All about Dialectical Behavioral Therapy (DBT): A Q&A With Ethos Wellness’ Martha Fontana

While Dialectical Behavioral Therapy (DBT) is offered by clinicians throughout Ethos Wellness healing centers, Ethos Wellness-Bellaire has been well known for their expertise and effectiveness in this type of treatment for many years, offering group, family and individual DBT-based sessions, as well as intensive outpatient programs rooted in DBT for teens and adults of all ages, and helping thousands of individuals quickly stabilize, improve daily functioning and relationships and move forward with their lives. We sat down with the extensively DBT-trained and experienced Martha Fontana, LCSW, founding member of Ethos Wellness-Bellaire and Ethos Wellness director of outpatient services, in order to share more about DBT and how it can help.

Q: What is DBT and why was DBT therapy developed?

A: Dialectical Behavior Therapy, commonly referred to as “DBT,” is an evidence-based treatment developed in the late 1980s by psychologist Marsha Linehan, PhD, a researcher at the University of Washington. Dr. Linehan had a unique interest in helping people–primarily women early on–who probably suffered more than any other segment of the population seeking help from psychotherapy and medication: those with “borderline personality disorder.” These individuals struggled with severe depression, suicidal thinking and overall intense emotions and had great trouble coping with triggers in the environment (like in relationships or with children), as well as coping with impulses under stress. Until DBT was developed, individuals with borderline personality disorder were frequently “fired” from therapists and psychiatrists because of their extreme emotionality, occasional self-harm behavior such as “cutting” under stress, suicide attempts, extreme anger, hopelessness, and more. 

“She believed her clients needed compassionate ‘skills coaching’ from therapists rather than ‘blaming and shaming’ so they could better learn to regulate and manage their emotions, thinking and behavior, especially under stress.”

Through her studies, Dr. Linehan quickly realized these intense and emotional individuals had a biological predisposition to being emotionally sensitive, and that the role of the environment was also playing a part in her clients’ emotional reactivity and trouble coping. Dr. Linehan saw her clients through a radically different lens than the majority of psychotherapists at the time: She believed her clients needed compassionate “skills coaching” from therapists rather than “blaming and shaming” so they could better learn to regulate and manage their emotions, thinking and behavior, especially under stress. She also believed her clients could benefit from learning sophisticated interpersonal skills to deal with other people in a more effective manner. This skills-based, compassionate approach worked!

Since the late 1980s, the DBT approach has been so effective in changing people’s lives that countless other teens and adults who struggle with emotion, mood, maladaptive thinking, problems coping and relationship struggles have sought the help of DBT therapists for problems including diagnoses such as bipolar disorder, major depression, anxiety syndromes, anger management issues, substance abuse, eating disorders and more. Men are now being treated in equal numbers as women; teens, college students, homemakers, executives and professionals across the globe are choosing this model of treatment. Several years ago, NFL football player Brandon Marshall was in the news describing his success story receiving treatment from Harvard’s McLean Hospital DBT outpatient program.

Q: Can you tell us more about how DBT works?

“...only working from a change perspective can be experienced by clients as very ‘invalidating’ and frustrating... In DBT, change is balanced and synthesized with acceptance and validation.”

A: A unique aspect of DBT is that therapists and clients work together in order to change strategies (i.e. alter certain thinking patterns or behaviors in response to certain triggers) as well as enact acceptance strategies. Most traditional therapies in the U.S. are very focused on the client changing. However, only working from a change perspective can be experienced by clients as very “invalidating” and frustrating, especially as clients can be experiencing emotions and perspectives that make sense in the relationships and circumstances in which they find themselves. In DBT, change is balanced and synthesized with acceptance and validation. Valid means “sound, well-founded and true,” so clients learn to more accurately assess their “truth” and to self-validate where it makes sense. This is life-changing for clients to experience acceptance and validation even in the midst of behavior that can be quite ineffective or even maladaptive. 

Q: What are some other components of DBT?

A: Ethos Wellness clients who pursue DBT-like care are aided in identifying a number of “treatment targets” they wish to change in therapy. They are encouraged to use a weekly “diary card,” which is a sophisticated tool used to monitor progress on their treatment targets and to record the various strategies or skills used during the day/week to better manage stress, emotions, thinking, behavior, and relationships. In classic or “comprehensive DBT,” clients will attend a weekly DBT Skills Group to learn skills (it takes about 7-9 months to learn all the DBT skills) and attend regular individual psychotherapy/skills coaching sessions. During these individual sessions, the therapist and client will review the diary card to see how self-regulation efforts are going and to evaluate what progress is or is not being made in various areas of the client’s life.

What also makes our approach to DBT unique is that in comprehensive DBT therapy, our therapists work as a member of a treatment team rather than working by themselves in helping the client. This team approach is invaluable in that therapists learn from each other, gain emotional support–especially when clients are really struggling with difficult behaviors early in treatment, and can consult with each other on how to best help a client. We also collaborate with the client’s psychiatrist in the area of medication management. This can help in preventing “over-medication,because the physician learns about the client’s stressors and what they are doing in therapy and skills coaching and therefore can minimize the use of medication.

Q: What sets DBT apart from some other forms of psychotherapy?

A: There are many different types of psychotherapies, and none are “one size fits all.” Some talk therapies are primarily “supportive,” providing a safe space and trusting relationship in which to explore issues, emotions and options. Psychodynamic approaches are very effective in helping clients explore their family-of-origin patterns and how they were raised, and to discover the development of behavior patterns in order to break deeply-entrenched ways of feeling, thinking and acting.

“DBT wants to help the client quickly gain skills to ‘feel better,’ to cope and function more effectively, and to arrest or stop maladaptive or self-defeating behavior. It is practiced within a very supportive client-therapist relationship.”

DBT has two phases: the first phase of treatment (after obtaining a detailed history and identifying the client’s goals and treatment targets) is very much focused on the here-and-now. This phase does not focus on exploring the client’s past or traumas. DBT wants to help the client quickly gain skills to “feel better,” to cope and function more effectively, and to arrest or stop maladaptive or self-defeating behavior. It is practiced within a very supportive client-therapist relationship. After initial progress is achieved, the client will generally delve more deeply into trauma and core “wounding” experienced during the life journey, patterns influenced by the family-of-origin or the greater culture, etc. during the second phase. Some clients may have considerable trauma and work on both levels of treatment simultaneously.

Q: Why did you choose to focus on DBT-based therapy at Ethos Wellness – Bellaire?

A: About 17 years ago, our team started the Bellaire clinic and PRISM programs. Fortunately, one of the therapists had recently completed training in DBT and came back raving about the treatment approach. After hiring a DBT consultant for an introductory training, our team was convinced! We pursued advanced training in DBT with teams from across the U.S. and throughout the world (Norway, Africa, Europe, etc.) and have continued to hone our skills through higher-level training for many years now. 

“The bottom line? It works. Teens, college-aged adults and older adults, many of whom are very accomplished, have found DBT self-regulation extremely effective in improving their mood, management of emotion and stress, coping skills and relationships.”

Throughout Ethos Behavioral Health Group, we offer many different types of therapy. The “change and acceptance” synthesis and the here-and-now skills training component is very attractive to clients. In addition to weekly DBT Skills Training groups and individual sessions, we also offer several DBT-based Intensive Outpatient Programs (IOPs) for teens and adults in crisis. The bottom line? It works. Teens, college-aged adults and older adults, many of whom are very accomplished, have found DBT self-regulation extremely effective in improving their mood, management of emotion and stress, coping skills and relationships. Treatment also helps clients stop problematic behavior that was previously deeply painful for the client and their loved ones. DBT can be life changing! 

If you or a loved one think you may benefit from DBT-based care or would like to learn more, please contact our care team confidentially. Ethos Wellness’ compassionate, master’s-level clinicians would love to help you reach your wellness goals through this skills-based, here-and-now approach. Help is available in Houston, in Chicago and virtually.

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