DBT Assumptions (Part 1)
When first looking into DBT, one of the main things that caught my eye was the DBT assumptions. This is an unassuming (ha!) page at the beginning of the DBT skills manual that details all of the things we take as truths. In DBT, they are self-evident, and we lean on these assumptions as the foundation of the therapy. Without further ado, each assumption, what it means, and why I freaking love it (no bias here, obviously). As an edit after I wrote this—wow, I'm going to have to do two posts on this one. Here we'll just focus on assumptions about you, the client.
People are doing the best they can.
What this means is that at any given time, any snapshot of your life, you are trying your hardest in that moment. We do the best we can with the skills, genetics, and vulnerabilities we bring to each situation. What this assumption means is that no one wakes up in the morning and says, “Let me be the worst person I can be today and make some really bad decisions.” What it DOESN'T mean is that this is the best you could possibly ever do in your life. We know you need to do better and try harder (more on that later).
-Examples of skills: communication strategies or lackthereof, mindful awareness or noticing an emotion only when it's 7/10, coping with paced breathing or coping with substances.
-Examples of genetic factors: a tendency towards emotion sensitivity or placidity, a tendency towards overcontrol vs. impulsivity, a tendency towards fight or flight, and other innate factors which are “preset” and also manageable.
-Examples of vulnerabilities: feeling rushed leaving the house, spilling coffee, suffering from the common cold, encountering misbehaving pets or people, and other per-day occurrences that influence ability to use skill and manage emotion.
People want to improve.
Otherwise, why in the world would you be doing this hard work of showing up to therapy? We recognize that even when therapy-interfering behaviors arise, the people who are arriving to therapy are doing so because a part of them wants to improve. Even if the part of you that wants to improve is the tiniest part, we know it's in there as long as you're coming to sessions. This is why one of the ways to be successful in DBT is to just show up, again and again, even when you don't want to. There are times in therapy where I speak specifically to the part of you that wants to get better, because I know that part is in there listening.
People must learn new behaviors both in therapy and in the context of their day-to-day life.
What this means is you have to generalize this stuff. I can teach you DEAR MAN and the TIP skill and Willing Hands and Opposite Action all day long, and even if you practice them perfectly in session with me, it's not going to change your life unless you practice it at home or in other settings. While therapy can be a safe place to learn and apply skills initially, you better believe the real application happens at home during a panic attack or an argument. The reason we ask you to practice so much is because you need to have the skills down before applying them in that difficult territory. Practicing skills at home when you are calm means you know more quickly how to draw on them during instances of intense emotion. This is like a basketball player practicing free throws on their own time so they can make foul shots more reliably at the game.
People cannot fail in DBT.
I like this one because many people with significant mental health concerns have received messaging that they are failing in some way, whether it is at relationships, at adulthood, at work or school, or at independence. In contrast, DBT assumes that if the therapy does not work for someone, it is not an indication that this client has failed but rather that this treatment was not the right one for them or that the therapist did not effectively tailor the treatment. We already take this view in other instances; for example, if your psychiatrist prescribes a medication that is not effective, we don't assign responsibility for that to you. After a fair trial of the medicine (which may mean waiting for it to build up in your system, titrating dose, etc), we simply acknowledge this is not the best medication to meet your needs and try something else. DBT is studied as a year-long therapy, although most skills groups run for six months. If there is little improvement after a “good college try” at this, it doesn't mean you as an individual are wrong or bad or failing—it just means we need to try a new modality.
People may not have caused all of their problems, and they have to solve them anyway.
I get the most grief from people about this assumption. On its face, this assumption can feel very unfair and very unpleasant. Let me emphatically validate you—your trauma, the fact that you may have been born with increased sensitivity to emotion, maybe not having resources to learn how to manage emotion, none of this is your fault. And (there's that pesky dialectic), allowing yourself to assume responsibility for solving your problems allows you to take the power back. Instead of waiting for the environment to change or other people to magically become more skillful, you take the reins and manage the situation yourself. Someone at your workplace is being unkind to you? You don't have to wait for them to change their behavior—you can use skills to manage the situation and your emotions. You're stuck in a relationship that is unfulfilling? You can assertively ask that your needs be met and you can choose to end the relationship if pros and cons dictate that it is needed. There's so much power here in this assumption, and I definitely recognize that the responsibility and the change can be anxiety-provoking.
People need to do better, try harder, and be more motivated to change.
This is sort of that uphill climb of therapy. At any time, you are not the best you can ever be, or what's the point of trying to get better? This assumption demands that not only do we validate you as you are and celebrate the skills you've learned, but we also push you to work harder, do better, and build that life that you want. This touches on the change within the core dialectic of acceptance vs change. Without pushing for this change, we go nowhere.
The lives of people who are suicidal are unbearable as they are currently being lived.
Essentially, this assumption acknowledges that if you are looking at suicide as an option, you are in a very hard place. There is so much stigma to suicide and self-harm (so much so that I'm not even going to touch on it here without a content warning), and half of that is a lack of recognition that these symptoms arise when we are truly, deeply, desperate and exhausted. When we recognize the depth of the pain that's present and the validity of a person's suffering, we can treat that client with the respect they deserve and pay adequate attention to their needs. This touches on the acceptance part of the acceptance vs. change dialectic. Without this validation and acceptance of you, we go nowhere.
My urge here is to tie up these assumptions with a neat paragraph summary, and at the end of the day these assumptions are made to be reviewed, interacted with, lived by, and certainly not tied up. If this therapy philosophy seems like something you can connect with and you want to start accepting yourself and making needed changes now, I offer in-person therapy in Huntersville, NC, and online therapy in NC and SC. Thank you for the time you invested reading this.
