The DBT: a co-therapy to manage emotions
Is not only individual therapy with a therapist but will I also have to attend groups in which they will teach me skills?
Yes, it is the Dialectical Behavior Therapy (DBT)that the scientific evidence and international guidelines indicate to us to be very effective for the treatment of some complex disorders, such as, but not only, the borderline personality disorder.
The DBT is therefore a Cotherapy, or a defined, structured, scientifically valid work method that integrates the intervention on several levels: individual therapy with its own psychotherapist and a group intervention whose objective is the learning and enhancement of specific skills (skills training) to manage emotions and interpersonal relationships.
Interview with Prof. Cesare Maffei: to discover the DBT
But let’s go by degrees, the Professor Cesare MaffeiEmeritus professor of clinical psychology and professor at Sigmund Freud University, founding partner and past president of the Italian company DBT He guides us to discover this therapeutic model.
The DBT is a psychotherapeutic treatment model conceived by Marsha Linehan in Seattle, between the 80s and 90s, aimed at patients with serious emotional and behavioral discomfort, or with episodes of self -harm, suicide attempts, risky behaviors, use of alcohol and substances, food symptoms, and other dysfunctional behaviors.
According to Linehan, dysfunctional behaviors are attempts to regulate profoundly deregated emotions, which become real emotional and behavioral crises since the person is unable to use (or has never learned) healthier and more adaptive ways to calm, face and tolerate negative emotions that lives in a very intense way. Therefore, dysfunctional behaviors are activated to transiently regulate and lower the unwanted emotional states into the immediate.
Of course, dysfunctional behaviors are harmful to the individual and should not be implemented (they accompany inevitable negative consequences for the individual in the short, medium and long term), but the DBT model pushes us beyond the border of judgment (“should not be done”) and takes us to a horizon of explanation, pushes us to question us what function they have these behaviors. In their dysfunctionality, what do they use the patient and why continue to implement them? What methods and strategies can be put in place to reduce them and to ensure that the patient learns and strengthen alternative ways to regulate unwary emotions?
Prof. Maffei highlights that today the DBT treatment is the most widespread in the world for borderline personality disorder. Therefore, they are not only theories, but these are clinical theories widely proven by solid empirical research bases.
Over the years, the model has seen further adaptations, for example for the treatment of multiproblematic teenagers, for addictions (alcohol and substances) and for eating disorders.
Prof. Maffei on the DBT for teenagers
Prof. Cesarei Maffei, in his interview, illustrates us clearly and exhaustively the application of the DBT for teenagers with problematic behaviors.
The DBT is indicated for multi -pupable adolescents from a behavioral point of view, teenagers who have problematic behaviors, primarily that of self -harm (e.g. cut, burning, get physical pain). When self -harm is configured as a repetitive, usual and stable phenomenon becomes a worrying condition. In fact, Prof. Maffei recalls that chronic self -injury predicts attempted suicide and that suicide is the third cause of death in the adolescent. In the mutable adolescent, other types of dysfunctional behaviors can also occur that are accompanied by self -harm, such as, for example, use of substances and alcohol, food symptoms, the tendency to withdraw and avoid social and school life. The teenager can have difficulties with the peer group and finds in the closure and retreat in the house an escape route to negative emotions; However, this is not the case, since, the teenager only often broods and rumin, tries negative emotional states and uncomfortable (I am alone, I don’t go to school and I feel that I remain behind, I feel guilty, I am excluded, etc.). And it is here that in some cases the dysfunctional behaviors are triggered to turn off the intense negative emotion and suffering. But the vicious circles are triggered since the problematic situation is not resolved, the negative emotion is reduced only transiently, further negative states achieve.
Prof. Cesare Maffei then explains how the DBT provides for clear steps to outline a therapeutic path of effective help.
With adolescents, as well as for adults, the therapeutic plan primarily provides for a pre -treatment phase in which diagnostic assessments and specific insights are carried out, with attention to the aspects of emotional vulnerability and emotional disregulation.
Once this phase of pre -treatment is completed, where indicated, a therapeutic itinerary is activated which sees the combination of very concrete individual weekly psychotherapy sessions and focused on specific objectives: the session is guided by the compilation of a precise weekly form, which starting from problematic situations, identifies what emotional suffering generates, what does not trigger dysfunctional behaviors and work on the skills Adaptive alternative strategies to regulate internal states.
In parallel, children are asked to attend group meetings weekly aimed at learning specific skills relating to emotional regulation, interpersonal efficacy, tolerance of suffering, fundamental skills to implement alternative methods of dysfunctional behaviors.
They are called in jargon “groups of skills training” and close collaboration between those who conduct the groups of skills training and the individual therapist is important: the individual therapist in his sessions also help the boy helps the skills learned in the groups of skills training and to generalize them in situations of daily life.
There are also groups of skills training aimed at the parents of teenagers to understand dysfunctional behaviors, do not judge them and learn strategies to be able to face them and manage more effectively.
Understanding dysfunctional behaviors and not judging them, does not mean resigning by accepting that they go well: vice versa, it means making the teenager feel that he is not judged or punished for what he does, but that we try to understand; It is important that the teenager feels that someone can help him understand why these dysfunctional behaviors are activated and to be able to reduce them.
Look at the complete interview with Professor Maffei:
