By Cassidy Lovallo, New Hope Counseling Group
Dialectical Behavior Therapy (DBT) has become a popular therapeutic approach for individuals struggling with emotional regulation, relationships, and distress tolerance. However, not every therapist who incorporates DBT into their practice offers the full, structured treatment that Dialectical Behavior Therapy is known for.
You might encounter terms like "DBT-informed counseling" or "DBT skills training" when exploring options, which can lead to confusion. What exactly is the difference, and how do you know which option is right for you?
What Is Full Fidelity DBT?
Full fidelity DBT is an intensive, structured therapy program developed by Dr. Marsha Linehan in the 1980s, designed originally to treat individuals with Borderline Personality Disorder (BPD) but has since been shown to benefit people with a variety of mental health challenges.
Full DBT typically includes four core components:
Individual Therapy – Weekly one-on-one therapy sessions with a trained DBT therapist.
Skills Training Group – Weekly group sessions focusing on teaching and practicing DBT skills, such as mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.
Phone Coaching – In-the-moment support where clients can call their therapist outside of sessions to receive guidance on applying DBT skills in real-life situations.
Consultation Team – A team of DBT therapists who meet regularly to ensure adherence to DBT principles and provide mutual support for the therapists.
Full DBT is highly structured and typically requires a commitment of six months to a year. It’s recommended for individuals who have chronic, severe emotional dysregulation or life-threatening behaviors like self-harm or suicidal ideation. It is also commonly used for individuals with a diagnosis of BPD, complex trauma, or other personality disorders where emotional regulation is a significant challenge.
What Is DBT-Informed Counseling?
DBT-informed counseling, on the other hand, refers to therapy that incorporates principles or skills from DBT without following the full DBT model. A DBT-informed therapist might teach you some of the core skills (such as mindfulness or distress tolerance) or use DBT techniques within the context of broader therapy work. However, this approach does not include all of the structured components of full DBT.
DBT-informed counseling can be highly effective for individuals who don’t need the intensity of full DBT but would still benefit from learning some of the key DBT skills. It can be integrated with other therapeutic approaches like Cognitive Behavioral Therapy (CBT) or trauma-informed care, allowing for flexibility in treatment.
How to Determine Which Approach Is Right for You
Figuring out whether you need full fidelity DBT or DBT-informed counseling can feel overwhelming, but it helps to consider the following:
Severity of Emotional Dysregulation
If you find that your emotions feel uncontrollable or that they frequently interfere with your daily life, relationships, and sense of well-being, full DBT may be the better option. Full DBT is designed to address intense emotional dysregulation and is often the most effective when traditional therapies haven’t worked. For those experiencing milder emotional struggles, occasional outbursts, or difficulty with interpersonal relationships but are otherwise functioning, DBT-informed counseling may be sufficient. A therapist can guide you through learning and applying DBT skills without the need for intensive group or phone coaching.
Risk of Self-Harm or Suicidal Behaviors
Individuals who engage in self-harm, suicidal ideation, or life-threatening behaviors typically benefit from the full structure of DBT, where ongoing support is available through individual therapy, group skills training, and phone coaching. Full fidelity DBT was originally developed to treat clients with these risks and provides a thorough system for managing crises and teaching long-term coping strategies.
If you do not engage in these behaviors but still struggle with anxiety, depression, or interpersonal conflicts, DBT-informed counseling could offer enough structure to help without the intensity of full DBT.
Willingness and Ability to Commit
Full DBT requires a significant time commitment, often with weekly individual sessions, weekly group sessions, and phone check-ins when necessary. It also requires a high level of personal commitment to practice the skills outside of therapy. If you are ready for this level of commitment and believe you need that structure, full DBT may be right for you. On the other hand, if you’re looking for flexibility or aren’t able to commit to such an intensive program, DBT-informed counseling offers a way to gain similar benefits without the same time investment.
Your Therapist’s Expertise Not all therapists are trained in full DBT, but many have training in DBT skills and incorporate them into their practice. If you're considering DBT, it’s important to ask your therapist about their level of training and the type of DBT they provide. For full fidelity DBT, therapists should have formal DBT training and follow the model closely, while DBT-informed therapists may have more general training in DBT principles.
The Bottom Line
Deciding between full fidelity DBT and DBT-informed counseling depends on your unique needs, the severity of your symptoms, and your willingness to commit to an intensive program. If you're unsure which approach is best for you, talk to a therapist who can guide you through the options and help you determine the right fit. At New Hope Counseling Group, we offer both DBT-informed counseling and can provide referrals for full DBT programs if needed. Reach out for a free 15-minute consultation to explore how we can support you on your journey to emotional wellness.
Cassidy Lovallo is a therapist at New Hope Counseling Group, specializing in trauma-informed care and integrating DBT techniques into her practice.
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