What are DBT sessions like?
DBT can vary between different services. See below for an outline of what DBT treatment might look like and entail:
DBT pre-treatment
Some therapists may offer you an assessment or pre-treatment phase of DBT. This is where the therapist will look at how suitable DBT is for you. They might offer you several sessions where you will learn about the DBT model. Then if you decide it is the right therapy for you, they will ask you to make a commitment to the treatment.
Individual therapy
Individual therapy usually involves weekly one-to-one sessions with a DBT therapist. Each session might last approximately 45–60 minutes.
The individuals sessions have a hierarchy of goals:
- To help keep you safe by reducing suicidal and self-harming behaviours.
- To reduce behaviours that interfere with therapy.
- To help you reach your goals and improve your quality of life by addressing what’s getting in the way. This might be other mental health problems like depression or hearing voices. Or it might be things in your personal life like employment or relationship problems.
- To help you learn new skills to replace unhelpful behaviours and help you achieve your goals.
Your DBT therapist is likely to ask you to fill out diary cards as homework, and bring them to sessions. This is for you to track your emotions and actions, and look for patterns and triggers in your life. You then use this information to decide together what you will work on in each session. You can find some sample diary cards on the DBT Self Help website.
“I’ve learned that emotions are not the enemy. They are useful and have functions. I still feel emotions intensely, but I can now identify them and know how to manage them without using harmful behaviours.”
Skills training in groups
In these sessions DBT therapists will teach you skills in a group setting. This is not group therapy, but more like a series of teaching sessions.
There are usually two therapists in a group and sessions might be weekly. The room is sometimes arranged like a classroom where your skills trainers will be sat at the front. The aim of these sessions is to teach you skills that you apply to your day-to-day life.
There are typically four skills modules:
- Mindfulness. This is a set of skills that focus your attention on the present, rather than worries about the past or the future. You might have a mindfulness module running between other modules. DBT sessions may often also start with a short mindfulness exercise. See our resource on mindfulness for more information.
- Distress tolerance. This means learning to deal with crises without harmful behaviours, like self-harm.
- Interpersonal effectiveness. This means learning to ask for things and say no to other people, with respect for yourself and others.
- Emotion regulation. This is a set of skills you can use to understand, be more aware, and have more control over your emotions.
In group sessions your therapist might ask you to do group exercises and use role-play. You are also given homework each week to help you practise these skills in your day-to-day life.
Telephone crisis coaching
DBT often uses telephone crisis coaching to support you in your day-to-day life. This means that you might be able to call your therapist for support between sessions. For example:
- when you need help to deal with an immediate crisis (such as feeling suicidal or wanting to self-harm)
- when you are trying to use DBT skills but want some advice on how to do it
- if you need to repair your relationship with your therapist.
But you need to check with your therapist whether this is something that is available to you, and it’s expected that your therapist will set some clear boundaries around this. For example:
- calls are usually brief
- calls should only take place between the hours you agree with them
- in particular circumstances, they might ask you to wait 24 hours before calling them.
“If I had a meltdown or crisis, she’d help me understand what may have contributed.”
During sessions DBT therapists will use a balance of acceptance and change techniques.
Acceptance techniques
Acceptance techniques focus on:
- understanding yourself as a person
- making sense of why you might do things such as self-harm or misuse drugs.
For example, a DBT therapist might suggest that this has been your only way of coping with intense emotions. So even though it’s damaging in the long-term, and may alarm other people, your behaviour makes sense.
“Finally someone is saying ‘yes it makes sense’ rather than ‘no that’s wrong’.”
Change techniques
Change techniques focus on replacing behaviours that harm you with behaviours that help you. This may mean your therapist:
- challenges your unhelpful thoughts
- encourages you to find new ways of dealing with distress.
“It’s not a short term thing… you have to work at it every single day. It’s hard to do, and even now, some 2 years after I completed the therapy, I’m still having to work at it.”
