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You can accept yourself and still change.
A plain-language guide to Dialectical Behavior Therapy (DBT): what it is, how it works, what the skills are, and what to expect.
What DBT is
Dialectical Behavior Therapy is a skills-based talk therapy. It was developed by psychologist Marsha Linehan in the late 1980s for people who were chronically suicidal, especially women diagnosed with borderline personality disorder (BPD). Many of those clients had not done well with standard cognitive behavioral therapy (CBT), because a constant push to change left them feeling misunderstood.
DBT's answer was to pair two things that can seem like opposites: acceptance of who you are and what you are feeling right now, and change toward a life that feels more worth living. The word "dialectical" means holding both of those truths at once.
DBT is a cognitive behavioral therapy at its core, and it is often called a "third wave" CBT because it adds acceptance and mindfulness. Today it is used for much more than BPD. It has research support for reducing:
- Depression
- Anger
- Emotion dysregulation (feelings that are hard to manage)
- Self-harm and suicidal behavior
- Eating disorder behaviors, such as bingeing
- Substance use
- Difficulties after trauma, including PTSD
DBT was not designed to treat psychotic disorders such as schizophrenia, and it is not an evidence-based treatment for them.
Where it comes from
DBT blends several ideas into one approach:
- Cognitive behavioral therapy
- Problem solving, skills training, and learning how thoughts, feelings, and actions connect.
- Mindfulness and Zen practice
- Radical acceptance, nonjudgment, and being present in the moment.
- Dialectical philosophy
- The idea that two opposite things can both be true. For example: "I am doing the best I can" and "I want to do better."
- Behavioral science
- How rewards and consequences shape behavior, and how to look closely at what keeps a pattern going.
- The biosocial theory
- DBT's explanation of why intense emotions develop. More on that below.
Why feelings can get so big
DBT explains emotional pain with the biosocial theory. It says difficulties grow when two things meet over time: a biologically based emotional vulnerability, and an invalidating environment. Neither one is anyone's fault.
Emotion vulnerability has three parts
- High sensitivity: you react quickly, to things that might not bother other people.
- High reactivity: your reactions are intense.
- Slow return to baseline: it takes longer than usual to calm down, so feelings can pile up on each other. Some people also sit at a high level of negative feeling even before anything happens.
Invalidating environments
Invalidation means that your feelings were dismissed, ignored, punished, or treated as wrong. Linehan describes three family patterns where this can happen:
Disorganized family
Chaos, neglect, or abuse mean a child's emotional needs get overlooked.
Perfect family
Appearances come first, so feelings that could disturb the image are discouraged.
Normal family
Loving caregivers whose style does not fit the child's temperament, such as a very sensitive child in a family that values stoicism. This is a "poor fit," not bad intent.
Understanding this is meant to reduce shame, not assign blame. Your emotions make sense given your wiring and your history, and skills can be learned.
What a full DBT program includes
Standard, full DBT has three parts you take part in, plus support behind the scenes for your therapist.
Individual therapy
Weekly sessions with your primary therapist. You bring your diary card, and your current problems set the agenda. Sessions focus on using your skills in real life. New skills are mostly taught in group.
Skills training group
A weekly, class-like group, usually about 2 to 2.5 hours, led by trained group leaders who are separate from your individual therapist. The full skills curriculum takes about 24 weeks, and a year-long program covers it twice.
Phone coaching
Brief contact with your individual therapist between sessions to help you use skills in a real moment. It is for coaching, not for long conversations or processing.
What a group session looks like
- Every group opens with a mindfulness exercise.
- You review the homework you tried since last time.
- A short break.
- The leaders teach a new skill and assign new homework.
Group is a place to learn skills, so it is not the place to work through a personal crisis in depth. If you are struggling, your group leader will help you use a calming skill and point you back to your individual therapist. Group also lets you learn from each other, hear that you are not alone, and practice skills with real people.
Acceptance and change
Dialectics is the synthesis of opposites. In DBT it means you can hold two things that seem to conflict and let both be true: you are doing the best you can, and you want to do better.
Validation
Validation means finding the truth in what someone says or feels, so they know they are not wrong to feel it. It does not mean agreeing with everything or approving of every behavior, and it does not mean validating what is invalid. You can validate other people and yourself.
The skills are sorted into acceptance and change
Walking the middle path
The "middle path" is about finding balance and stepping out of all-or-nothing thinking. It is built on dialectical thinking, validation (of yourself and others), and radical acceptance.
How emotions work
In DBT, emotions are brief, involuntary, full-system responses to what happens inside and around us. They are not chosen, and they are not "wrong."
- Full system means a feeling involves your body, your urges to act, your expressions, your thoughts, and your subjective feeling all at once.
- Emotions have jobs. They motivate us to act (fear pushes us to flee, anger to defend), they communicate to other people through our face and body, and they give us information about ourselves and the situation.
- Primary emotions are the first reaction. Secondary emotions are reactions to the primary one, like shame about feeling angry or worry about feeling sad. Secondary emotions can cover the primary one up and make it hard to know what you really feel, so skills teach you to notice both.
Emotion regulation is not about getting rid of feelings. It is the ability to influence which emotions you have, when you have them, and how you experience and express them, even when they are strong.
What can make emotions hard to change
- Not yet having the skills
- An environment that reinforces the painful pattern, for example when an outburst is the only way to get attention or relief
- Biology that makes emotions stronger or slower to settle
- Emotion overload, when intensity is too high to think or use skills
The four skill modules
Select a module to open it. Mindfulness comes first because it is the foundation for all the others. The color on each shows whether it is mostly an acceptance skill set or a change skill set.
MindfulnessFoundation for everything else. Being aware, on purpose, without judgment.
Mindfulness means being aware of the present moment as it is. The goal is to experience reality as it is, reduce suffering, and make more room for peace and joy. Formal meditation is one way to practice, but it is not the goal, and everyday mindfulness counts too.
Three states of mind
- Emotion mind: feelings are running the show.
- Reasonable mind: facts and logic are running the show.
- Wise mind: both are working together, and you often get a sense of what feels right. This is where you aim to make big decisions.
A story sometimes used to teach this is The Well Within. Everyone has a deep source of wisdom inside, like a well. Strong emotions or rigid thinking can pile up like rocks on top, and mindfulness helps you settle enough to reach it again.
"What" skills: what you do
- Observe: notice without getting caught up.
- Describe: put words to what you notice.
- Participate: enter fully into what you are doing.
"How" skills: how you do it
- Nonjudgmentally: notice without labeling things good or bad.
- One-mindfully: give full attention to one thing at a time.
- Effectively: do what works for your goals in this situation.
Mindlessness
Mindlessness is the opposite: avoiding the present moment by rejecting, suppressing, blocking, or running on autopilot.
Everyday mindfulness and loving kindness
In daily life, mindfulness includes letting go of judgments and attachments (clinging to how things should be). Loving kindness is a practice of sending warm, caring wishes toward yourself first and then toward others, to soften self-criticism and resentment and build compassion for yourself and other people.
Distress toleranceGetting through painful moments without making them worse, and accepting what cannot be changed right now.
A crisis is a highly stressful, short-term situation with the potential for negative outcomes. Distress tolerance has two parts: crisis survival skills and reality acceptance skills.
Four ways to respond to any problem
- Solve the problem.
- Change how you feel about it (your emotional reaction).
- Radically accept it.
- Stay miserable. It is on the list because doing nothing is also a choice, and often the default when we feel stuck.
Crisis survival skills (short-term tools)
These are stopgaps to get you through a hard moment. They are not long-term fixes, so they work best when paired with problem solving once the intensity comes down.
- STOP: for impulses
- Stop. Take a step back. Observe what is happening inside and around you. Proceed mindfully.
- TIPP: to quickly lower body arousal
- Temperature (cold water on the face), Intense exercise, Paced breathing (longer out-breath than in-breath), Paired muscle relaxation.
- ACCEPTS: distraction
- Activities, Contributing, Comparisons, Emotions (create a different one), Pushing away, Thoughts, Sensations.
- Self-soothing
- Comfort yourself through the five senses: sight, sound, smell, taste, touch. This can be a safer way to relieve pain when you have urges to hurt yourself.
- IMPROVE the moment
- Imagery, Meaning, Prayer, Relaxation, One thing in the moment, Vacation (a short break), Encouragement.
- Pros and cons
- Write out the advantages and disadvantages of acting on an urge versus resisting it, in the short and long term, so you choose from wise mind instead of the urge.
Want more tools to try? Grounding exercises that work in real life are on the grounding techniques page, and more everyday options are on the coping skills page.
Reality acceptance skills
Radical acceptance means fully acknowledging the facts of reality as they are right now, including facts about the past that cannot be changed, without fighting them. It does not mean you approve of what happened or that you give up on changing things later. A phrase that captures it is "it is what it is."
The idea behind it: pain plus non-acceptance equals suffering. You cannot always avoid pain, but fighting reality adds a layer of suffering on top of it. Related skills include turning the mind (choosing acceptance again and again) and willingness.
Emotion regulationUnderstanding your emotions, reducing painful ones, and lowering your vulnerability to emotion mind.
Goals
- Understand and name your emotions.
- Reduce emotional suffering.
- Decrease emotional vulnerability.
Step one: check the facts
Before changing an unwanted emotion, look at whether the emotion and its intensity fit the facts. Notice the event, notice the interpretations and assumptions you are adding, consider other explanations, and ask how likely the outcome you fear really is. The answer tells you which skill to use:
- If the emotion fits the facts, use problem solving to change the situation.
- If it does not fit the facts, or acting on it will not help, use opposite action to change the emotion.
Problem solving
Check the facts and describe the problem, identify your goal, brainstorm solutions, choose one that fits your goal and is likely to work, put it into action, and evaluate how it went.
Another way to remember it is SOLVED: Step back and be objective, Observe your options, Limit barriers, make it Values driven (your priorities and goals), put Effectiveness first, and use Dialectical thought and action.
Opposite action
Act opposite to the emotion's urge. For anger, that means gently avoiding the person or topic for a while, being kind or empathic instead of hostile, and letting go of judgmental thoughts and replaying the event.
Reducing vulnerability: ABC PLEASE
- ABC
- Accumulate positive emotions (short-term pleasant activities and long-term goals and values). Build mastery (do things that make you feel capable). Cope ahead (plan and rehearse how you will use skills in a situation you expect to be hard).
- PLEASE
- Treat PhysicaL illness, balanced Eating, avoid mood-Altering substances, balanced Sleep, and Exercise.
Regular mindfulness practice also lowers your vulnerability over time by helping you notice feelings and urges before you act on them.
Interpersonal effectivenessAsking for what you need, saying no, and keeping relationships and self-respect intact.
Healthy relationships rely on a stable sense of self, the ability to express emotions in a healthy way, and the ability to tolerate and regulate distressing emotions. This module helps you make and keep healthy relationships, set boundaries and limits, and end relationships that are harmful.
Know your three priorities
- Objective: "What result or change do I want from this interaction?"
- Relationship: "How do I want the other person to feel about me after this interaction?"
- Self-respect: "How do I want to feel about myself after this interaction?"
Self-respect means being grounded in your own priorities, goals, and values. It is the foundation for your skills in every other relationship.
DEAR MAN: get what you need
Describe the situation, Express how you feel, Assert what you want or say no, Reinforce why it will work out well, stay Mindful, Appear confident, Negotiate.
GIVE: keep the relationship
Be Gentle, act Interested, Validate, use an Easy manner.
FAST: keep your self-respect
Be Fair, no over-Apologizing, Stick to your values, be Truthful (honest, with no exaggerations or excuses, and accountable for your part).
Deciding how strongly to ask
How hard to push depends on your priorities and on factors such as short-term versus long-term goals, whether the request fits your values, and how much the relationship matters here.
Ending a harmful relationship
Try to make this decision from wise mind. Writing a script and practicing it ahead of time, alone or with your therapist, can help you stay clear and steady in an emotional conversation.
When the skills are not working
Ask yourself questions like: Is a short-term urge (avoiding conflict, winning the moment) getting in the way of my long-term goals? Has emotion mind taken over? Am I unclear on my priorities? Am I worried about consequences? Do I need more practice?
Validating other people: VALIDATE
Validation is not agreeing with everything, and it is not validating what is invalid. It means finding the truth in what someone said so they know they are not wrong to feel it. One way to remember ways to do it:
- Value the other person
- Ask questions
- Listen and reflect
- Identify with them
- Discuss emotions
- Attend to nonverbals
- Turn the mind (choose acceptance again)
- Encourage participation
Boundaries
A boundary is anything you need to keep yourself healthy and safe: physically, mentally, and emotionally. Boundaries can be physical, psychological, emotional, spiritual, or biographical (how much of your personal story you share). Validation and boundaries balance each other. Validation creates safety, and boundaries create respect when you state your needs without attacking the other person. Both are part of the acceptance and change balance.
Signs of healthy boundaries include saying no without guilt, saying yes because you want to and not because you have to, being treated as an equal, taking care of your own needs, not being responsible for someone else's happiness, and feeling safe to express your feelings.
How boundaries help: your needs get met, your self-respect and confidence grow, other people's respect grows, and stress, anger, and relationship conflict tend to go down.
The word BOUNDARY can help you remember what to check in with:
- Be aware of yourself
- Observe others and the situation
- Understand your limits and the limits of others
- Negotiate sometimes
- Differences exist
- Always remember your values
- Your safety comes first
You can also set boundaries at different strengths:
| Level | Example |
|---|---|
| Soft boundary: indirect, focused on the relationship | "I'd love to help, but I'm really overwhelmed right now." |
| Firm boundary: a direct, clear statement | "I won't be able to help with that." |
| Hard boundary: final and non-negotiable | "I will not be spoken to that way. I am leaving this conversation." |
Social media: MEDIA
Online, your words travel farther and stay longer. MEDIA is a reminder to pause before you send or post:
- Moments can live on.
- Everyone could possibly see it.
- Don't send or post in emotion mind, or under the influence.
- Imagine the possible outcomes.
- Add positive communication to your social network.
Practice, tracking, and understanding what gets in the way
Homework
Skills work like any other skill: you learn them by using them. Homework between sessions is how the skills move from something you know to something you can use when you are upset. If it does not get done, that is information about what got in the way, not a failure.
The diary card
A daily card you fill out between sessions. It tracks urges and behaviors you are working to reduce, such as self-harm urges, suicidal urges, and other targets, along with your emotions and the skills you used or tried to use. Your individual therapist reviews it at the start of each session to decide what to work on first.
Chain analysis
A set of questions that helps you and your therapist understand what led to a problem behavior and what keeps it going. The links in the chain are:
- Vulnerability factors, such as poor sleep or high stress
- The prompting event
- Thoughts, feelings, and body sensations
- Your actions, including the problem behavior
- Consequences, short and long term
Missing links analysis
After the chain, you look at where an effective behavior or a DBT skill could have fit, and what got in the way: not knowing the skill, emotion mind taking over, worry about consequences, or something rewarding the old pattern. Then you plan what to try next time.
Chain analysis is not about blame. It is a way to find the exact spots where a different choice becomes possible.
More coping tools
Skills work best when you have plenty of options and can match one to the moment. These two pages sort tools by what is actually happening for you, so you can find one that fits instead of forcing the same one every time. Star the ones you like so they are easy to find again.
Grounding techniques
Is 5-4-3-2-1 not landing? This page has grounding exercises sorted by what gets in the way: people around who would notice, feeling awkward or "on the spot," feeling too distracted or checked out to focus, and resetting as a group.
Coping skills
A quick picker that matches a coping tool to the moment, grouped by what you are feeling: flat or checked out, racing thoughts, cynical or on edge, or worn down by the work itself. It is written with caregivers and helpers in mind, and many tools work for anyone in a demanding season.
These tools can help with everyday stress and overwhelm. They are not a replacement for your safety plan or for support from your therapist.
Safety: self-harm and suicidal thoughts
Self-harm is deliberate hurting of your body as a way to cope with emotional pain. It is not accidental, and it is different from a suicide attempt, though the two can overlap and both are serious. Being honest on your diary card about urges is one of the most helpful things you can do.
Make your safety plan
Fill this in for yourself, ideally with your therapist. It follows the six steps of the Stanley-Brown Safety Planning Intervention. Start at step 1 and work down. If a step feels hard, leave it blank and come back to it.
Private by design. Nothing you type here is saved or sent anywhere by this page, and it is gone if you refresh or close it. When you choose "Email to myself," your own email app opens with your plan filled in, and you press send. Only email it to an account that only you can open.
Safety plans and crisis resources
A safety plan is a short, written guide you build with your therapist and keep where you can reach it fast. You will find safety plan tools and crisis resources on my resource page.
Open the safety plan and crisis resources page
You can also download the Stanley-Brown Safety Plan, a form you can fill out with your therapist. Open the Stanley-Brown Safety Plan (PDF)
If you are in immediate danger, call 911. In the United States you can also call or text 988 (Suicide and Crisis Lifeline) at any time.
DBT for different people
The core skills stay the same, and the way they are taught is adjusted so it fits the person, including their age and developmental stage.
Teens and children
DBT for adolescents (DBT-A) usually involves parents. Parents often attend the skills group with their teen, learn the same skills, and share a common language at home.
Trauma survivors
Treatment follows four stages, and trauma processing happens in stage 2, after you are stable.
- Gain stability and behavioral control
- Reduce traumatic stress and feel emotions more fully
- Build an ordinary life
- Move toward ongoing joy and freedom
Substance use
Extra skills such as urge surfing and dialectical abstinence (a firm commitment to abstain, with a plan for getting back on track after a slip) are added. Diary cards track urges and use, and chain analysis helps you understand them.
Common questions
Do I have to have BPD to do DBT?
No. DBT was developed for BPD, but it is now used for many concerns involving intense emotions and hard-to-manage behaviors, and skills are taught to many different groups.
Can I do DBT if I have suicidal thoughts?
Yes. DBT was originally built for people who were chronically suicidal. Suicidal thoughts are not a reason to be turned away.
Does accepting something mean I approve of it?
No. Acceptance means acknowledging what is true right now so you can stop spending energy fighting it. You can accept a fact and still work to change things.
Will DBT get rid of my emotions?
No, and that is not the goal. Emotions carry useful information. The aim is to have more influence over which emotions show up and how you experience and express them.
Why can't I bring my crisis to skills group?
Group is class-like so that it stays focused and safe for everyone. Personal crises are handled in individual therapy, and if you are struggling in group the leader will help you use a skill and connect you with your therapist.
What if I already know the skills?
Knowing a skill and using it when you are upset are different things. Practice and repetition, which is why the curriculum runs twice in a year, are what make skills available under stress.
What if I miss homework or forget my diary card?
It happens. Bring it up with your therapist, and you can look together at what got in the way, often with a chain analysis, so it is easier next time.
What does success look like?
Over time, people often find they can pause before acting on urges, name what they feel, get through hard moments, and build relationships and a life that fits their values.
Who I Work With
For kiddos
If your child is having a hard time, it can feel confusing, overwhelming—and sometimes really lonely.
But your child is not the problem.
I see children as expressive, intuitive, and full of information about what they need—even when it comes out as big feelings, shutdowns, or behaviors that don’t quite make sense yet.
In our work, we slow things down and get curious together. We look underneath the surface, make sense of what’s going on, and help your child feel more confident in their own body, emotions, and voice.
There is room here for play, creativity, and moments of joy—not just “working on problems.”
I support your child in feeling more understood, and I support you in building rhythms and responses that feel more connected and actually doable in real life.
This isn’t about control or quick fixes.
It’s about helping your child feel safe enough to be fully themselves—and watching what becomes possible from there.
For TEENS
No, this is not a trap.
And no, I’m not here to “fix” you.
If you’re here, something in your life is probably giving ✨too much✨— anxiety, school, family stuff, feelings that won’t chill, or just existing in the world right now.
You don’t need a dramatic reason to be here. “I’m tired” counts.
Therapy with me is not:
- getting lectured
- being told to “just think positive”
- being forced to talk before you’re ready
What it is:
- a low-pressure space where you can be real
- going at your pace (talking or not talking—both are okay)
- figuring out why your feelings actually make sense
- learning how to feel a little less overwhelmed
I work with a lot of teens who are anxious, burnt out, neurodivergent, sensitive, or carrying more than people realize.
Some feel like they’re “too much.”
Some feel like they’re never enough.
(Spoiler: neither is true.)
You don’t have to have the right words.
You don’t have to know what’s “wrong.”
You don’t have to open up all at once.
We’ll figure things out together—calmly, honestly, and without pretending you’re fine when you’re not.
For parents & caregivers
Parenting—especially when things feel hard—can be exhausting, confusing, and full of pressure to somehow “get it right.”
If you’ve ever thought, why isn’t this working? or am I messing this up?—you’re not alone.
…And you are not the problem.
In our work, I see you as an essential part of the process—not someone to blame, but someone to support. We slow things down and look at what’s actually happening underneath the surface: patterns, environments, nervous system needs—not just behaviors.
Together, we figure out what’s getting in the way of connection—and build ways of responding that feel more doable, more sustainable, and actually fit your real life.
I don’t do quick fixes, pressure, or compliance-based approaches.
I focus on understanding, repair, and helping you feel more grounded in your role—without shame.
You don’t have to be perfect here. Just willing.
And when parents and caregivers feel supported instead of judged, things don’t just change for the child—the whole system starts to soften, shift, and open up in new ways.
For families
When something feels off in a family, it’s almost never just one person.
It can look like tension, shutdown, conflict, big reactions, quiet disconnection—or that feeling where everyone is trying…but somehow still missing each other.
I see families as a whole system—full of relationships, patterns, personalities, and nervous systems all interacting in real time.
Which means we don’t zoom in on one “problem.”
We zoom out, get curious, and start to understand how everyone is affecting—and being affected by—each other.
There’s space here for all of it:
the loud parts, the quiet parts, the messy parts, the funny parts, the “wait…why do we always do this?” parts.
This isn’t about blame or picking sides.
It’s about helping everyone feel more understood, creating room for each person’s experience, and building new ways to connect, repair, and actually enjoy being in a relationship again.
We move at a pace that works for real life.
And when even small things start to shift—how someone responds, how someone feels seen—the whole family system can begin to feel lighter, softer, and a little more like home.
Therapy Isn’t
onesize fits all
What works for one client, does not work for the other. I work with a variety of therapy theories, interventions, and modalities. Here are a few of my favorites.
Nervous System-Informed, Regulation Based Work
Support stress responses through co-regulation and sensory strategies.
Intersectional, Social Justice Framework
Considers identity, power, culture, and caregiving inequities within a decolonial framework.
Play-Based, Expressive Work
Uses play, creativity, and symbolic expression with early bloomers, late bloomers, and everyone in between.
Relational, Attuned Therapy
Attuned, regulated presence with collaborative, validating dialogue.
Attachment Theory
Centers connection, co-regulation, attachment needs, and repair.
Neurodivergent-Affirming
Affirms neurodiversity, autonomy, and rejects compliance-based models
What it’s like
We build safety first.
Because nothing meaningful happens without it.
We look at patterns.
Not just behaviors.
We include parents & caregivers.
Without blame.
We move at a pace
that actually supports change.
CONTACT
sarah@clearwavescounseling.com
480-359-7950
4100 S Lindsay Rd #124
Gilbert, Arizona
www.sarahapotter.com
Professionally insured through the American Counseling Association
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