What Dialectical Behavior Therapy (DBT) Assumes About You

That’s right, we don’t even know you and already we are jumping to conclusions. But before you dismiss this post, please read on. Individuals with eating disorders have often experienced many different treatments across different levels of care, which may lead to feelings of hopelessness and self-blame. Thoughts such as “I’m never going to get better” or “something must be wrong with me” are common. Sometimes even those that are in a position to be helpful and supportive, like family, friends, or even treatment providers, give in to the notion that the individual “isn’t trying,” “doesn’t want to get better,” or “is destined to be sick for the rest of his or her life.” Not only are these ideas incorrect, but they are harmful and prevent those who are suffering from getting the help they need and deserve.

In Dialectical Behavior Therapy (DBT), we explicitly commit to the following assumptions about our clients, their families, other treatment providers and ourselves.  Why? It works. It’s effective in helping us achieve our goals. It allows us to come from a place of acceptance and compassion and to maintain hope and certainty that recovery is possible for everyone. It is a commitment to provide the best treatment possible.  So what are these assumptions we speak so fondly of?

  • You are doing the best that you can. In any given moment or situation, no matter what the behavior or outcome, DBT firmly believes you are doing your very best. If you could do better, you would. Yesterday’s binge was not an attempt to cause difficulties or make things worse; it was an attempt at survival and the best you could do in that moment.
  • You want to improve. While imaging life without your eating disorder may be scary, DBT believes that all those suffering truly do desire to recover. No one chooses to have an eating disorder. No one chooses to experience emotional pain, tormenting thoughts and self-hatred on a regular basis. There are likely many things that contribute to lack of improvement, such as environmental factors or faulty beliefs, but lack of intent or desire is not one of them.
  • You must learn new behaviors both in therapy and in the context of your day-to-day life. Wanting to recover is not enough. You must actively participate in learning new behaviors and be willing to try new things, even if you’re skeptical or fearful of failure. So yes, you must give self-soothing skills, mindfulness and distracting activities a chance. And not just in the therapy room, but in your regular life where it really matters. Don’t worry, you’re not on your own. DBT skills group is specifically designed to teach you new skills to try!
  • You cannot fail in DBT. If a cancer patient received chemotherapy and the cancer continued to spread, we would not tell the patient they failed chemotherapy. We would say the chemotherapy failed them. The same goes for DBT. If you participate in treatment and do not improve, the treatment failed you. Maybe it was not implemented effectively or maybe DBT was not the right treatment for you in the first place or at that particular time in your life. Bottom line, you did not fail.
  • You may not have caused all of your problems, but you have to solve them anyway. While it may seem unfair, it is reality. Assigning blame to yourself or others, or waiting for others to fix your problems for you is not effective.  It does not bring you any closer to building the life that you want. It is effective to identify these problems, solve those that can be solved, and learn to accept those realities that cannot be changed.
  • You need to do better, try harder and be more motivated to change. While DBT firmly believes you are doing your very best, you must also keep trying harder. Life and recovery are all about continuing to learn and grow, which takes an extraordinary amount of effort and hard work. This means continuing to experiment with new ways of coping, allowing others to help you, facing your fears head on, and being gentle with yourself in the process.  To commit to this journey, you must have something to work towards that is meaningful for you personally, such as graduating college, building relationships, bringing joy back to your life, or being present for your family.
  • Your life is unbearable as it is currently being lived. Life with an eating disorder is miserable. The physical, emotional, cognitive, interpersonal and spiritual suffering can be so unbearable that self-destructive behaviors may be the only way you’ve survived. While this is completely understandable, it is not okay. Settling is not okay. You deserve to build a life you truly want to live… and you can.
What assumptions do you make about yourself? Are they effective? Do they move you closer to or further away from your goals?
Stay tuned… more to come on DBT in future posts! If you have any questions you would like answered, please send them to me at Thanks!

Our DBT team at Webster Wellness Professionals is the only team specializing in eating disorder recovery in the state of Missouri , and one of few teams overall to be certified by the Missouri Department of Mental Health.

If you would like to learn more about our DBT services, please visit our website or schedule an intake with one of our DBT therapists at (314) 737-4070.