DBT (Dialectical Behavior Therapy)

You can accept where you are and still work to change it. You can be doing your best and still need to do something different. A lot of what wears people down is getting stuck at one end or the other. All acceptance, so nothing moves. Or all change, with no kindness toward yourself while you push. DBT lives in the middle of that.

Mostly it’s skills, and they sort into four rough groups. Mindfulness is learning to notice what’s going on inside you instead of getting carried off by it. Distress tolerance is getting through a bad hour without doing something that makes tomorrow worse. Emotion regulation is understanding what you feel and being able to turn the volume down when it spikes. And then there’s the work of loosening black-and-white thinking, so your life stops reading as all-or-nothing and you get a little room to move. One clinician here describes the aim simply: helping you hold two truths at once, and seeing how that fits into the bigger shape of your life.

• Emotions that arrive faster and bigger than you can manage
• Black-and-white thinking about yourself, other people, or how a day went
• Distress that feels unbearable rather than uncomfortable
• Complex PTSD, particularly from chronic relationship trauma
• Impulsive responses you regret afterward
• Relationships that swing between too close and cut off
• People preparing for trauma processing who need stability first
• Anyone who wants concrete skills rather than open-ended conversation

Sessions work through the four skill areas, and which one gets attention depends on what your week actually looked like. Mindfulness comes early because the rest depends on being able to notice yourself in real time. Distress tolerance is the piece most people feel first, since having something to do in an unbearable moment changes what that moment is. Expect practice between sessions and expect it to be uneven, because a skill that works on a calm Tuesday behaves differently in the middle of a fight. Your therapist will keep pointing you back at both halves of the dialectic, which means you won’t be told to just accept it, and you won’t be told to just fix it either.

Available in person or by telehealth.

Rohan Roy is person-centered by default, validating and building trust before anything else, and brings DBT in when someone needs skills rather than more insight.

Holly Brooks works the same order, saying the healing starts in the relationship and the evidence-based work follows, sometimes DBT, sometimes CBT, depending on the person.

Linzie Ridings uses it most deliberately. She’s found herself drawn to clients with complex PTSD, usually from chronic relationship trauma, and she leans on DBT specifically to build distress tolerance and emotion regulation before touching anything deep. The goal is an internal sense of safety plus real external support, so that moving into EMDR or somatic work becomes possible rather than overwhelming.