Dialectical behavior therapy, usually called DBT, is a structured way of understanding what happens when emotions, thoughts, body sensations, and relationships become hard to manage. It is not about telling you to calm down, think positively, or simply try harder. Instead, it combines compassion for what you are experiencing with practice aimed at making situations more workable. In DBT, acceptance and change are not opposing choices. Both can be useful at the same time.
A clear guide to the approach
Dialectical Behavior Therapy
A flexible, skills-focused approach that balances acceptance of your current experience with practical changes that may support steadier emotions, more manageable stress, and clearer relationships.
Written by Andrew Qualy, MSW, LICSW, LCSW · Reviewed September 2026
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A practical balance of acceptance and change
Acceptance means making room to notice your present experience without adding shame or a fight with yourself. You might acknowledge that you are angry, exhausted, afraid, lonely, or overwhelmed, even while deciding that a familiar reaction is not serving you well. Change means identifying a next response that is more consistent with your values and longer-term needs. The balance can sound like this: your feelings make sense in context, and you may still want support choosing what to do next.
The approach is distinctive because it turns broad goals such as coping better or communicating clearly into learnable skills. Mindfulness helps you notice what is happening in the present moment. Distress tolerance offers ways to get through a painful moment without making it harder. Emotion regulation focuses on recognizing emotions and understanding what influences their intensity. Interpersonal effectiveness supports asking for what you need, setting limits, handling conflict, and protecting self-respect.
I integrate these areas into individualized counseling rather than treating every person as if the same workbook or sequence should fit. We may slow down and practice one skill, examine a difficult interaction, or connect a present reaction with a pattern that has developed over time. This is individual therapy, not a claim to provide a comprehensive DBT program with every standard component. The work stays collaborative, practical, and responsive to your goals.
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What research says, and what it does not say
DBT has a substantial research base. It was originally developed for adults with persistent suicidal behavior and later became widely studied for people experiencing borderline personality disorder, a condition associated with severe emotion regulation and relationship difficulties. Controlled clinical research has found that comprehensive DBT can reduce some high-risk behaviors and support treatment engagement for some participants in those settings. Professional psychology resources describe DBT as an empirically supported treatment, while also recognizing that research findings belong to defined programs and study populations.
The evidence has also expanded beyond the original use. Adapted DBT skills and related programs have been studied for concerns that can include self-harm, substance-use concerns, eating-related difficulties, depression, and intense emotional reactivity. Findings are not identical across all concerns, formats, or people. Some research examines full programs that include weekly individual therapy, group skills training, coaching between sessions, and a clinician consultation team. A person receiving selected DBT skills in individual counseling is not automatically receiving that same comprehensive treatment or its evidence base.
That distinction matters for honest care. Research can show that an approach is useful for certain people under particular conditions; it cannot predict exactly what will happen for one person. DBT skills may be relevant when emotions rise quickly, urges feel difficult to manage, conflict repeats, or coping strategies bring short-term relief but create later problems. They may be less central when another approach better matches your concerns, resources, safety needs, or preferences. I will discuss fit rather than presenting DBT as the answer to every problem.
Evidence-based does not mean rigid or guaranteed. It means the approach has been examined in professional research and has identifiable principles that can guide care. In our work, I use those principles thoughtfully and explain why a skill may be relevant. We can also draw from other counseling approaches when that would make the work more understandable or useful. If your needs call for a level of care or specialized service outside individual counseling, I can be direct about that and discuss appropriate next steps.
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What an individual session can look like
A session often begins with a brief check-in about the week, your current stress level, and anything that feels especially important today. We may identify a situation that brought up strong feelings, a behavior you want to understand, or a conversation that did not go as you hoped. You do not need to arrive with polished language or a complete explanation. Part of the work is slowing down enough to describe what happened before deciding what it means.
Next, we may map the chain of events. Together, we look at the prompting situation, thoughts, body cues, emotions, urges, actions, and consequences. This is not an exercise in blaming you. It is a way to find points where another response might be possible. For example, we might notice that poor sleep, a tense message, and an old fear combined to increase the urge to withdraw or react sharply. Seeing the sequence can create more choices without denying how difficult the moment felt.
Then we choose a skill or small experiment that fits the situation. Mindfulness practice may involve observing thoughts and sensations, describing them in plain language, and returning attention to the present without judging yourself for getting distracted. Distress tolerance may focus on safely riding out a short-term surge, accepting what cannot be changed in that moment, or using grounding and self-soothing.
Emotion regulation may involve naming the feeling, noticing what intensifies it, and making room for experiences that support steadiness. Interpersonal effectiveness may involve preparing a request, setting a boundary, or planning how to stay engaged during disagreement.
We may practice the skill in the session through a rehearsal, written reflection, or discussion of a recent event. I can invite you to try a modest between-session practice, such as noticing one body cue, writing down the sequence of an interaction, or using a communication plan once. Practice is an invitation, not a test of whether you are doing therapy correctly. At the next meeting, we review what you noticed, what got in the way, and whether the skill should be adjusted.
Some people expect DBT to mean that a therapist will dismiss feelings in favor of techniques. Acceptance is actually central. Others expect a therapist to agree with every action because the emotion makes sense. Validation and accountability can coexist: we can understand the reasons a response developed while examining its effects and considering a different response. Individual counseling also does not automatically include group training, phone coaching, or a consultation team. We will be clear about the format and boundaries of the service.
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Who may find these skills useful, and when another fit may be better
DBT-informed individual counseling may be worth considering if you feel emotions intensely, take a long time to come back to baseline after stress, or find yourself acting quickly and regretting it later. It may also fit when you are working through repeated relationship conflict, difficulty saying no, trouble asking for support, shame after an argument, or a pattern of avoiding conversations until pressure builds. You do not need to use a diagnostic label or have a particular history to ask whether these skills could be relevant.
The approach can be useful for adults facing anxiety, chronic stress, burnout, grief, identity or purpose questions, occupational pressure, sleep challenges, and difficult transitions when emotion regulation or communication is part of the picture. It may provide a practical complement to trauma work, cognitive therapy, or other counseling. For a veteran, first responder, healthcare professional, or another person accustomed to functioning under pressure, learning to notice internal signals can be as important as learning to respond effectively to external demands.
Fit is individual. A skills-based approach may feel too structured if you primarily want open-ended space to process an experience, although the structure can be adjusted through conversation. Another modality may be a better starting point when the main need is a different kind of focused trauma treatment, medication evaluation, medical care, substance-use treatment, or a higher level of support. If you are dealing with immediate danger, severe impairment, or a crisis that cannot be safely managed in routine outpatient counseling, individual DBT-informed work is not a substitute for emergency or crisis services.
I will not assume that a difficult feeling means you have a disorder, and I will not use DBT to force you into a predetermined plan. We can talk about your reasons for seeking counseling, what has and has not helped before, your capacity for practice, and what you want to be different in daily life. Reaching out does not require waiting until things are unbearable. Many people seek support while still meeting work, family, or community responsibilities, and that is a valid time to begin a conversation.
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Duration, pacing, and reviewing progress honestly
There is no single correct length for individual counseling using DBT skills. Comprehensive DBT programs often run for at least six months and may continue for a year or longer because they teach and repeat multiple skill modules alongside other treatment components. That timeline should not be presented as the required length of every individual counseling relationship. A focused piece of work may be shorter, while concerns that involve several patterns may need more time and repetition.
Early sessions are usually used to understand your goals, establish a workable focus, and decide whether this approach fits. We can then set a review point rather than assuming that therapy must continue indefinitely. At a review, we might ask what you are noticing in your reactions, whether you can access a skill when stress rises, whether relationships or routines feel more manageable, and whether the focus still matches your priorities. These observations are not promises or a scorecard; they help guide a thoughtful decision about next steps.
Progress is often uneven. You may understand a skill in a calm session and find it difficult to remember during a painful interaction. A setback does not erase what you have learned, and a good week does not prove that every concern is resolved. We can look at barriers such as exhaustion, competing demands, fear of conflict, limited support, or a practice that was too ambitious. Sometimes the appropriate change is to simplify the skill, slow the pace, shift the focus, or consider a different form of care.
Frequency and ending are collaborative topics. We can discuss a regular rhythm that is clinically appropriate and realistic for you, then revisit it as circumstances change. When counseling is nearing an ending, we can review useful skills, warning signs that you want to notice earlier, supports you can draw on, and questions that remain. If ongoing or more intensive care would be helpful, I will not frame that recommendation as a failure. The goal is an honest match between the support available and what you are asking therapy to address.
Related ways to explore support
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Questions about the method
Frequently Asked Questions
No. Full or comprehensive DBT commonly includes individual therapy, group skills training, between-session coaching, and a clinician consultation team. Andrew offers individualized counseling that may draw on DBT principles and skills. He will explain what the work includes, what it does not include, and whether another program or level of care would better match your needs.
Acceptance means making room to understand your feelings and circumstances without shame or judgment. Change means exploring responses that may better support your values and daily life. A session can hold both: your reaction may make sense in context, and you may still want to practice a different way of responding to a difficult moment.
No. DBT skills are used in different settings and may be relevant to adults who are struggling with intense emotions, stress, conflict, avoidance, or communication. You do not need to diagnose yourself. Andrew will listen to your concerns, discuss fit, and avoid presenting a skills-based approach as appropriate for every person or every situation.
The length depends on your goals, the concerns you bring, your preferences, and how the work develops. Comprehensive DBT programs often last six months or longer, but individual counseling using selected skills may have a different timeline. Andrew can set review points with you and discuss whether to continue, adjust the focus, conclude, or seek additional support.
In-person sessions are not offered at this time. Telehealth is available statewide in Colorado and statewide in Minnesota. If you are in one of those licensed markets, you can ask about the format that fits your circumstances. There is no office or in-person service represented here.
A grounded next step
Ask whether Dialectical Behavior Therapy fits your goals.
A free consultation can focus on what the approach involves, how I use it, and whether another option would serve you better.