DBT With a Certified Clinician
Dialectical behavior therapy was built for emotions that arrive fast, hit hard and take a long time to settle. It teaches concrete skills in four areas, mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, and pairs acceptance of where you are now with steady work toward change.
I am a DBT-Linehan Board of Certification Certified Clinician. With Dr. Shireen Rizvi I co-wrote Real Skills for Real Life, an illustrated DBT skills guide published by Guilford Press, and I illustrated the DBT skills video series from the DBT-RU program at Rutgers.
What to Expect
DBT begins with an assessment of your goals and of the moments that tend to go wrong. From there, we:
Map what drives the intense moments
Learn the skills one module at a time
Practice between sessions and track what works
Review progress and adjust the plan
Sessions are structured and active. You leave each one with something specific to practice before the next.
Who DBT Helps
DBT was first developed for chronic emotional crises and is now used far more widely. People most often come to it for the situations below.
Intense Emotions
Emotions that arrive faster, hit harder and take longer to settle than for the people around you. DBT teaches concrete emotion regulation skills: naming what you feel, lowering vulnerability through sleep and routine, and acting opposite to emotions that do not fit the facts.
Crisis Moments
Getting through acute distress without making things worse, when the urge to lash out or escape feels like the only option. Distress tolerance skills such as TIP and STOP give you something to do in the moment and help you get through the next hour.
Impulsive Reactions
Saying or doing things in the heat of the moment that you later regret, from angry texts to walking out. DBT builds a pause between the feeling and the action, using mindfulness and skills like STOP to choose a response that fits your goals.
Relationship Conflict
Recurring arguments and difficulty asking for what you need. Interpersonal effectiveness skills such as DEAR MAN, GIVE and FAST help you ask, say no and still keep both the relationship and your self respect.
Teens and Parents
DBT skills for adolescents and the adults around them, so teens and parents share the same language when things get heated at home. Families learn validation, walking the middle path and using natural consequences.
Not Sure DBT Fits
DBT started as a treatment for chronic emotional crises, but the skills help people well beyond the original diagnosis, including anxiety, depression and burnout. If CBT or ERP fits better, you will hear that directly in the consultation.
The Four DBT Skill Modules
DBT skills are taught in four modules. Each one has its own guide on the blog:
Mindfulness
Observing and describing what is happening so you can choose a response instead of reacting.
Distress Tolerance
TIP, STOP and crisis survival skills for getting through the worst moments without making them worse.
Emotion Regulation
Understanding emotions, lowering vulnerability to them, and riding a feeling out instead of acting on it.
Interpersonal Effectiveness
Asking for what you need, saying no, and validating others while keeping your self-respect.
For a self-guided route, Real Skills for Real Life covers 26 core DBT skills with decision trees for when to use each.
Common Questions
Short answers to what people usually ask before starting DBT.
How do I know if DBT is right for me?
That is what the consultation is for. We talk through what is going on, which moments go wrong, and whether DBT or another approach fits better. The consultation is free and there is no obligation to book after it.
Individual DBT or a skills group?
Individual sessions focus on your own goals and the situations where things go wrong. The skills group teaches the skills themselves in a structured class. Many people do both, and the consultation is where we work out which fits.
Do I need a diagnosis to start DBT?
No. DBT was first developed for chronic emotional crises, but the skills help anyone whose emotions regularly get in the way of the life they want. What matters is whether the skills fit your goals.
What are the four DBT skill modules?
Mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Each one targets a different kind of moment, from staying present to getting through a crisis to asking for what you need.
How is DBT different from CBT?
DBT grew out of CBT. Both work on thoughts and behavior, but DBT adds acceptance and a set of skills for intense emotions, crises and relationships. The consultation helps decide which one fits better.
Is there a book to use alongside DBT?
Real Skills for Real Life, co-written by Dr. Shireen Rizvi and Dr. Jesse Finkelstein, is an illustrated guide to DBT skills published by Guilford Press. Many people use it to practice between sessions.
