Dialectical behavior therapy (DBT) is a treatment that was originally created by Marsha Linehan and her team to treat individuals with borderline personality disorder (BPD). Folks with BPD have what’s called pervasive emotion dysregulation—in other words, they struggle to identify what they’re feeling, don’t have the skills to effectively manage the emotions that arise, and end up turning to problem behaviors (such as suicide attempts, self-harming behaviors, or substance use), in an attempt to cope.
Your session is almost complete and you and your client are ready to say goodbye. You are both walking to the door and suddenly your client says, “By the way…” and tells you something worrisome. It could be anything from “I’ve decided to go off my medication” to “I just met this woman and we’re getting married!” Why didn’t your client tell you this at the beginning of the session?
Are some of your clients overwhelmed by their emotions? Does the knob seemed turned all the way up when they’re angry, ashamed, fearful, or sad? Do they struggle to avoid painful affect, and then, as they lose control, become overwhelmed by a tsunami of feelings? Do they believe that certain emotions are unbearable (distress intolerance), and that they lack the ability to face them? As you know, these are all features of emotion dysregulation, and a corresponding lack of emotion efficacy.