Dialectical Behaviour Therapy (DBT)

Dialectical Behaviour Therapy is a structured, skills-based talking therapy. It was developed for people whose feelings arrive faster and harder than they can be managed — where the emotion is not the problem so much as the speed and the size of it, and where the things that bring relief in the moment cost a great deal afterwards.

The word dialectical points at the balance the therapy is built around: accepting where you are today, and working to change it, held together rather than traded off. In practice that means sessions do two things at once. Part of the work is learning specific skills — noticing what you are feeling before it has already decided what you do, tolerating distress without making it worse, asking for something or refusing something without the relationship paying for it. The other part is looking at what actually happened this week and walking back through it, step by step, to find where it turned.

What it is not: it is not a crash course in coping, it is not a set of worksheets handed over without a relationship, and it is not something you are given before anyone has worked out what is going on. DBT is one of several modalities our psychologists are trained in. Whether it is the one indicated for you is a clinical decision made after an initial session, not a choice you have to make from a website.

PHC is an assessment-first practice. Nobody begins DBT here because they asked for it by name — they begin it because an initial session found it was what the situation called for.

1. An initial session.We ask what has been going on, for how long, and what it is costing you. Nothing is administered before this conversation. Where the picture needs more than a conversation, emotional assessment and symptom screening decides which further tests, if any, are clinically warranted.
2. A psychologist matched to what that found.Psychologists at PHC are not assigned on availability. Assignment is based on speciality, your presenting needs and clinical fit. If the fit is not right, tell us and we will move you to someone else.
3. 50-minute sessions, in clinic or online.A standard session is 50 minutes. Skills work and reviewing the week both happen inside that session; DBT programmes elsewhere sometimes run a separate skills group alongside, and if group work is part of what is proposed for you your psychologist will say so and explain what it would involve. If a session runs beyond 50 minutes and your psychologist has the time, you can extend by an hour at an extra fee — you are told what that is before it happens. Minor overruns of one to five minutes are not charged.
4. Reviewed as it goes.What you are working on is revisited rather than assumed. Where the difficulty turns out to be more about thought patterns than about managing emotion, CBT may be used instead; where something unprocessed sits underneath it, your psychologist may raise trauma therapy.

At PHC, DBT is used with teenagers and adults. It asks something of you between sessions — noticing, recording, trying a skill in a situation where you would normally not have one — so it suits someone who has the room for that, or who can be helped to make the room.

For younger children the same ground is usually covered through play therapy and behavioural approaches rather than through skills taught in words, with the parents closely involved.

It is also not the first thing that happens in every case. Where screening points somewhere else — a picture that needs psychiatric input, a trauma that has not been addressed, a difficulty better met by a different modality — you will be told that, and DBT is not started for the sake of starting something.

Each of these has a page of its own explaining what PHC does about it. DBT is named on each of them as a modality that may be indicated — which one applies to you is decided at the initial session.

• Personality disorders
• Depression
• Low self-esteem

These are some of the presentations DBT is used for at PHC, not all of them. See every condition we work with.