“DBT is too soft.”
We have heard the judgment that DBT accepts inexcusable behaviors or expects environments around clients to do the changing for the client. This comes from a lack of understanding the change acceptance dialect.
DBT balances strategies between the dialect of acceptance vs. change. Acceptance strategies are necessary for change and applied first during interventions. Many other treatment modalities do not have acceptance as a central focus so DBT may be judged as “agreeing” with difficult client behaviors. Those unfamiliar with DBT may overlook how much DBT is about learning and building effective behaviors, while being respectful of emotion.
DBT provides generous assumptions that balance acceptance vs. change. Non DBT clinicians may misunderstand generous assumptions on the acceptance end if the dialect, for instance everyone is doing their best. They may believe this assumption validates ineffective behaviors. Other acceptance assumptions are that suicidal client’s lives are unbearable as they are being lived, clients want to improve, therapists can fail DBT, DBT can fail even if the therapist cannot, clients cannot fail in DBT, etc. These assumptions may be misunderstood that DBT clinicians expect too little of clients, however these assumptions serve to decrease shame in individuals who live lives full of shame and often make egregious, regretful mistakes in their relationships. Shame leads to self-destructive behaviors and prevents learning. Strategies from the acceptance end of the dialect serve to reduce shame, providing a space from where change strategies can and must be implemented.
Assumptions from the change end of the dialect include everyone is doing their best and they can do better. Clients may not have caused all the problems in their life, but it is their job to solve them anyway. Clients need to do better, work harder and be more motivated to change. New behavior must be learned in all relevant contexts, and clients must learn skills in therapy and use them in their lives outside of therapy.
We are at times a little nonplussed when we hear complaints leveled against DBT for having low expectations of clients. We believe the assumption that suicidal patient’s lives are unbearable as they are being lived. They MUST change, since not changing is life threatening. In spite of most DBT naïve practitioners knowing that DBT is skills-based, they can paradoxically believe that clients aren’t expected to change in treatment. DBT has roots in stoic philosophy--sitting around complaining isn’t going to help. Teaching others to feel their feels and move forward effectively is the path to building a life worth living.
All Therapists are Jerks, and . . .: "DBT is too soft." (libsyn.com)
All Therapists are Jerks, and . . .: Ep 3. Notes on Suffering (libsyn.com)
All Therapists are Jerks, and . . .: Ep 4. Radical Acceptance (libsyn.com)
All Therapists are Jerks, and . . .: Assumptions (libsyn.com)
All Therapists are Jerks, and . . .: Ep 13. Validation (libsyn.com)
All Therapists are Jerks, and . . .: Ep 14. Levels of Validation (libsyn.com)