1 Marsha Linehan's origins and dialectical philosophy
Developed in the 1990s by American psychologist Marsha Linehan, Dialectical Behaviour Therapy was designed specifically for people experiencing severe, chronic emotional dysregulation. It rests on a fundamental dialectical tension between two poles: radical acceptance of oneself and one's experience as it is today, and the pressing need to change destructive behaviours.
2 The four skills-training modules
DBT combines weekly individual sessions with group skills-training workshops. The skills taught cover four areas: mindfulness, observing and describing emotions without acting impulsively; distress tolerance, getting through crises without worsening the situation through self-harm; emotion regulation, identifying and modulating emotional intensity; and interpersonal effectiveness, asserting oneself while respecting others.
3 Clinical indications and empirical validation
DBT is the internationally validated treatment of reference for borderline personality disorder, repeated self-injury, chronic suicidal thoughts, severe eating disorders such as impulsive bulimia, and addictions associated with complex trauma.
4 The place of this approach within care
This approach provides an exceptionally containing, secure framework: the therapeutic contract is clear, predictable and committed. As people learn to navigate their emotional storms, they rebuild a life worth living and achieve lasting stability.
5 Clinical team supervision and peer consultation networks
Given the emotional intensity of DBT care, therapists are required to attend weekly peer consultation meetings. This continuing professional support ensures a robust framework, prevents caregiver exhaustion and sustains unwavering compassion towards clients.