sessions and a team of therapists working together. It was developed by Marsha Linehan, originally for suicidal behaviors and for people with borderline personality disorder, and it uses mindfulness alongside practical skills for handling intense emotions. Standard outpatient DBT has four modes, and a full program asks for a real commitment of time and practice.

Where DBT came from and who it was designed for

Marsha Linehan developed DBT for people who struggle with intense, fast-changing emotions and with self-harm or suicidal urges. Its first use was with suicidal behaviors and borderline personality disorder. That history matters when you are looking at programs: some DBT services are built specifically for people with those concerns, while others use DBT skills more broadly.

DBT is one of many approaches you will see described in an overview of types of therapy, and it is often grouped with cognitive and behavioral therapies because it shares their focus on thinking patterns and behavior. The difference is the dialectic in the name: acceptance on one side, change on the other, and a therapist who works to hold both at once.

The four modes of a standard DBT program

Standard outpatient DBT is not just a weekly hour with one therapist. It has four parts, and they are meant to work together.

Individual therapy

A person meets one therapist regularly to work on goals, review what happened during the week and apply skills to specific problems. This is the place where the therapy is tailored to the person’s own life and priorities.

Skills training

Skills training is usually run as a class-like group, often weekly, where people learn and practice the four skill sets. It is taught more like a course than a discussion group, with homework between meetings. That structure is one reason DBT skills groups differ from the open-ended process of group therapy.

Phone coaching

Phone coaching means a person can contact their individual therapist between sessions, in the moment, to get help using a skill during a difficult stretch. It is not a general crisis line and it is not for every kind of problem; the therapist sets the boundaries for when and how it is used.

Consultation team

A consultation team is a group of DBT therapists who meet to support each other and keep the treatment on track. It is a mode for the clinicians, not for the person in therapy, and it is one of the things that distinguishes a real program from a therapist who borrows a few DBT ideas.

The four DBT skill sets

Skills training teaches four sets of skills. They are practical, and they are meant to be practiced outside the group.

A person in a full program works on all four. A therapist who uses some DBT skills may teach one or two of them without the rest of the program.

How DBT differs from CBT

Cognitive behavioral therapy, or CBT, helps people identify and change thinking and behavior patterns that are unhealthy or ineffective. DBT grew out of that tradition but adds acceptance, mindfulness and a strong focus on the therapeutic relationship. Where CBT often works on a defined problem over a set course, DBT is built as a program with several parts and a team behind it.

If you want the CBT side explained on its own, what cognitive behavioral therapy is and how it works covers the basics. The practical difference for a person choosing therapy is the shape of the commitment: CBT may mean one weekly session, while DBT usually means individual therapy plus a skills group plus between-session coaching.

What a full DBT program asks of you

A full program asks for time and practice. There is individual therapy, a skills group, homework, and the expectation that you will use skills between sessions and bring the results back. Phone coaching means being willing to reach out in hard moments, within the therapist’s rules. The program also asks for honesty about self-harm and suicidal urges, because those are the behaviors the treatment was designed around.

Goals, and how long and how often to meet, are discussed by the patient and therapist together. Sessions in psychotherapy are typically held once every 1-2 weeks for about 30 to 50 minutes, though a DBT skills group usually runs longer and on its own schedule.

Who offers DBT

DBT can be delivered by several kinds of licensed professionals, including psychologists, clinical social workers, counselors, marriage and family therapists, psychiatric nurses and psychiatrists. Training in DBT is not the same as a license, so it is fair to ask what specific DBT training and supervision a therapist has had. A prescriber (a psychiatrist, a psychiatric nurse practitioner or another doctor) can talk about whether medication is an option; DBT itself is a talk therapy.

How to tell a full program from DBT-informed therapy

Many therapists use DBT skills without running a full program. That is not automatically a problem, but it helps to know which one you are getting.

Ask directly: is this a comprehensive DBT program, or DBT-informed therapy? Both can be reasonable, but they are different things.

Questions worth asking before you start

Ask about the therapist’s credentials and DBT training, what the program includes, how often the skills group meets, whether phone coaching is part of it, and what the expectations are between sessions. Ask about fees, insurance and whether there is a sliding scale. Ask how progress will be assessed and what happens if the program is not a good fit.

Rapport and trust matter. A person should feel comfortable with the therapist, and it is fair to say so if something is not working.

When DBT touches crisis

DBT was developed for people with suicidal behaviors, so crisis comes up. In the US, anyone can call or text 988 (the 988 Suicide & Crisis Lifeline), or call 911 in an emergency. The line is for anyone who is struggling, not only for suicidal thoughts, and people can also call about someone they are worried about.

What goes wrong with DBT

The most common mix-up is expecting a full program and getting a therapist who uses a few DBT skills. That can still be useful, but the four modes are the structure, and without them the experience is different.

Another is treating the skills group as a drop-in class. Skills training is meant to be practiced, and the homework is part of the work.

A third is assuming DBT is only for people with borderline personality disorder. It was developed for that group and for suicidal behaviors, but DBT skills are taught in other settings too. The reverse mistake also happens: assuming any therapist who mentions mindfulness is offering DBT.

Finally, people sometimes expect phone coaching to work like a crisis line. It is a between-session contact with your own therapist, within agreed boundaries, not a crisis service. If you need immediate help, 988 and 911 are the numbers to use.