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Dialectical Behavioral Therapy (DBT)

DBT or Dialectical Behavior Therapy is one of the main methods Dr. Raphaeli uses in treatment.  Dialectics underlies everything in DBT – this is the idea that there are no absolutes; we look for truths in all viewpoints.

The Central Dialectic of DBT – Accept where you are in the moment while moving toward change.  This is a difficult concept for many people. When utilizing DBT skills it is possible to accept what is– in the here and now— with the knowledge that everything is— as it should be— given all of the events and circumstances preceding the present moment.



How It Was Developed

DBT 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.

Marsha Linehan was raised as a devout Catholic and was taught that “suffering makes you stronger.” She firmly believed in this adage and she applied this idea to her own life.  However, 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 devastate 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.



DBT Informed Skills Training Groups

DBT informed skills training groups are led by licensed and specially trained clinicians who facilitate structured and supportive therapeutic environments.    Weekly 90-minute skills training groups include mindfulness practice, homework review, and the presentation of new skills.



Modules in DBT

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


Mindfulness: In Mindfulness Module we learn the bare bones of mindfulness; what it is, where it came from and how to practice it. We will learn to examine our consciousness from a different perspective; through a non-judgmental stance.  We will explore the doing and being minds and we will discover practices of loving kindness. Mindfulness skills and a dedicated mindfulness practice helps us to objectively approach situations; learn to be in the present moment non-judgmentally, and to effectively control our attention and create space between emotions and reactions. (6-week module)

Interpersonal Effectiveness: In the Interpersonal Effectiveness Module we learn how to skillfully meet our needs in relationships, strengthen our current relationships, figure out ways to end destructive relationships and create new relationships.  We will also learn to maintain balance in relationships by 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 what skills to use to meet priorities. (8-week module)

Emotion Regulation: In the Emotion Regulation Module, we will learn how to identify emotions and interpret what they communicate to us about ourselves and a situation. Using mindfulness skills, we will learn how to observe our emotions non-judgmentally from a place of self-validation. We will learn skills to help us change unwanted emotions, reduce vulnerability to painful emotions, and manage the intensity of our emotional reactions. (10-week module)

Distress Tolerance: Distress Tolerance skills to help us cope when our emotion minds start to take over. We will learn Evidence-Based skills to distract ourselves or immediately cope with panic, cravings, anger, fear etc. instead of acting out of impulse or habit potentially making things worse.  Then, we will learn Radical Acceptance Skills.  Radical Acceptance skills help us tolerate our reality just as it is, without adding or subtracting anything.  In time, we can achieve the quieting of intense desires freeing us from cravings and unhealthy patterns. Radical Acceptance is the way to turn suffering that cannot be tolerated— in to pain that can be tolerated. Radical Acceptance is the ultimate goal of DBT. (8-week module)