Dialectical Behavior Therapy: Does One Size Fit All?

By Erin Murphy, M.Ed, Spruce Mountain Inn Case Manager

Dialectical Behavior Therapy (DBT) is the gold standard for Evidence-based practice (EBP) in the treatment of Borderline Personality Disorder. Since its inception at The University of Washington by Dr. Marsha Linehan, DBT has also been utilized to treat substance abuse, eating disorders, bipolar disorder, depression and anxiety. The DBT curriculum has even been adapted for the treatment of children, adolescents and adults with developmental disabilities.

If this sounds like DBT is a “one size fits all” approach to mental health treatment, that’s because it is!

I call myself a DBT socialist because I believe the demonstrated success of this EBP in clinical practice can be applied more broadly to the “masses.” By this I mean that DBT skills are life skills which can be taught and utilized widely to broaden their impact.

Here is an example from my own practice. I was asked to teach a DBT skills class to young adults with combined developmental and psychiatric disorders. By all assessments I failed. What was taught in the classroom did not translate to learned behavior outside of it. What was wrong? I analyzed my data and discovered that because the caretakers in the home environment did not know and could not use DBT skills, what I was teaching in class had no carryover. I changed my approach. I broadened my target learners to include the caretakers. The improvement in function among the “un-diagnosed’ caretakers, and between the caretakers and their charges was dramatic.

The implications of the example above is that the demonstrated efficacy of using DBT skills in the clinical setting may also be realized by using those same skills in our daily lives.  So what are they? Most simply, they are techniques for managing our own emotional reactivitywhen communicating with others, especially in charged situations. The two key ingredients are the learning ofempathy for self and others, and the cultivation of mindfulness practices.

DBT is an important aspect of the therapeutic milieu at Spruce Mountain Inn. The skills are taught formally in specific groups and the practice of mindfulness is incorporated into many aspects of daily activities. And just as importantly, the DBT approach to solving social conflict is employed regularly by SMI staff and residents because it works.BIO ERIN CP



Erin Murphy, M.Ed, has worked as a therapist, consultant and trainer of DBT in Massachusetts, Colorado and Vermont. She has specifically adapted and/or applied DBT curriculum to work with adolescents and adults with developmental disabilities, sexual assault and trauma histories, anxiety and depression.