My DBT Experience
What is DBT?
DBT, otherwise known as Dialectical Behaviour Therapy, is a talking therapy adapted especially for people who feel emotions very intensely and have trouble regulating them. The goals are to regulate emotions, be able to live in the moment, improve relationships and be able to cope in stressful situations better and as a result, reduct self destructive behaviours. It was originally developed to treat a condition called borderline personality disorder (BPD) also known as emotionally unstable personality disorder (EUPD).
BPD is characterised by a pattern of unstable relationships, an intense fear of abandonment, extremes of emotion and rapid mood swings, chronic feelings of emptiness, no strong sense of “self”, impulsive and often self destructive behaviour (eg. binge eating, substance abuse, unsafe sex), difficulties controlling anger, self harm and frequent suicidal feelings and episodes of dissociation and paranoia, particularly when under stress. To meet the diagnostic criteria, you need to tick at least 5 out of these 9 boxes.
I have a formal diagnosis of BPD and qualified for DBT on the NHS, for which I am incredibly grateful! This is my personal experience.
I, like many others with a diagnosis of BPD, have been in the mental health system for a long, long time. Our problems are often considered “too high risk” and complex for basic counselling, but the waiting lists to access longer term therapies can several be years. After a lot of hoop jumping, I waited 2 years before there was room on the programme for me to start my DBT journey.
My first impression of the therapy was, “Wow, that’s a lot of rules!”
DBT follows a very specific rigid structure and at the beginning there were even contracts to sign to say that you would commit to therapy and the agreements between you and your individual therapist. I was honestly quite overwhelmed and intimidated by this, especially when I hadn’t known my therapist very long.
DBT has two different “parts” that run concurrently and take place once a week – Group therapy, with other patients for 2 hours, and one to one sessions with an individual therapist who stays with you throughout the treatment. There is also the option of telephone coaching with them where you can call or text any time within their agreed hours for support.
Diary cards, where you score your emotions from 0-5 and log any major happenings or symptoms every day are mandatory. I didn’t like the template I was given so made my own plus there are lots of examples online too! I find the process of rating my emotions (plus self harm and suicidal urges) very stark and clinical, but it got easier. It was also interesting to see particular patterns emerge – I have realised that my worst symptoms often flare up before my period which I have now been able to get specific treatment for – but that’s another blog post!
I have nothing but high praise for my therapist, we have an amazing therapeutic relationship and he has helped me no end. This aspect of the therapy is obviously subjective though, so I won’t go into much more detail other than it is so important you get along with this person or I imagine the rest of the skills training is even more difficult.
Joining the group was, as I’m sure most people expect, incredibly daunting. Some people had been there a while and only had a couple of modules left, whereas a few were joining for the first time too. I spent my first session sat rocking in my chair struggling to really say anything. On reflection I was extremely judgmental of pretty much everything! I thought the room was really dingy and smelled weird, I didn’t want to interact with any one, the facilitators were annoying… I was pretty miserable. But after the two hours has past, it wasn’t so bad after all.
The DBT programme I did was split into three modules which you have to do twice. These are “Interpersonal Effectiveness”, “Emotion Regulation” and, my favourite, “Distress Tolerance”. These each lasted something like 8 weeks. The first two weeks of each focussed specifically on mindfulness skills which I thought I already had down from doing other therapies, but this went into a lot more detail.
Oh, and there is homework. I know, ew. This was set every week and the first hour of each group session would be “homework feedback” during which everyone would have to *gags* read out what they had written for the week. This was absolutely mortifying at first, but once you get over it and rationalise that everyone is in the same boat, it’s still horrible but it’s not really that big of a deal. Definitely my least favourite part though!
I found the group sessions to be a bit of a mixed bag and some sessions were definitely easier than others. It was not uncommon for people to get upset by the content and have to leave the room for a few minutes (which I did on only one occasion). Tears were normal. Some sessions everyone would be super talkative and cooperative, other times were quieter or occasionally a bit disruptive if I’m honest!
I really enjoyed learning and starting to use the different skills. Some were more relevant to me than others. For example, I don’t really struggle with my interpersonal skills in the ways others in the group did, and actually do not meet that part of the BPD diagnostic criteria. So I really found the Interpersonal Effectiveness module quite tedious. The skills made absolute sense, but they’re just the way I have taught myself to communicate naturally so I didn’t find those particular weeks beneficial.
The Emotion Regulation and Distress Tolerance modules have been invaluable though. At first it is a lot of information to process and a lot of internal monologues going, “Pfft, that’ll never work, I’ll never be able to do that, what a waste of time!” This is exactly why each module is done twice. The second time through, having gained a lot more understanding of the therapy (and myself actually), it is so much clearer.
Unfortunately, when I had just my last two modules to go, the COVID-19 pandemic struck and both one to one and group therapy moved to video call format. Honestly, I was so gutted as I was really getting into the swing of it and dare I say, kind of enjoying it. Dealing with technology glitches which everyone seemed to have at one point or another, really detracted from the content. I get screen fatigue easily, so the second hour could feel like torture.
Graduation and What’s Next
I completed DBT in December 2020, almost 2 years since I started working with my individual therapist who I am still seeing.
It was incredibly bitter sweet and I am still sad I didn’t get to say goodbye to everyone in person.
For me, DBT has been a game changer. I had never done therapy that intensive and that long term before but feel it really suited me.
I still, for want of better words, have problems. I am not cured, and never will be. I feel I have better coping strategies, but I still use self destructive behaviours. It’s therapy, it’s not a miracle!
My next steps are to engage in trauma work as I now feel stable enough to tackle this and further my recovery.
Overall, I really recommend DBT. I personally think it would benefit most of the population, not just people with personality disorders!
- Mind UK page on DBT
- Mind UK page on Borderline Personality Disorder
- ReThink Mental Illness page on Self Harm
- Behavioural Tech – Official DBT Website