DBT Gone Wrong. Skills are not Enough. Here's What You Need to Know.

DBT gone wrong. Skills are not Enough. Here's What you Need to Know.

I learned DBT over 20 years ago in Seattle,

in a little house at the edge of UW

with Marsha Linehan and her quaint team at the BRTC.

DBT is more than skills.

The teachings were deep, layered

and the skills were accessories.

Here are some things I’ve never shared, and how DBT has gone wrong:

Fundamental practices & concepts to be understood BEFORE practicing the skills, before teaching the skills and before disseminating them, if your intention is the greatest benefits of DBT.

I've seen countless organizations and clinicians with DBT certifications teaching skills completely wrong, here are a few issues that need attention. My clients and clinicians in consultation with me learn DBT, in-depth, more than I can offer here.

ONE: Our reality is made up of THOUGHTS, EMOTIONS, SENSATIONS, URGES.

-If one is dominating, thoughts for example, then using skills to get EMOTIONS SENSATIONS, URGES more active is imporatant. EMOTIONS-journal to locate emotions, SENSATIONS-cold shower, tea, pushups, URGES-observe, do not move compulsively.

-PRACTICE: imagine a conveyor belt with boxing coming one at a time, put a label on each box, THOUGHTS, EMOTIONS, SENSATIONS, URGES. This must be cultivated as a foundation for all of the skills.

**DBT was built entirely on this principle, not practicing it and teaching it as foundational misses what DBT is and how to use it.

DBT is not novel.  It reminds us of what we've forgotten. Practice and teach DBT as if waking up a sleeping reservoir of inner resources, instead of doing "skills".

TWO: OPPOSITE-EMOTION-ACTION is NOT for avoiding emotions, and it's often taught that way. DBT does not support avoiding emotions.

-OPPOSITE-EMOTION-ACTION can only be used when an emotion is UNJUSTIFIED. If the emotion is justified, then distress tolerance skills and mindfulness skills are needed. Using OPPOSITE-EMOTION-ACTION on justified emotions means teaching the psyche and body that the emotion is bad, wrong and needs to be suppressed and ignored.

-OPPOSITE-EMOTION-ACTION requires knowing the biological actions of each emotion, and applying that knowledge to the present situation for assessing if the emotion is justified or unjustified.

THREE: DBT skills and modules were not meant to be used at random.

-Mindfulness Skill are required for the other skills to be effective. Mindfulness skills can be practiced anytime, and this helps build the mind's ability to control its awareness.

-Distress Tolerance-high subjective units of distress, so high that Emotion Regulation Skills and Interpersonal Skills cannot be used effectively. **Use with mindfulness

-Emotion Regulation-low to moderate subjective units of distress, use with mindfulness, and when safe enough to process emotions and apply these skills appropriately.

-Interpersonal Effectiveness-with mindfulness, when subjective units of distress are low enough to use these skills while staying regulated, assessment for and application of distress tolerance and emotion regulation were completed.

Is this interesting to you? You can contact me at kristina-bravo@outloook.com or 737-825-5005

*consulting for clinicians, therapy, autism evaluations.

More writing on Substack, Ecologies of Autism

Thank you.

Kristina Bravo, LMFT