Comprehensive DBT vs. “I've learned some DBT skills before: What's the Difference?”
“I’ve already done DBT.”
I hear this a lot. But when I ask a few more questions, what someone often means is that they learned some DBT skills—maybe in a residential or IOP program, a skills group, or with a previous therapist.
Learning DBT skills can be incredibly useful. But the skills are only one part of comprehensive DBT. Real, real DBT includes several pieces working together, and it’s important to understand the difference when you’re trying to figure out what kind of treatment you actually received—or what kind of support you need now.
DBT skills training is one part of DBT
DBT skills training can happen one-on-one or in a group setting, although it is usually done in a group. The simplest way I explain it is: it’s like a class.
There’s homework, a manual, mindfulness activities, and a facilitator who functions as a teacher of the DBT skills. The facilitator is also a DBT therapist, but the group itself is not individual therapy. There isn’t processing of emotions or a lot of probing questions. The goal is to learn the skills.
That distinction matters because people are often told they “did DBT” when what they actually did was learn DBT skills. Again, that can be very helpful. It just isn’t the same thing as participating in comprehensive DBT.
What is DBT-informed therapy?
There’s also a middle ground that we call DBT-informed therapy.
DBT-informed therapy means you are in therapy with a DBT therapist and getting elements of DBT, but you are not enrolled in a full comprehensive program. You may be taught skills as they become relevant to your life, but you aren’t necessarily required to attend a skills group or participate in all of the other pieces of the treatment.
I joke that as a DBT therapist, I can’t stop myself from giving people DBT. So even clients who are seeing me for individual therapy are getting DBT-informed therapy at a minimum.
But DBT-informed therapy and comprehensive DBT are not interchangeable.
What does comprehensive DBT actually include?
Comprehensive DBT is the full program. In my practice, that means a six-month commitment that includes four main parts:
Weekly individual DBT therapy
Weekly DBT skills training
Between-session coaching calls
A therapist who participates in an ongoing DBT consultation team
There is also more structure around the treatment. Clients complete diary cards, follow an attendance policy, and have access to coaching calls between sessions.
The important part is that these pieces are designed to work together. You are not simply learning skills in one room and then hoping you remember to use them when life gets hard.
Skills group teaches the tool. Individual therapy applies it to your life.
In skills training, you learn the skills in a general way. In individual therapy, your therapist helps you apply those skills to your specific situation.
For example, there is a DBT skill called DEAR MAN that helps you assert yourself, ask for something, or say no. In group, you might learn how the skill works through different examples. In an individual session, I can look at what is actually happening in your life and say, “This is a great moment to write out a DEAR MAN.”
That means I don’t have to spend your entire individual session teaching every single skill. You learn the material in group, and then we can spend our one-on-one time figuring out how to apply it to your real life.
That connection is a big part of what makes the full DBT model different from skills training alone.
Coaching calls help you use DBT when you actually need it
Coaching calls are another piece people often haven’t experienced before.
The purpose of a coaching call is not to have therapy over the phone or discuss all the drama. We do that in session. The purpose is to help you apply the DBT skills to that exact moment.
I function sort of like a sports coach. Group and therapy are practice, and real life is the game. I wouldn’t be that good of a coach if I wasn’t at the game.
In a full program, clients can reach out between sessions for help using the skills when the situation is actually happening. That is very different from learning a skill on Tuesday and trying to remember on your own how to use it during a crisis on Saturday.
The consultation team is part of the treatment too
This is the piece that may be invisible to clients, but it is important to know: if there is no team, it is not DBT.
A DBT therapist in a comprehensive program should be in ongoing consultation with other DBT therapists. While sometimes the make up of the team changes, I have been attending consultation team every week for the last 13 years.
Essentially, you are being treated by a team of therapists rather than one individual clinician working in a vacuum.
In consultation team, we discuss challenging cases, where clients may be stuck, and situations where therapy is not moving in the expected direction. We also check ourselves and talk about the impact our own personal stuff may have on the treatment we are providing.
The point is to make sure we are providing the best possible DBT.
So who needs comprehensive DBT?
Not every person who benefits from DBT needs the full six-month program.
Part of my job during an intake is figuring out how much structure someone needs. I’m looking at things like how chaotic their relationships are, the level of impulsivity, how out of control things feel, how out of touch they are from a life worth living, and whether there are higher-risk behaviors involved.
If someone is self-harming or experiencing suicidal ideation, I would recommend comprehensive DBT rather than something less structured. If someone has been diagnosed with Borderline Personality Disorder and has never done DBT, I would also be looking very seriously at the comprehensive program.
Other people may be a better fit for individual therapy that is DBT-informed. The point is not that one form is “better” for everyone. The point is that they are different levels of treatment, and the right fit depends on what is actually going on.
How to tell what kind of DBT program you’re considering
If you are comparing therapists or programs, ask specific questions. Don’t assume that “DBT” means the same thing everywhere.
You can ask:
Is there weekly individual DBT therapy?
Is there weekly DBT skills training?
Are coaching calls included?
Is the therapist part of a DBT consultation team?
What specialized DBT training has the clinician completed?
How long is the program?
Some programs require a one-year commitment. Mine is six months, although a client may sometimes be asked to complete a second round.
The terminology can get confusing, especially if you have already been told that you “did DBT.” But once you know what to ask, it becomes much easier to understand what you are actually signing up for.
DBT is not just skills
If there is one thing I wish more people understood, it is this: DBT is not just about skills.
Knowing how to teach DBT skills is one part of the treatment. Knowing how to do DBT therapy is a different thing and requires specialized training. There is also a lot happening behind the scenes through coaching, treatment coordination, and consultation.
That is what makes comprehensive DBT comprehensive.
If you are trying to figure out whether you need DBT-informed therapy or the full program, the first step is an intake evaluation. We can look at what is happening, how much support you need, and whether comprehensive DBT is the right fit for you.
