Dialectical Behavior Therapy
DBT is a serious commitment to change.
One of the most well-researched treatments available for people dealing with intense emotions, suicidal thoughts, or urges to self-harm. Offered in person on Vashon Island and by telehealth across Washington.
What DBT is
DBT was developed originally for people with chronic suicidal behavior. It has since become the most well-supported treatment for a range of presentations involving emotional dysregulation — people who feel things intensely, react fast, and have a hard time coming back down.
“Dialectical” refers to holding two things at once: we are all doing the best we can at any given point, and we need to do more if we want meaningful change. In DBT you learn specific skills to help you build the life you want, and you practice using them.
Standard DBT has two components: weekly individual therapy and a weekly skills training group. Both are required. Research consistently shows the combination outperforms either alone.
The four skill modules
Practical tools, not frameworks to think about.
Mindfulness
The foundation of DBT. Learning to observe your thoughts and feelings without judgment, and to act with intention rather than impulse.
Distress tolerance
Skills for surviving crisis moments without making things worse — accepting pain when you cannot immediately change it.
Emotion regulation
Understanding your emotions, reducing vulnerability to intense feelings, and changing emotional states when you want to.
Interpersonal effectiveness
Getting what you need from relationships while keeping your self-respect and preserving the relationships that matter.
Who DBT is for
DBT was built for suicidal behavior but works for a wider range of presentations. It tends to be a good fit if you recognize yourself in any of these:
- Emotions. Intense reactions that feel out of proportion; difficulty returning to baseline after being upset.
- Behavior. Urges to self-harm, suicidal thinking, impulsive actions you regret, substance use to cope.
- Relationships. Turbulent or unstable relationships, fear of abandonment, difficulty asking for what you need.
- Identity. Feeling empty, uncertain about who you are, or as though your sense of self shifts depending on who you are with.
How we offer it
We work with DBT clients in partnership with Columbia City DBT. You meet with your individual therapist here each week and attend a weekly skills group through Columbia City DBT.
That combination is what makes DBT work. You learn the full curriculum of skills in group, and you work in individual therapy on applying them to your own life.
DBT is a six to twelve month commitment. People who complete a full course see different outcomes than people who stop at three months.
We see DBT clients in person on Vashon Island and by telehealth for anyone in Washington state.
DBT is one of the most effective approaches for teens experiencing intense emotions or self-harm urges. Read more about our work with teenagers and young adults, or see the FAQ for fees and logistics.
Not sure?
Whether DBT is right for you is a reasonable question to start with.
We offer a free 30-minute consultation — a chance to talk through what has been hard and whether DBT makes sense for your situation.