Dialectical behaviour therapy (DBT)
Skills for intense feelings, difficult moments and relationships that matter.
By Richard Mann · 15 October 2026
← Integrative therapy and the different approaches
When emotions rise quickly, you may act before you have had time to think. Afterwards, you might feel ashamed, frightened or angry with yourself. Being told to calm down rarely helps you understand what happened or what to do differently next time.
DBT brings acceptance and change together. It takes your feelings seriously while helping you develop responses that are less likely to make life harder. The word ‘dialectical’ refers to holding more than one truth: you can be doing your best and still need support to change.
Four areas of skills
Mindfulness helps you notice what is happening before reacting. Distress tolerance offers ways to get through an intensely difficult moment without adding further harm. Emotion regulation involves understanding feelings and reducing vulnerability to becoming overwhelmed. Interpersonal effectiveness focuses on asking, saying no and maintaining self-respect in relationships.
These are skills to learn and practise, rather than instructions to stop having emotions. What helps in one situation may not fit another. The aim is to build a choice of responses and recognise when each might be useful.
What might the work involve?
You might look back at a difficult incident step by step: what was happening beforehand, what you noticed, the thoughts and urges that followed, and the consequences. This is sometimes called a chain analysis. It can reveal an earlier point where support or a different action might have helped.
You may practise pausing before responding, describing a need clearly or making a plan for a predictable trigger. Practice between sessions helps make a skill easier to use under pressure. Work also considers sleep, stress and other demands that can leave you with less capacity. A difficult week is something to understand, not a reason to blame you.
DBT skills and a full DBT programme
Comprehensive DBT is a specialist treatment arrangement, usually including individual therapy, skills training, between-session coaching and a therapist consultation team. It was developed for people with severe and persistent difficulties regulating emotion, including recurrent suicidal and self-harming behaviour.
Using selected DBT skills in counselling is different from receiving that full programme. This article does not mean that I offer comprehensive DBT or an out-of-hours coaching service. If you need more intensive support, the type and level of care should be discussed directly with an appropriately qualified service.
The text you wish you had not sent
As an illustration, you receive a short reply and feel dismissed. The urge is to send an angry message immediately. You might practise noticing the physical build-up, stepping away briefly and describing what you know rather than assuming an intention. Later, you could ask about the exchange more directly. The aim is not to deny the hurt; it is to give yourself a better chance of being understood without escalating the situation.
What might change?
More space before acting
You may notice an urge early enough to choose a response.
More confidence during distress
A plan and practised skills can make a difficult moment less bewildering.
Clearer conversations
You may become more able to ask for what you need while respecting limits.
These are possible signs of progress, not promises. What matters is whether the work is making a useful difference to your life. You and your therapist can review that together.
How this fits with integrative therapy
DBT skills can support practical work on emotional regulation and relationships within integrative counselling. We can also explore the history and meaning of an emotional response, so learning skills does not become a way of dismissing what you feel.
Read about integrative therapy and explore the other approaches →Sources and further reading
- Behavioral Tech Institute: DBT intensive training and comprehensive treatment
- Behavioral Tech Institute: DBT skills training
- NICE: Borderline personality disorder—psychological treatment recommendations
This article explains an approach in general terms. The right support depends on your needs, preferences and the practitioner’s training.
We can begin with a conversation.
You do not need to work out which approach you need before getting in touch. I offer a free 15-minute consultation to talk about what is troubling you and whether working together feels right.
Sessions are available in North London and online across the UK.
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