Dialectical Behavior Therapy (DBT) in Atlanta
What is DBT
Dialectical Behavior Therapy (DBT) is a structured, skills-based form of therapy developed for people who experience intense emotions which they sometimes find hard to manage. Many people have heard of DBT skills training groups, but DBT is actually a comprehensive approach that can be used in individual therapy as well. Decades of research have established DBT as an effective treatment for borderline personality disorder, as well as depression, anxiety, eating disorders, and substance use. It can also be an important part of the treatment of trauma and PTSD. DBT’s effectiveness across all these domains makes it an excellent tool in the work I do with many of my clients.
Where DBT Came From
DBT was developed in the late 1980s by Dr. Marsha Linehan, a psychologist at the University of Washington. She created it originally for people who were chronically suicidal and who found that standard cognitive-behavioral counseling wasn't sufficient. Those clients needed something more than techniques for changing thoughts. They needed genuine validation, practical coping skills, and a framework that took emotional intensity seriously rather than treating it as something to be corrected.
Linehan, who later shared that she experienced the same kind of emotional suffering she was treating, built DBT from a combination of behavioral science and Zen philosophy. Since it’s such a good fit for the client’s I enjoy working with, I trained as a DBT therapist very early and have been incorporating this approach into my work for almost 30 years.
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5 Core Components of DBT Therapy
1. The Dialectical Philosophy
The word "dialectical" in Dialectical Behavior Therapy refers to a philosophical position about how change happens. At its core, it's the idea that two things that seem to be in tension can both be true. We work with that tension to find balance, rather than choosing one side or the other.
The central dialectic in DBT is between acceptance and change. We are all doing the best we can given our history and our circumstances. And we can do better. Neither half of that can be sacrificed for the other. Therapy that pushes only for change, without genuine acceptance of where a person is, often produces shame and dropout. Therapy that offers only acceptance, without the expectation of change, can inadvertently reinforce the idea that things can't be different.
2. The Biosocial Theory
DBT doesn't treat emotional dysregulation as a personal failing. It has a specific explanation for how it develops, called the biosocial theory, and that explanation has real implications for how treatment works.
The biological half of the theory states that some people are born with a nervous system that is more emotionally sensitive than average. Their emotions arise faster, reach greater intensity, and take longer to return to baseline. This isn't pathology; it’s variation in how nervous systems work, with genetic and neurological components. Sensitivity itself isn't the problem.
The social half describes what happens when a child with that kind of sensitive nervous system grows up in an environment that consistently invalidates their emotional experience. Invalidation doesn't have to be cruel or intentional. It can look like being told to calm down, being dismissed when upset, having emotions minimized or ignored, or being given the repeated message that what you're feeling is wrong, excessive, or inconvenient.
When those two things combine (biological sensitivity and a chronic invalidating environment), the result is predictable. The child learns that their internal experience isn't trustworthy, that strong emotions are dangerous or shameful, and that the only way to be heard is to either suppress feelings entirely or escalate until someone pays attention. These adaptations make sense as an attempt to cope during childhood, but they don’t tend to work well in adult life. Therapy helps create other response options.
3. The Consultation Team for Therapists
Dr. Linehan believed that just as clients need skills and support to manage difficult emotional experiences, therapists need support too. I participate in regular peer consultation with DBT-trained colleagues. Without disclosing any private information, I can get an outside perspective from people who know the model well and get new ideas to help me in my work with clients.
4. The DBT skills
The skills are the part of DBT that people tend to hear about first. In the original DBT model, skills were taught in group classes which is excellent because it provides peer support, decreases shame and isolation, and lets group members learn from observing other people’s growth. I’m not leading any DBT groups at this time, but my clients still learn these important skills. If I’m working with someone in individual therapy and they are willing to attend a group, I have several trusted colleagues I refer them to. This works well because it’s best to have your skill group leader be a different person than your individual therapist. That way you get more perspectives which leads to deeper learning. These skills also get incorporated into individual therapy organically, and if a client needs structured skills training and is unable to participate in a group, we can do individual skills training more formally together. The DBT skills are organized into four areas including:
Mindfulness — Learning to observe thoughts, feelings, and sensations. Being present with your experience without immediately reacting and without judging
Distress tolerance — Skills for getting through a crisis without making things worse, such as healthy self-soothing and radical acceptance
Emotion regulation — Understanding how emotions work, identifying them more accurately, reducing vulnerability to emotional escalation, and gradually building a life that has more positive experiences in it
Interpersonal effectiveness — Practical tools for communicating clearly, asking for what you need, setting limits with other people, and maintaining relationships without either abandoning yourself or damaging the connection
5. Skill coaching between DBT Therapy sessions
Another important component of this treatment is in-the-moment support and coaching when difficult situations arise between sessions. These tend to be brief phone calls so you can get solution-oriented support from me focused on using skills rather than needing to wait until your next scheduled session.
What People Gain from DBT
Most people who engage with DBT describe a gradual shift in their relationship with their own emotional experience. Feelings that once seemed to arrive without warning and take over completely become more recognizable, more manageable, and less likely to drive decisions you later regret. The space between feeling something and acting on it grows wider.
Relationships tend to change too. With clearer communication skills and a better sense of your own needs and limits, the patterns that have caused repeated pain in relationships become easier to see and to change.
That doesn't happen quickly or through insight alone. It happens through practice, over time, and with consistent support. I've watched people make real and lasting changes through this work, including people who came in feeling like their emotions were running their lives and left with genuine confidence that they could handle what came at them.
Questions about how DBT Therapy works?
If you want to talk about DBT and whether I might be a good therapist for you, I’d be happy to connect. I offer a free 15-minute phone consultation. Call me at 404-668-9893 or contact me using the form below.
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