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Dialectical Behavior Therapy (DBT) Works if You Want it To

OK, maybe it seems like I’m being a bit hard on commenters. I swear I’m not. I like people who comment and express their opinion, but sometimes their opinion spurs one of my own. This is one such comment:

I’m bipolar, and I think we ALL should have to take a Dialectal Behavior Therapy course. The DBT course helps with coping skills, year class, and helps  . . . these skills work if you want them too.

Here’s someone singing the praises of dialectical behavior therapy (DBT). She would certainly not be alone as many people find DBT to be helpful. The problem I have with this comment is the last bit, “these skills work if you want them too [sic].”

So, this means that if the skills learned in DBT don’t work for someone it’s because they didn’t want them to?

I don’t think so.

Bipolar Therapies

There are many therapies that have been shown to help with bipolar disorder (DBT, by the way, has only a tiny bit of recent evidence behind it.) and I believe these therapies can help people. Cognitive behavioral therapy (CBT) and, even more convincingly, interpersonal and social rhythm therapy (IPSRT) can be very beneficial.

But like all bipolar treatments, therapies only help some people. While there is evidence that IPSRT helps people with bipolar disorder stay well, it does not support the notion that therapy can help everyone that uses it. Therapy is like any treatment – it helps some and not others.

Dialectical Behavior Therapy (DBT)

DBT was actually designed for the treatment of borderline personality disorder (and there is evidence it works for this), but there is interest in using it to treat other disorders such as bipolar and depression too. DBT combines mindfulness, psychoeducation, CBT, stress tolerance and other skills together into a therapeutic package. DBT is normally adapted slightly for use with other disorders such as bipolar.

DBT Works if You Want it To

Now, there is no doubt that therapy takes work and you have to do this work in order for it to be effective. Thus, you do have to “want” DBT to work in order for it to be effective.

However, simply “wanting” it to work, or, indeed, doing the work of therapy guarantees the success of DBT. The problem with saying that “it works if you want it to” is that it suggests that if it fails, it’s the patient’s fault. They didn’t want it enough. They didn’t do the work enough. The therapy was fine; the patients were the ones who were deficient.

And I don’t think this is a message we should be giving patients. Patients feel bad enough about being sick without being told it’s their fault that they didn’t get better.

So yes, I say give DBT and other bipolar therapies a try, but if you work at them and, for some reason, they are not effective, it’s not that you didn’t “want” it enough; it’s just that they didn’t work for you.

You can find Natasha Tracy on Facebook or GooglePlus or @Natasha_Tracy on Twitter.

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate and author of Lost Marbles: Insights into My Life with Depression & Bipolar.

Find Natasha Tracy on her blog, Bipolar Burble, Twitter, Google+ and Facebook.

20 thoughts on “Dialectical Behavior Therapy (DBT) Works if You Want it To”

  1. To irma rios :
    Unfortunatly, your post have been writing long time ago, and there is less chances that you read this answer. If too, I just want to say that your son presented some symptoms in his early age that made thinking at asperger’s syndrome (routines and socks that bother him…) Asperger may make difficult to find and maintain a job as an adult and the social difficulties can lead to distress or depression. Maybe he can benefit from an assessment with an autism specialist. (Sorry for my english, it’s not my usual language).


    THIS IS HOW MY X TO BE DEALS MY PROBLEMS ARE THE REASON ..BLAH BLAH BLAH I HAVE TRIED TO GO and be the better try to get him excited about changes ect…leave his house more often…I am done I do not want to live with someone who cannot be happier and have less fears of every day life. I deal with p t s d I don’t have to own it each day ….I love humor this man has NEVER busted a gut laughing ever but there is nothing wrong with him we are like oil vinager got to go and separate it is not healthy to expect someone else to make us happy we will be denied .I like me finally I like me I have a lot to work on sure who doesn’t but I don’t like being dragged around like this ………any more..

  3. My daughter is a psychiatrist and all she tells me sounds rather cold and professional. I tried DBT. Got nothing from it. Do try very hard to correct my mistakes, but if I slip when I’m around family they disect and talk about me. All I want is some slightly unconditional caring. I feel very alone.

  4. I desperately wanted DBT to work for my severe bipolar depression, but the harder I tried, the more depressed I got. Why? because I was putting so much effort into something that wasn’t the right treatment for me and more it failed, the more of a failure I felt. Eventually I was put on a different medication and within a week I was better and stayed better for 5 years. It wasn’t that I didn’t want to be well, it’s just I needed (the right) medication and ALL I needed was that medication.

    Different treatments work for different people. I tried so hard with DBT, just as I had with CBT and both made me so much worse. I know it works for most people – I see it in my own professional life – but I am not one of them.

  5. I want to hug you. No, really I do. I am literally crying right now.

    I was told over and over again that I didn’t want it hard enough. How I felt was exactly as you described it. I couldn’t and can’t say it though. Saying things like that to mental health professionals would get me written down as “non-complaint” or seen as anti-psychiatry. That enables people even more to treat me as if I have no self awareness and make them assume that I am trying to stir some kind of trouble. It’s like walking on eggshells around them but I am glad someone finally said it. I feel a bit better that there is a voice.

    Thank you

  6. Hi,
    I was diagnosed bipolar when I started to go back into therapy my Freshmen year of college. The diagnoses came from my psychiatrist. When I has another session with my therapist I told her what I was diagnosed with. She doesn’t believe that I have bi-polar disorder cause I haven’t have a manic episode. I was in therapy in my college for 2 years and when it ended I was unsure if I wanted to continue seeing a therapist.
    1 week after graduation I meant with a new therapist. After sharing my background she diagnosed me with Borderline Personality Disorder. I was upset to hear that I have another mental illness. I was told that in order to solve the problem I need to do DBT. As the program continued I was later told that part of the therapy is a skills group. I have a huge fear of being around people because I know that I will be judged. After contacting one support group I had no luck getting in. I wouldn’t be able to continue the program without doing the group. When I wasn’t able to find any possible groups my therapist came up with me just doing Skills Training with another therapist instead of a group I would be by myself.
    I have been doing skills training for a little over a month. I find it at times beneficial but have been getting more and more depressed when the skills don’t work how they are suppose too.
    I feel like I am alone because I am not able to talk about my disorders with my parents or any family member. Does anyone know a support group I could join online?

  7. Laurie,

    I don’t think that your opinion and Natasha’s are really at odds with each other. You’re both effectively saying the same thing: “try out any and all therapies until you figure out what works for you.”

    A person without a will to beat the illness won’t try different therapies, and that’s what both of you are saying. Natasha was just adding that if something doesn’t work, it doesn’t NECESSARILY mean that it’s your fault. It could be, if you didn’t do the work, but it doesn’t otherwise have to be.

    Yay for all of us, who obviously want to beat our collective bipolar!

  8. Suffering from bipolar disorder has caused me to seek out a solution in many places. For the longest time, I persistently avoided medication. I read a ton – books on spirituality and religion (which helped form a lot of my opinions, but unfortunately did nothing to quell what I now accept is a disorder). I have changed my diet, exercised, tried various herbal remedies. I’ve talked to various therapists from different disciplines. I’ve tried some really wacky approaches, too. If you are plagued with this disorder (yes, I do feel it is a tremendous burden), you will do anything. I don’t knock what people choose to pursue. I do get annoyed by people who dare tell me that I haven’t put in enough effort, did not try hard enough, that I do not want to be well. I will bet money that EVERYONE with this disorder wants to be well. It is an individual journey.

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