We’re excited to have recently welcomed a new clinician on board who specializes in Dialectical Behavioral Therapy (DBT). Danny is eager to share more about what DBT is and how it works as an effective form of therapy. So, without further adieu, let’s hear from Danny himself: 

Hi everyone! My name is Danny Shaheen, and I am brand new to DC and Kennedy Counseling Collective, though I have been seeing clients as a therapist since 2015. I am originally from Minneapolis, MN, and while living there served as therapist and clinical director at a mental health agency that provided DBT services via group and individual appointments. More on what DBT is and how I incorporate it below. 

What is DBT? 

DBT is an approach to therapy that involves teaching coping skills that are categorized into four modules; Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. In this series I’ll be describing each of those modules, as well as a couple other relevant elements of DBT. My training background involves learning how to teach these coping skills in a structured, classroom-type format. For our purposes At KCC, these skills will be incorporated into therapy with either individuals or couples. 

DBT was originally created by a woman named Marsha Linehan who devised the theory and painstakingly sought its empirical validation single-handedly. Marsha is a fascinating, inspiring person who was institutionalized for the intensity of her own mental health symptoms in early adulthood. The seed that grew into DBT being a full-fledged, internationally recognized mode of therapy began with Marsha creating the very treatment that she believed would have been necessary to treat her own symptoms.

While DBT was originally conceived of to treat individuals with chronic suicidal and self-harm behaviors, its application has expanded to include a much wider range of symptom presentations, and anyone interested in learning more practical ways to improve their mental health can find benefit here.    

I believe practicing what I preach is important, and I use my training in DBT in my personal life on a daily basis. It is a passion of mine to teach to others! 

What is “Dialectical?”

The word “Dialectical” is at the heart of this theory. A “dialectic” describes the process of reconciling two notions that seem to be the opposites of each other. Within the philosophy of DBT, the central dialectic explored is balancing acceptance and change. 

“Acceptance” in this case may be an outlook on life summed up with phrases like “it is what it is,” or “everything happens for a reason.” There is a wonderfully zen-like quality to life viewed through this lens, though also there exist instances where intention and effort need to be exerted instead of remaining passive. For example, advocating for oneself, rather than merely tolerating something uncomfortable or harmful. 

“Change” describes attempting to bring about a desired outcome. Some examples could include exercising to meet a certain fitness goal, asking for a raise at one’s job, or giving someone constructive feedback. 

Of course, a life lived with intentional action is something admirable to strive for. Without a healthy sense of balance, however, an orientation toward change can bring about such troublesome qualities as perfectionism, workaholism, and an inability to feel satisfied. 

All of us exist on a spectrum between acceptance and change, and ideally we would each find the happy medium between the two. Where a person lands on this spectrum can dictate where to most effectively focus the direction of their therapy sessions. 

Tell us About The Biosocial Theory

In work with individuals who are highly sensitive, it is often revealed that there was a disconnect between some traits that person was born with and the environment they grew up in. To use a common example from dominant American society, young boys who are naturally predisposed to emotional sensitivity often are raised in environments that are invalidating of these qualities. In these sorts of circumstances, it may not have felt safe to express vulnerability or one’s true nature for fear of criticism, or even outright hostility.

The discrepancy between an individual’s natural traits and an invalidating environment can result either from one’s nuclear family, the community they were raised in, society at large – or any combination of those. 

Gaining an understanding of parts of your personality that may not have felt safe to express early in life can bring healing as an adult. Therapy can help with this!

What Role Does Mindfulness Have In DBT?

Mindfulness is usually used to describe the process of gaining a greater quality of awareness of one’s inner experience. This is remarkably helpful with identifying one’s emotions, and making decisions. Learning mindfulness can also be helpful with how well an individual pays attention to others, and can give insight into such cues as body language, tone of voice, etc., which can improve relationships. 

All skills that are taught within DBT require mindfulness in order to be used effectively. In therapy, we’ll work together both to develop practices surrounding mindfulness that are conducive to your unique needs, and also help to identify what barriers may be in the way of you living in accordance with your values. 

What is Distress Tolerance?

When setting goals for ourselves or trying to change ineffective patterns of behavior, various barriers can easily arise – often in the form of impulsive behaviors. An example of this could include trying to manage impulsive spending. This is a common, short term stress reliever that can create bigger problems long-term if left unchecked. Especially as stressors mount, it becomes harder and harder not to rely on a trusted strategy like overspending, though this can also result in a vicious cycle that is hard to break. What to do? 

Distress Tolerance skills can help with resisting the urge to give in to impulsive actions. Many involve intentionally changing your physiology or thought patterns – such as paced breathing, a brief burst of intensive exercise, or finding a temporary distraction like a word puzzle or cell phone game. The point is identifying the urge to act on a behavior you’d like to change, and interrupting that urge with other actions until over time the urges become less intense and easier to manage. This is all about consistent practice, which we can set accountability goals for in therapy appointments!      

Tell Us About Emotion Regulation

Understanding one’s emotions – which ones are which, why we have them, how to utilize them to make decisions and make sense of the world – all of this information is remarkably helpful in navigating life generally, yet many of us were never taught how to interpret emotions effectively. If this describes you, now is your chance to learn!

Once you have learned to identify what actions your emotions are leading you toward, you can be intentional about whether to follow those actions or “Act Opposite” of them if they are not going to be effective in a given situation. 

As with so much of DBT, Emotion Regulation is a spectrum as well. Some folks have trouble feeling their feelings at all, whereas others feel them so intensely that it becomes overwhelming. Regardless of where you fall on that spectrum, we could all benefit from having a greater understanding of this area of life.

Describe the Build Mastery Skill

The “Build Mastery” skill teaches us that a central component of living well is regularly doing things that give us a sense of self-satisfaction; that we can feel competent while doing, where we can mark progress, meet goals, and generally feel proud of ourselves for. 

How someone applies this skill is completely open to their own interpretation. Some examples could include creative pursuits, like painting, playing an instrument, or writing. It could also include gardening, learning a new skill like a home renovation project, or even something distinct from the above like setting a financial budgeting goal and meeting it. 

Perfectionism is the biggest barrier to this skill being utilized that I see in my work with clients (and in my own life). Due to our evolutionary history, each of us have a “negativity bias” that can interfere with our ability to give ourselves credit for the effort we put towards various endeavors. For example, I often see clients feeling discouraged to clean their entire house, so instead of just tidying a bit, they let the mess continue to grow. Over time, this cumulative effect makes it harder and harder to make progress. So you see, this negativity bias can really reduce our capacity to recognize progress we are making, and block opportunities we have to feel good about ourselves. What we’re trying to do here is diversify the range of what we allow ourselves to feel accomplished for. 

How this gets addressed through using the skill Build Mastery would be learning to give oneself credit for the work that did get done, as opposed to being bogged down in all that still needs to be completed. For example, “I am going to stick to a goal of cleaning whatever I can for 15 minutes, and then I am going to challenge myself to feel good about the fact I accomplished that, as opposed to berating myself for still having more work to do.”

The above is a subtle mindset shift that takes practice, though has far-reaching implications for all sorts of areas of life. 

What is Interpersonal Effectiveness?

In line with much of the topics we’ve already covered, within interpersonal relationships DBT theory describes individuals as being on a spectrum as well. 

One end of the continuum describes people who have a tendency to put others’ needs before their own, and may have a difficult time asserting themselves (they may even have trouble identifying preferences in the first place). On the other side, we have individuals who may have a harder time predicting the needs of others, validating others’ experiences, or thinking outside of their own needs. 

Either end of the continuum described above can prompt relationship difficulties if taken to its extreme. For some individuals the work necessary in this area may involve learning to identify wants and needs and express these to others in a way that is firm yet respectful. For others, perhaps what is needed is guidance surrounding how to more effectively anticipate other peoples’ needs, broaden one’s perspective, and loosen rigid thinking (e.g., “if I can’t do things my way, I’m not going to do them at all”).

Let’s Discuss Validation as the First Step

Validation as the first step is technically part of Interpersonal Effectiveness, though it’s so central it deserves a post on its own. Whether it’s related to parenting, navigating a romantic relationship, helping a friend with a difficult situation, or any other number of circumstances, validation is key to reducing emotional intensity and increasing connection. 

I’ll use a common dynamic in parenting (though this applies at all ages and in all types of relationships); say your child is experiencing emotional difficulty, and throwing a temper tantrum. This is getting on your nerves, and you wish your child would calm down. It may feel natural to raise your voice at your child and tell them to “knock it off,” however, this may inadvertently escalate your child’s emotional intensity rather than lower it.

As paradoxical as it may feel, if you are able to give your child a sense that you understand what may be prompting their emotional outburst, this will likely reduce their distress and begin to calm them naturally. For example, you may say something along the lines of “it seems like you’re frustrated that we needed to leave the park to go home for lunch. I get upset when I am asked to stop doing things I like too.” In many instances, a gesture as small as this one creates an opening for a request to be made of the person having the difficulty. 

We never outgrow these types of tendencies we develop at a very young age, and each of us needs understanding and validation from others throughout the lifespan!

Explain When to Use Validation as Opposed to Problem Solving 

One of the most core building blocks to arise from learning Interpersonal Effectiveness and Emotion Regulation skills is determining when it is going to be more effective to use validation or problem solving. This is a topic that arises frequently in couple’s counseling in particular. 

Let’s say you’re upset about a situation that occurred at work earlier in the day, you arrive home to your partner, and start to tell them about what happened. Immediately your partner launches in with “OK, so here’s what I’d do if I were in your shoes, have you already tried **a, b, c, or d idea**?” While sometimes problem solving (e.g., suggesting solutions, strategies, perspective, etc.) may be what’s most effective, often – especially when someone is particularly upset – they are not going to be receptive to problem solving until after their feelings have been validated. 

Or, in many instances the problem solving step isn’t needed at all. This is an individual who just wants to be heard and made to feel as though what they are experiencing is understandable. A real challenge here can be in situations when you see clearly what you perceive to be a solution to someone else’s problem, and yet what they are looking for is to be validated – not to hear your idea for them!

When someone in my life tells me about something they are upset about, I will often directly ask whether what they are needing is validation or problem solving. Try this out in your relationships!