Trauma is one of the main issues I specialize in & I implement many of Marsha Linehan’s (Dialectical Behavioral Therapy) DBT interventions (Barlow, 2001; Neacsiu et al., 2012). This therapy integrates concepts from different counseling theories and has very specific behavioral techniques to address the severe emotional responses related to past trauma and relationship/attachment issues. DBT skills can strengthen your ability to cope with strong emotions without losing control and acting less harmfully or impulsively (McKay, Wood, & Brantley, 2007). Such strong, extreme, overwhelming emotional responses may be ‘hard-wired’ at birth and is often related to trauma or neglect during the critical periods in childhood development (McKay et al., 2007). I implement DBT interventions to address issues regarding: attachment issues (related to abuse, neglect, missing parent, and the fears of abandonment & rejection) & current cycles of unhealthy relationships.
Relationships are often the main reason clients seek counseling. Often we are unable to move past traumatic or dysfunctional relationships with parents or other major caretakers. Trauma ends up being the lens we see our current relationships so we often repeat and replay past traumas. Having an understanding of our relationship with early caregivers, perception of that relationship and developmental history may reveal crucial information, especially about current relationships and ability to handle strong emotions.
DBT is based on behavioral theory and incorporates Zen philosophy principles such as acceptance, mindfulness, validation, and dialectics(Neacsiu et al., 2012). Mindfulness, the core of DBT, defined as the ability to live in the present moment without judging or rejecting the moment or experience (Barlow, 2001). Mindfulness is learned through a number of exercises that emphasizes remaining in the current moment and experiencing the range of thoughts, feelings, and sensations with the goal of achieving control of negative emotions (Neacsiu et al., 2012).Acceptancefocuses on the here and now, accepting the current reality, and not resisting it or get stuck in the past.
The dialectical part encourages moving between acceptance and change (Neacsiu et al., 2012). There is continuous movement of our current reality, which is always changing and moving. Zen philosophy in DBT says that we need to give up beliefs about what reality ‘should’ be and find the ‘middle path’ by considering different views, using acceptance, self-validation, & tolerance. Ultimately, in DBT the therapist provides the validation the clients need until they are able to provide it for themselves.
This may all seem complicated and initially it is, but what does all of this look like in practice? In its traditional structure and delivery DBT teaches four skills: 1)Distress tolerance 2) Mindfulness 3) Emotion regulation skills 4) Interpersonal effectiveness. It is often offered in individual and group therapy to receive the best outcomes, however I find many clients find it difficult to do both due to time restraints & comfort level with group therapy.
Is DBT for me?
Cultural considerations must be taken into consideration when attempting to modify any treatment. While DBT was developed based on “primarily Eurocentric samples” (p. 1022), DBT can be adapted for other populations (Neacsiu et al., 2012) but more research is needed. However, I believe DBT has principles that align with the Afrocentric worldview, including the holistic perspective, spirituality, and a collectivist view of relationships. The concepts of DBT are based on Zen philosophy, which is rooted in Buddhist principles. Although many of my African American clients identify as Christian or raised with Christian beliefs I haven’t found that it conflicts with those beliefs. I often refer to Christian beliefs of forgiveness, not focusing on what’s behind & moving forward to draw similar parallels.
Although DBT must be delivered by a professional who has received training many clients make progress just by practicing the mindfulness strategies so that is place you can start on your own if you are not ready for counseling yet. If you are interested in learning DBT counseling let’s schedule an initial assessment to see if it’s right for you.
Barlow, D. (2001). Clinical handbook of psychological disorders: A step-by-step treatment manual (3rd ed.) New York, NY, US: Guilford Press, New York, NY.
McKay, M., Wood, J., & Brantley, J. (2007). The dialectical behavior therapy skills workbook; practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance. Oakland, CA, US: New Harbinger Publications, Inc, Oakland, CA.
Neacsiu, A. D., Ward-Ciesielski, E. F., & Linehan, M. M. (2012). Emerging Approaches to Counseling Intervention: Dialectical Behavior Therapy. The Counseling Psychologist, 40(7), (1003-1032) doi: 10.1177/0011-000011421023