An overview of Dialectical behavioral therapy (DBT) as a Neo-Adlerian approach by Christene Narikkattu
Christene Narikkattu
Dialectical behavioral therapy (DBT) is a third-wave form of cognitive behavioral therapy (CBT) aimed at reducing symptoms associated with borderline personality disorder. In the late 1980s, Marsha Linehan derived this form of therapy, as she was frustrated with the current system set to help individuals with this form of psychopathology. Since its conception, DBT therapy has been used to help individuals change maladaptive behavioral patterns such as reducing self-harming behaviors, suicidal ideation, and substance abuse. This approach looks at increasing the individual’s emotion and cognitive regulation skills to better manage negative emotion states through changing and bringing awareness to behaviors that are problematic. Traditionally, DBT theory has been considered a cognitive and behavioral approach. However, one would argue that DBT might be more appropriately termed a “Neo-Adlerian” approach. The purpose of this entry will describe the similarities of Adlerian and DBT theory while focusing on the core tenets of Adlerian psychology. Furthermore, the entry will also discuss the unique features of both theories.
Surprisingly, there are many similarities between DBT and Adlerian theory. One of the first ways in which DBT and Adlerian theory are related is social embeddedness. Adlerians conceive that that behavior is related to one’s social networks and their attempts to belong within their community. Their striving for belonging generates behavior and their goals to feel connected with others. In a similar fashion, DBT grounds treatment in a systematic approach. For instance, DBT relies on a consultation team, group therapy, and phone consultation where community and the system provides a way for the individual to gain relief from their symptoms. Both theories share a familiarity with positive psychology. Adlerians assume that all individuals are act in accordance with their strengths and weaknesses and not seen in terms of their liabilities. In the same manner, DBT postulates that as one of their assumptions individuals are acting the best the can to reduce problematic behaviors. In both theories, having a positive outlook on human behavior is considered to be highly important. Phenomenology, or the subjective experience of being, is relatively important to both theories. Both DBT and Adlerian theories suggest that the context of how the individual views their own world is a product of their own beliefs and this is considered to be highly important regardless of the condition of their actual environment. Motivation is also central to both theories. DBT theorists suggest that an individual’s goals and progress through therapy is a direct result of their motivation to make change in their lives. DBT therapists focus on making change their therapy. In a similar sense, Adlerian theorists indicate that motivation helps gauges an individual’s ability to make sense of their life and how to create judgments about the world around them. In addition, DBT and Adlerian theorists agree on the term of optimism. Both theories agree that behavior can be changed and used as something that is purposeful. Although they disagree in the manner in which they execute positivity, the importance of optimism is a core tenet of each theory.
While they have distinct similarities, their unique features should also be noted. The theories diverge on the fundamental aspect of treatment. Adlerian theory is focused less explicitly on biological aspects of behavior. Adlerian theory tends to focus on the social context and the behaviors that grew out of a need for belonging, influence of birth order, lifestyle, and holism of the individual. However, by DBT therapeutic design, the theory is used to reduce or eliminate triggers that lead to stressful negative states. In addition, both theories carry out the function of treatment in distinctly different ways. DBT theory functions as a means of changing behavior, whereas Adlerian theory’s focus is not changing behavior. However, Adlerian theory focuses on making movement towards goals. In this instance, treatment and the way treatment is carried out looks distinctly different within the two theories.
While both theories focus on the here-and-now relationship of therapy, there is less of an emphasis in DBT theory to look at personal history of the patient. DBT theories would not need to conceptualize the client holistically or consider birth order since history is not relevant towards treatment. However, Adlerians might emphasis a client’s personal history and their attributes towards understanding the client’s meaning making process. Due to their distinctly different conceptualization skills, both theories utilize different types of therapeutic interventions. For instance, Adlerians might utilize interventions that get at the core of the client’s understanding of themselves and their environment. For instance, they might use “The Question” asking things like “What would be different if you were well?” This helps determine if the individual’s issues were physiological or psychological. In addition, they might also practice “Catching Themselves” in behaviors that they wish to change and become introspective about their decisions. Another common practice in Adlerian theory uses “Spitting in the Client’s Soup” or indicating that the client’s specific behaviors are undesirable. DBT therapists use concrete tools to increase the client’s level of wellness, which might be through diary cards or metaphors. In addition, the support of the milieu therapy showcases the effectiveness of DBT.
While DBT and Adlerian theories come from different psychological frameworks, they share similarities on their core tenets. This would lead one to believe that DBT is a Neo Freudian theory based on its focus of social embeddedness, phenomenology, positive psychology, and optimism. These tenets would also lead one to believe that DBT as well as CBT has profound commonalities with the theory. Overall, DBT and Adlerian theorists have a similar understanding of human behavior, conceptualization of treatment, and the way in which an individual should consider their world around them. For a detailed discussion on the commonalities between Adlerian and DBT theory, please reference this link to gain further information. The following are essential writings in DBT theory:
Koerner, K. (2012). Doing dialectical behavior therapy: A practical guide. Guilford Press.
Linehan, M. M. (2014). DBT skills training manual. Guilford Publications.
Pederson, L., & Pederson, C. S. (2011). The expanded dialectical behavior therapy skills training manual: Practical DBT for self-help, and individual and group treatment settings. PESI Publishing & Media.
Robins, C. J., Ivanoff, A. M., & Linehan, M. M. (2001). Dialectical behavior therapy. Handbook of personality disorders: Theory, research, and treatment, 437-459.
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