Dialectical Behavior Therapy

What is DBT?


Dialectical Behavior Therapy (DBT) is an evidence-based treatment method for people with multiple problems such as intense emotions and considerable conflict in interpersonal situations. They may engage in various destructive behaviors compromising their safety including, but not limited to, chronic thoughts and urges for suicide, suicidal actions, self-injury, substance abuse or other addictions, disordered eating, and more. People who need DBT may have been previously admitted to a hospital for these concerns and/or they may have tried several other forms of outpatient therapy (such as “DBT-informed” therapy).  

DBT is the “gold standard” treatment for Borderline Personality Disorder. Dr. Marsha M. Linehan and her team at the University of Washington developed this modified version of cognitive behavior therapy adding in specific components of dialectics, validation, and Zen Buddhist mindfulness principles. It is a skill-based treatment, focusing heavily on teaching, strengthening, and generalizing skills to a variety of contexts in which clients are struggling. Practicing DBT skills allows clients to build their Life Worth Living, one they will not only want to preserve but will enjoy. 

The Skills of DBT 

Core Mindfulness skills are the foundation for all of the other skills. Mindfulness helps with building a stronger sense of self and gaining control over your thoughts. Here is where we address feelings of emptiness, confusion about self, scattered thoughts, or obsessive thinking. These skills are woven throughout the skills training experience.

Distress Tolerance skills help people avoid impulsive, desperate behaviors without “making it worse” so you can continue building your Life Worth Living. They promote acceptance of reality so you can move to using other types of skills.

Interpersonal Effectiveness skills help you with relationship conflict and fear of abandonment. These skills can help you to get what you want from others and say “no” in safe, effective ways. They help strengthen relationships and increase self-respect. 

Walking the Middle Path skills further help you in relationships and beyond to combat black and white thinking, validate, and use behavioral principles to your advantage. In adolescent DBT, families use these skills to reduce conflict in their households.

Emotion Regulation skills help you to understand your emotions, reduce sensitivity, and change unhelpful emotions. Here is where we learn to build joy and ride the wave of emotions in order to have more “even” moods.


Who can benefit from DBT Therapy? 


Many people who have undergone DBT report, “Everyone should learn and use these skills!” We could not agree more. And, this more intensive form of outpatient therapy is the best fit for people with a history of extreme emotional dysregulation, pervasive interpersonal issues, non-suicidal self-injury, suicide ideation, and/or repeated hospitalizations. We often have clients in our DBT program who also struggle with Post-Traumatic Stress Disorder (PTSD), eating disorders, severe anxiety, addictions, and chronic depression. DBT has the capacity to treat these multiple problems through progressive stages of treatment (see below).

DBT at Upaya  

Upaya’s DBT program is a comprehensive treatment model including all 4 required components for Stage 1 DBT. We have 12 spots in our adult (ages 18+) program which is currently open to admissions. Our adolescent DBT program (13-18) is unfortunately closed at this time. 

1. Weekly skills training group (2 hours)

This is where clients learn the skills of DBT as a group. It is run as a “class,” a place to practice use of skills with each other, and homework is assigned. Current group for adults is Wednesdays 5-7pm.

2. Weekly individual therapy (50 minutes)

This is where the primary therapist and client works to strengthen a client’s skills based on their unique concerns, circumstances, and goals. 

3. Phone coaching

This is a critical component of DBT where clients call their therapist between sessions, as needed, to enhance and increase the likelihood of effective skill usage. In adolescent DBT, caregivers have access to phone coaching as well.

4. Consultation team (for therapists)

All Upaya DBT therapists attend a weekly consultation team meeting to support each other and promote adherent delivery of Linehan’s DBT model. 

DBT Graduate Group/Stage 2 DBT  

Once someone has met criteria for graduating from Stage 1 DBT, they are in Stage 2. Clients who have graduated no longer attend the 2 hour skills training group. Depending on their treatment plan, they may take a break from therapy, transfer to a new primary therapist for specialized care, or stay with their primary therapist from Stage 1 (most common) with a focus on maintaining the progress made during Stage 1. At Upaya Counseling, we also specialize in two of the most evidence-based treatments for trauma/PTSD (Prolonged Exposure and EMDR). This allows us to continue providing care to clients in Stage 2, when addressing any concerns with trauma/PTSD is prioritized. 

Upaya Counseling has a DBT Graduate Group for clients in Stage 2 DBT. Although not necessarily required, it is available to assist in maintaining clients' generalization of DBT skills achieved in Stage 1. It is a one hour group (Tuesdays 5-6pm) using a peer-led or support model. Upaya's Director, Dr. Amanda Bittner, leads this group; it is open to folks who have graduated from either Upaya's Stage 1 program or outside programs (pending screening). All DBT Graduate Group participants are required to do concurrent individual therapy, at least monthly.


Upaya’s DBT team is led by Amanda Bittner, PHD, who is a Linehan Board of Certification, Certified DBT Clinician. We have excellent therapists of varying experience levels with different specialties in addition to DBT. A few are just starting out in their journey to become a DBT clinician and some have been delivering it for 12+ years. At Upaya, we believe in growing accessibility to this important treatment in the St. Louis and surrounding areas and thus, we welcome therapists at different stages of development to join us and strengthen our team. 

At Upaya Counseling, DBT is provided by Dr. Amanda BittnerBecky Connor, Deborah Hargrove, and Ashleigh Cole. Please contact us below or call 314-252-0675 to get started.



If you are struggling with suicidal thoughts and do not believe you can keep yourself safe, please call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255 immediately for help. Their support is free, confidential, and available 24/7.

Behavioral Health Response at 314-469-6644 OR 1-800-811-4760 offers confidential telephone counseling and crisis support 24/7. 

Behavioral Tech: Learn more about research on DBT

Info on DBT Certification

Books & Websites

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