Do You Have to Be in Crisis to Do DBT? | DBT Therapist Greensburg, PA

A lot of people read about DBT, recognize themselves in about half of it, and then talk themselves out of it, often because they don't understand fully or because of stereotypes.

The reasoning usually goes one of two directions. Either "I'm not bad enough for that," or "that's for people with borderline personality disorder and that's not me."

Both of those are worth a closer look, because we've watched a lot of people wait years longer than they needed to before reaching out.

Who is DBT actually for?

Simply put, DBT is meant for individuals who experience things like a rollercoaster of emotions, difficulty in their personal relationships, feel like stressors are piling up, and have trouble staying in the here and now.

Read that again, because there's nothing in it about hospitals or diagnoses. ‍

A rollercoaster of emotions. Relationships that keep going sideways. The sense that everything is stacking up faster than you can handle it. Difficulty staying in the present moment.

That's a much wider door than most people assume.

Was DBT created for borderline personality disorder?

Yes, originally. Absolutely.

Marsha Linehan developed DBT while working with people who were chronically suicidal and repeatedly self-harming, many of whom met criteria for borderline personality disorder. She has spoken publicly about her own history with that kind of suffering, which is part of why the treatment is built the way it is. It was designed by someone who understood the problem from the inside.

What she was trying to treat was suicidal behavior. BPD was the diagnostic category the research world had for those patients, so that's the category the studies got built around.

That origin gave DBT the strongest evidence base of any treatment for BPD. It also gave it a reputation that has since stopped being accurate.

Because here's what happened next. Researchers kept studying DBT in other populations, and it kept working. Today it's used for eating disorders, substance use, treatment-resistant depression, PTSD alongside other diagnoses, and emotion dysregulation generally, whether or not anyone has ever put a personality disorder label on it.

Do you need a BPD diagnosis to do DBT?

‍No. Absolutely not. You don't need any particular diagnosis.

We aren't screening for a label. We're looking at how your emotional system works and what it's costing you.

If your emotions come on faster and bigger than other people's and take longer to settle, if you've found ways to survive those feelings that help in the moment and cost you later, if your relationships keep ending in ways that leave you wrecked, DBT was built for that pattern. The diagnosis is beside the point.

The same is true in reverse. Plenty of people carry a BPD diagnosis and don't need comprehensive DBT right now. What matters is the pattern and the level of intensity, not the paperwork.

What if you've tried therapy for depression and nothing has worked?

DBT is also recommended for treatment-resistant depression. If you have tried everything and nothing seems to be helping with a depressed mood, DBT may be the answer.

Depression that doesn't move often isn't just depression. It's frequently sitting on top of emotion dysregulation, or a history of being invalidated, or a set of coping strategies that made sense once and are now keeping things stuck. Insight alone doesn't shift that. Skills, practiced weekly, in your real life, with a therapist watching the patterns with you, sometimes does.

What if you think your emotions are too much for a therapist?

If you've had the experience of a therapist looking overwhelmed, or changing the subject, or gently suggesting you find someone else, you learn something from that. You learn to manage the room. You show up to therapy and give the tolerable version. Or, more likely, you don't call at all.

DBT was designed for intensity, and actually calls for supervision of the therapist. So, your therapist isn't alone in dealing with intensely em

DBT Therapist in Greensburg, PA

Amanda Caldwell, LCSW utilizes DBT with clients to help clients manage intense emotions, reduce self-destructive behaviors, and improve relationships. Ready to get started? We offer in-person sessions in Greensburg, PA, and virtual appointments across PA - because DBT just might be a fit for you in Allentown, Uniontown, Ulysses, and everywhere in between. Give us a call - 724.201.9815. You deserve healing.