My DBT-Centred Approach

What Is DBT?

If you have the gas for my long-winded answer, check out this blog post I wrote for a former workplace: DBT 101: It's So Much More Than Just the Skills!

Or, here’s my TL:DR: Dialectical Behaviour Therapy (aka DBT) is a “third wave” evolution of cognitive-behavioural therapy (CBT). It was created for suicidal folks with “BPD” because original-CBT wasn’t helping them well enough. One of DBT’s big differences from original-CBT is how it emphasizes dialectics, which is about allowing seemingly opposite things to both be true at once. DBT’s most important dialectic is balancing acceptance versus change. My favourite example of acceptance and change is with emotions: All emotions are totally understandable for some reason and worthy of our loving attitude toward them, and some of those emotions are helpful to act on right now (acceptance); and, some of those emotions aren’t helpful to act on anymore, and we can learn to change our relationship with them (change).

That’s barely scratching the surface, and I could talk about this forever. So let’s chat more about what DBT is during our free 60min initial phone consultation.

How You Can Feel Out if We’re a Good Enough Fit to Work Together

My “Getting Started Handbook.” Some people prefer to read stuff before deciding whether to talk to people! You’re welcome to e-mail me with a request for my “Getting Started Handbook,” which is more detailed than this website and tells you a lot more about how I work. If you get your bearings more from reading rather than talking, you may like to do this even before you book your free 60min initial phone consultation.

Free 60min initial phone consultation. We’ll have a free phone call together before we decide whether to book a first session. This’ll be to ask some questions and rule out anything obvious that would get in the way of us working well together. Go to this page to book the call.

Pretreatment. Our first 6-8 sessions is called “pretreatment,” during which time we’ll still be figuring out whether to commit to working together for longer than that. This phase is about orienting you to how we can work together and assessing what we both need to know for that to work well. By our eighth session, we’ll decide whether or not to commit to working together for at least a year, or whether another therapist or approach might be a better fit for you.

A “Week in the Life” of Therapy With Me

Once we’ve finished pretreatment, in every week in therapy with me, there will be:

  • an 80-min session at your regular weekly time,

  • a formal and separate individual DBT skills-training lesson for the final 30 minutes of the above session,

  • at-home DBT skills-training for you to do,

  • a daily DBT Diary Card for you to fill out and

  • DBT phone coaching during my on-call hours.

Occasionally outside of your weekly individual session time, there may also be:

  • inter-professional meetings that you and I have together with other health providers or workers in your life;

  • family meetings with your loved ones (including chosen family).

What Each Weekly Session Looks Like

Once pretreatment is done, here’s what each 80min session looks like.

Diary card review. We spend the first 5min or so reviewing your diary card together and setting our session agenda based on that. DBT diary cards are a way for you to quick-and-mindfully self-monitor each day…kinda like mini-journaling. I can show you how to fill one out.

The central part of the session. We spend the next 45minutes of the session working on the things we chose for the agenda, which I can tell you more in our free 60min initial phone consultation.

Individual skills-training lesson. We spend the last 30 minutes of the session together on an individual DBT skills-training lesson. This lesson feels more like a class than therapy — but, like, IMHO a fun class, NOT like Ferris Bueller’s history class! In each in-session skills-training lesson, 1) we’ll review the skill you were assigned for practice in the past week, and then 2) I’ll teach you a new skill and 3) assign you the new skill to practice for the next week.

DBT Phone Coaching

I offer DBT phone coaching between sessions, during my on-call hours. I’m on-call 7.5 hours per week or 1.5 hours per day, Tuesday-Saturday. This is because your day-to-day stuff often looks different than your therapy session. So I’m there on the phone to coach you in how to transfer what you’re learning in therapy to the rest of your life. Each phone coaching call is about 5-7 minutes long.

The Limitations of my Program

Since I represent myself as a DBT practitioner, it’s important for you to know how closely I do and don’t practice DBT. While I believe that my approach is an in-depth use of DBT, my program is not Comprehensive DBT. Comprehensive DBT requires the therapist to engage in and offer all four DBT treatment modes:

  • individual DBT therapy;

  • DBT skills-training as a separate component from the “individual therapy process” that is typically in a 2.5hr skills group, as opposed to “teaching skills as they comes up;”

  • DBT phone-coaching that is either 24/7 or multiple hours per day;

  • the weekly DBT consultation team (i.e., the DBT therapist meets with a weekly consultation team of other DBT therapists who share the same clients for phone-coaching and skills-training, who discuss their work strictly based in a DBT framework).

I offer a version of all 4 DBT treatment modes, but each of them except individual therapy is modified:

  • I teach formal individual skills training as a 30min component of your weekly 80min session (rather than in a 2.5hr weekly skills group);

  • I offer on-call hours for phone coaching during set shifts for 90min per day, 5 days per week (rather than 24/7 or multiple hours per day);

  • I participate in a biweekly DBT consultation team with other solo providers (instead of sharing clients with providers in a group practice).

So The DBT that I use is classified as DBT-centred but not DBT-comprehensive.

There are great benefits to a more comprehensive DBT approach. Having more than one person connected to your psychotherapy can be extremely helpful, and I don’t offer that: I’m a one-enby band. That’s a drawback for sure. On the other hand, my clients and I have found the modified treatment modes that I offer to be incredibly helpful. You may wish to talk more about the pros and cons of comprehensive versus non-comprehensive DBT with me in our free 60min initial phone consultation.  

Alejandra Lindan, MMT, RP

Registered Psychotherapist #001976