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Dialectical Behavioral Therapy (DBT)

Dialectics underlies everything in DBT – this is the idea that there are no absolutes; we look for truths in all viewpoints. 

DBT or Dialectical Behavior Therapy is one of the main methods Dr. Raphaeli uses in treatment.  It was designed by a clinical psychologist, Marsha Linehan and initially developed to treat individuals having great difficulty managing moods and relationships.   Since then, DBT has been modified to treat all kinds of problems.


How It Was Developed

Marsha Linehan was raised as a devout Catholic and was taught that “suffering makes you stronger.”  This was something she firmly believed in and  she applied this idea to her own life.  But, she started to notice that for many of her patients, suffering did not make them stronger.  It emotionally decimated them and she wanted to make sense of how this could be.  How could suffering on the one hand make some people stronger, while on the other hand emotionally decimate certain people?

She began to look at a group of people who had suffered greatly – Holocaust survivors.  Among these individuals, she found that those people who had survived the Holocaust and were able to accept the reality of their situation were able to become stronger.  These people of course still recognized that horrible things were done to them, and the awful things that happened during the Holocaust.  However,  simply by accepting their reality these people were able to problem solve and eventually become emotionally healthy.  Meanwhile, other survivors (understandably) were stuck in the “how can it be???” cycle and were therefore unable to move on.  These people could not accept their reality.


Modules in DBT

In DBT, you learn “Change” skills (Interpersonal Effectiveness, Emotion Regulation) and “Acceptance” skills (Mindfulness, Distress Tolerance)

Central Dialectic – Accept where you are in the moment while moving toward change.  This is a difficult concept for many people, but it is possible to accept where you are in this moment while still moving toward change, with the knowledge that everything is as it should be at a given point in time given everything that has come before it.


  1. Mindfulness: this is Core in the sense that it is learned first (whereas the other modules don’t come in a specific order).  Mindfulness underlies everything that comes in the other modules so it must be taught first.  Goals: Helps people to more objectively approach their current situation; learn to be in the present moment non-judgmentally
  2. Distress Tolerance: How to tolerate emotions/situations and not make things worse.  Many people tolerate their situation by making things worse (e.g., “checking out” through unhealthy behaviors).  When we can’t problem solve, DBT teaches people to distance themselves from the distressing feelings.  (e.g., distract self so don’t make things worse)
  3. Emotion Regulation: Evaluate what it is to experience a given emotion – what emotions tell us about ourselves and the situation; identify emotions; determine whether emotions are valid or not (i.e., based in truth and logic), and if so, whether the intensity is “valid.”  Depending on these answers, DBT teaches skills to “deal with” various emotions
  4. Interpersonal Effectiveness: Balancing 3 fundamental goals – a) Preserve sense of self; b) preserve relationship; c) get objectives met.  DBT will help with determining which of these is most important in any given situation, and learning skills to meet priorities