Is Using Dialectical Behavior Therapy (DBT) in DID Treatment Okay?
Dialectical behavior therapy (DBT) can be used in dissociative identity disorder treatment. Dialectical behavior therapy is a type of therapy used in the treatment of numerous psychological disorders, including borderline personality disorder (BPD), mood disorders, and eating disorders. The skills taught in DBT -- distress tolerance, emotion regulation, mindfulness, and interpersonal effectiveness -- can also be helpful for people with dissociative identity disorder (DID). But that doesn't mean that DBT is the best choice for treating DID. As with any type of therapy, there are pros and cons.
Pros of Dialectical Behavior Therapy in the Treatment of DID
Distress Tolerance and Emotion Regulation Skills Can Reduce Impulsive Behaviors in DID
While it's not a criterion for DID, many people with DID struggle with impulsive behaviors, including self-injury, eating disorders, and substance abuse. The distress tolerance and emotion regulation skills taught in DBT can help people regain control and decrease these harmful behaviors. Alters can also learn the skills, which can be useful for systems that have destructive parts.
Mindfulness Can Help Decrease Dissociation and Improve Grounding Skills
While dissociation can be useful in some circumstances, it can also wreak havoc on the person's ability to function well. The mindfulness exercises taught in DBT can help decrease dissociation by using grounding techniques and allowing the person to be in the present moment. This can lead to better functioning
Cons of Dialectical Behavior Therapy in DID Treatment
DBT Does Not Recognize Dissociative Identities
Traditional DBT does not recognize or acknowledge the presence of dissociative identities or "alters". DBT aims to treat the whole person as an individual, and does not include treatment of multiples. This can be harmful, as the lack of acknowledgment can feel invalidating for both the host and other parts in the system.
In addition, it is essential to promote communication within the system, especially early on in treatment. When a system isn't recognized, it can slow down or even stop any possible progress in improving symptoms and managing life with DID.
DBT Does Not Treat DID Trauma Directly
Though DBT is commonly used with survivors of trauma, it is not meant as a form of processing therapy. The main focus in DBT is on learning skills and building a life worth living. There is little processing of past trauma involved -- it is more about understanding the effects trauma has in the present moment. While this can be beneficial, for those with DID, many systems need to process trauma in order to function more effectively.
Dialectical Behavior Therapy Can Be a Beneficial Supplement in DID Treatment
Taking both the pros and cons into consideration, DBT does have benefits for people with DID. Learning to tolerate emotions and practicing grounding can help systems be more functional, and also provides the skills that many systems need in order to process trauma safely and effectively.
DBT can be considered as a supplemental form of therapy. Because of its lack of recognition of DID and limited trauma-processing, another form of therapy should be used in addition to DBT. Finding a therapist experienced in the treatment of trauma and/or dissociative disorders is the first step. He or she can help you decide what types of therapy will be the most helpful for you and your system.
Matulewicz, C. (2017, July 20). Is Using Dialectical Behavior Therapy (DBT) in DID Treatment Okay?, HealthyPlace. Retrieved on 2022, June 30 from https://www.healthyplace.com/blogs/dissociativeliving/2017/07/pros-and-cons-of-using-dialectical-behavior-therapy-for-did
Author: Crystalie Matulewicz
BPD sufferer here, DBT is highly praised, but let's be honest, it sucks even for BPD. My schema therapist introduced DBT elements and they were huge part why I stopped going to her after almost 3 years. Plus, DBT has misleading marketing or to make it clear: DBT proponents lie. Most BDT claims are exaggeration, half of therapy is pure speculation (never tested, if I am wrong, please, tell me where are studies about 3rdand 4th phase of DBT) and in studies 85-100% population are girls/women. How you can say that something that is tested on 20 yo girls who have significant self harm and addiction problems applies to 35-40 yo male without any kind of dependence and self harm on level "too much scratching" is beyond me. And spare me stories about studies, scientific work etc, I have published paper in high (actually huge) impact factor journal so I know thing or two about whole process. DBT gimmicks that supposed to calm me down just infuriated me and therapist (and probably supervisor how suggested inclusion of DBT or I was told that) were too stupid to see that and crumbling therapeutic alliance. But at I least, I have learned that "therapeutic alliance", "unconditional acceptance" and "limited reparenting" are just euphemisms for emotional prostitution and that therapist are just emotional prostitutes. DBT for this, DBT for that, tons of people are doing DBT therapy and I have never seen single post in any BPD or C-PTSD facebook group saying "I was doing that for 3-5 years, now I live normal life". You can read how DBT is amazing etc, some say it sucks, but where are cured people? There are almost none. And now you want to do same quackery to people with DID. What kind of people therapists are? I would say, too many (almost all?) are pure misanthropes, enjoying taking money for useless therapy or even worse, inflicting emotional wounds to highly vulnerable population that is widely open for any kind of manipulation.
When we started therapy our therapist tried DBT. It was hell. We hated it. The program is rigid and cold. Much too similar to our childhood. We would never try DBT again.
Desperately seeking a cure. We have been waiting for an opening to become available with our local DBT group and are currently in weekly Psychotherapy for over six years now. Diagnosed with DID, BPD, OCD and Gender Dysmorphia. Living Hell. We have little hope that DBT will benefit us, but we will try.
Another problem with relying on DBT for the treatment of dissociative disorders is that frequently the individual with a dissociative disorder gets triggered at the mid-brain level (fight/flight/freeze) and just goes 'off-line', which makes it impossible to use higher cortical functions (like wise-mind). The inability to be mindful in the face of being triggered creates a sense of failure (and often accusations from clinicians that the dissociative person is not trying). One has to be able to be aware of what the triggers are in order to stay mindful and avoid dissociative defenses. However, often switching occurs and the trigger is forgotten as it's left in the last identity that was in the body when the trigger occurred. One person said to me, "If I could do DBT, I wouldn't need it!" In that case, it becomes just another treatment situation in which, in order to please the therapist, the individual 'fakes' being "mindful' and then doesn't end up learning new skills. I also agree that to the extent that DBT doesn't treat the underlying problems of compartmentalization and escapism that healing cannot really occur.
Agree with this! Although we might be biased as she was our psychiatrist lol
And obv we have very similar viewpoints as you, crystalie.