DBT Assumptions about Therapy

DBT has a series of assumptions about clients and therapy.  Remember the first two assumptions are that the clients are doing the best they can and they want to improve, in part because they are motivated to change and their lives are unbearable as they are being lived.  For more information about the citations and references from Shari Manning, Kelly Koerner, and Marsha Linehan, please see the last paragraph of this post.

Before we look at the DBT assumptions about therapy, let's review the terms.  

To clarify, assumptions are not facts, so these assumptions might not fit with every client 100% of the time.  They do, though, set the context for the for treatment planning (Linehan, 1993, p. 106).

The most caring thing therapists can do is to help clients change in ways that bring them closer to their ultimate goals, also termed life-worth-living goals. 

Clarity, precision, and compassion are of the utmost importance in the conduct of DBT.  Shari Manning describes dialectical behavior therapy as compassionate behaviorism.  One goal is to hold up hope, "I know this can be better."   This is a reminder for both the client and therapist because therapy is intense and, at times, a painful process, as change and acceptance of "what is" are not easy to do.

The therapeutic relationship is a real relationship between equals.  In DBT, therapists are not on pedestals, so they do not have "more power" in the relationship dynamic. 

Principles of behavior are universal, affecting therapists no less than clients.  At times, there are characteristics and/or behaviors that the client does not like about the therapist and vice versa.  The client can bring these concerns to light during the session, just as the therapist can mention characteristics and/or behaviors that are affecting the therapy.

DBT therapists can fail and DBT can fail even when therapists do not.  "The analogy here is much like chemotherapy: when the patient dies, we don't blame the patient.  Rather, the assumption is that 'treatment fails' because the practitioner failed to follow the protocol or it could be that the treatment itself is inadequate and must be improved" (Koerner, 2012, p. 23).

Therapists treating highly dysregulated clients need support.  Highly dysregulated clients can be difficult to treat.  "Some of the problem stem from the patient's intense cries for immediate escape from suffering.  Often therapists are capable of soothing the pain, but giving such relief frequently interferes with providing help for the longterm.  Therapists get caught between these demands for immediate relief and for long-term cure" (Linehan, 1993, p. 108).  Therapists can do this by joining a consultation team that meets regularly and getting supervision when needed.

Citations and references: Shari Manning and Kelly Koerner have published a series of DBT assumptions about therapy in DBT.  Marsha Linehan also has a series of assumptions about therapy mentioned in the section about Assumptions About Borderline Patients and Therapy in "Cognitive-Behavioral Treatment of Borderline Personality Disorder;" see pages 106 to 108.  

 

To see Kelly Koerner's list, you will find this information on pages 20 to 24 of "Doing Dialectical Behavior Thearpy: A Practical Guide" (Koerner, 2012).  Both books can be purchased at Amazon.com or Guilford.com.

Quotes from Shari Manning and the Treatment Implementation Collaborative are published in the Core Clinical Training in Dialectical Behavior Therapy Participant Materials (Manning & TIC, 2013).