Dialectical Behavior Therapy (DBT) Works if You Want it To

February 6, 2013 Natasha Tracy

OK, maybe it seems like I’m being a bit hard on commenters. I swear I’m not. I like people who comment and express their opinion, but sometimes their opinion spurs one of my own. This is one such comment:

I’m bipolar, and I think we ALL should have to take a Dialectal Behavior Therapy course. The DBT course helps with coping skills, year class, and helps . . . these skills work if you want them too.

Here’s someone singing the praises of dialectical behavior therapy (DBT). She would certainly not be alone as many people find DBT to be helpful. The problem I have with this comment is the last bit, “these skills work if you want them too [sic].”

So, this means that if the skills learned in DBT don’t work for someone it’s because they didn’t want them to?

I don’t think so.

Bipolar Therapies

There are many therapies that have been shown to help with bipolar disorder (DBT, by the way, has only a tiny bit of recent evidence behind it.) and I believe these therapies can help people. Cognitive behavioral therapy (CBT) and, even more convincingly, interpersonal and social rhythm therapy (IPSRT) can be very beneficial.

But like all bipolar treatments, therapies only help some people. While there is evidence that IPSRT helps people with bipolar disorder stay well, it does not support the notion that therapy can help everyone that uses it. Therapy is like any treatment – it helps some and not others.

Dialectical Behavior Therapy (DBT)

DBT was actually designed for the treatment of borderline personality disorder (and there is evidence it works for this), but there is interest in using it to treat other disorders such as bipolar and depression too. DBT combines mindfulness, psychoeducation, CBT, stress tolerance and other skills together into a therapeutic package. DBT is normally adapted slightly for use with other disorders such as bipolar.

DBT Works if You Want it To

Now, there is no doubt that therapy takes work and you have to do this work in order for it to be effective. Thus, you do have to “want” DBT to work in order for it to be effective.

However, simply “wanting” it to work, or, indeed, doing the work of therapy guarantees the success of DBT. The problem with saying that “it works if you want it to” is that it suggests that if it fails, it’s the patient’s fault. They didn’t want it enough. They didn’t do the work enough. The therapy was fine; the patients were the ones who were deficient.

And I don’t think this is a message we should be giving patients. Patients feel bad enough about being sick without being told it’s their fault that they didn’t get better.

So yes, I say give DBT and other bipolar therapies a try, but if you work at them and, for some reason, they are not effective, it’s not that you didn’t “want” it enough; it’s just that they didn’t work for you.

You can find Natasha Tracy on Facebook or GooglePlus or @Natasha_Tracy on Twitter.

APA Reference
Tracy, N. (2013, February 6). Dialectical Behavior Therapy (DBT) Works if You Want it To, HealthyPlace. Retrieved on 2024, July 14 from

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate, and author of Lost Marbles: Insights into My Life with Depression & Bipolar. She's also the host of the podcast Snap Out of It! The Mental Illness in the Workplace Podcast.

Natasha is also unveiling a new book, Bipolar Rules! Hacks to Live Successfully with Bipolar Disorder, mid-2024.

Find Natasha Tracy on her blog, Bipolar BurbleX, InstagramFacebook, and YouTube.

August, 27 2016 at 6:23 pm

It works if you want it to means it works no better than a placebo because, clearly, that's what it is.

October, 3 2015 at 11:53 pm

To irma rios :
Unfortunatly, your post have been writing long time ago, and there is less chances that you read this answer. If too, I just want to say that your son presented some symptoms in his early age that made thinking at asperger's syndrome (routines and socks that bother him...) Asperger may make difficult to find and maintain a job as an adult and the social difficulties can lead to distress or depression. Maybe he can benefit from an assessment with an autism specialist. (Sorry for my english, it's not my usual language).

October, 3 2014 at 10:55 am

THIS IS HOW MY X TO BE DEALS MY PROBLEMS ARE THE REASON ..BLAH BLAH BLAH I HAVE TRIED TO GO and be the better try to get him excited about changes ect...leave his house more often...I am done I do not want to live with someone who cannot be happier and have less fears of every day life. I deal with p t s d I don't have to own it each day ....I love humor this man has NEVER busted a gut laughing ever but there is nothing wrong with him we are like oil vinager got to go and separate it is not healthy to expect someone else to make us happy we will be denied .I like me finally I like me I have a lot to work on sure who doesn't but I don't like being dragged around like this .........any more..

August, 9 2014 at 2:01 pm

My daughter is a psychiatrist and all she tells me sounds rather cold and professional. I tried DBT. Got nothing from it. Do try very hard to correct my mistakes, but if I slip when I'm around family they disect and talk about me. All I want is some slightly unconditional caring. I feel very alone.

July, 26 2014 at 4:18 am

I desperately wanted DBT to work for my severe bipolar depression, but the harder I tried, the more depressed I got. Why? because I was putting so much effort into something that wasn't the right treatment for me and more it failed, the more of a failure I felt. Eventually I was put on a different medication and within a week I was better and stayed better for 5 years. It wasn't that I didn't want to be well, it's just I needed (the right) medication and ALL I needed was that medication.
Different treatments work for different people. I tried so hard with DBT, just as I had with CBT and both made me so much worse. I know it works for most people - I see it in my own professional life - but I am not one of them.

November, 29 2013 at 10:48 pm

I want to hug you. No, really I do. I am literally crying right now.
I was told over and over again that I didn't want it hard enough. How I felt was exactly as you described it. I couldn't and can't say it though. Saying things like that to mental health professionals would get me written down as "non-complaint" or seen as anti-psychiatry. That enables people even more to treat me as if I have no self awareness and make them assume that I am trying to stir some kind of trouble. It's like walking on eggshells around them but I am glad someone finally said it. I feel a bit better that there is a voice.
Thank you

November, 25 2013 at 6:00 am

I was diagnosed bipolar when I started to go back into therapy my Freshmen year of college. The diagnoses came from my psychiatrist. When I has another session with my therapist I told her what I was diagnosed with. She doesn't believe that I have bi-polar disorder cause I haven't have a manic episode. I was in therapy in my college for 2 years and when it ended I was unsure if I wanted to continue seeing a therapist.
1 week after graduation I meant with a new therapist. After sharing my background she diagnosed me with Borderline Personality Disorder. I was upset to hear that I have another mental illness. I was told that in order to solve the problem I need to do DBT. As the program continued I was later told that part of the therapy is a skills group. I have a huge fear of being around people because I know that I will be judged. After contacting one support group I had no luck getting in. I wouldn't be able to continue the program without doing the group. When I wasn't able to find any possible groups my therapist came up with me just doing Skills Training with another therapist instead of a group I would be by myself.
I have been doing skills training for a little over a month. I find it at times beneficial but have been getting more and more depressed when the skills don't work how they are suppose too.
I feel like I am alone because I am not able to talk about my disorders with my parents or any family member. Does anyone know a support group I could join online?

August, 14 2013 at 5:19 pm

I don't think that your opinion and Natasha's are really at odds with each other. You're both effectively saying the same thing: "try out any and all therapies until you figure out what works for you."
A person without a will to beat the illness won't try different therapies, and that's what both of you are saying. Natasha was just adding that if something doesn't work, it doesn't NECESSARILY mean that it's your fault. It could be, if you didn't do the work, but it doesn't otherwise have to be.
Yay for all of us, who obviously want to beat our collective bipolar!

June, 20 2013 at 10:39 am

Suffering from bipolar disorder has caused me to seek out a solution in many places. For the longest time, I persistently avoided medication. I read a ton - books on spirituality and religion (which helped form a lot of my opinions, but unfortunately did nothing to quell what I now accept is a disorder). I have changed my diet, exercised, tried various herbal remedies. I've talked to various therapists from different disciplines. I've tried some really wacky approaches, too. If you are plagued with this disorder (yes, I do feel it is a tremendous burden), you will do anything. I don't knock what people choose to pursue. I do get annoyed by people who dare tell me that I haven't put in enough effort, did not try hard enough, that I do not want to be well. I will bet money that EVERYONE with this disorder wants to be well. It is an individual journey.

March, 29 2013 at 9:49 am

Hi everyone,
I just googled and found this site. Thanks Natasha for having it.
I only had one real manic episode too and it was after my first week of Prozac but I have depression, anxiety, tons of fear, obsession, and an addiction I'm working on. I have been told by like 4 psychologists and my psychatrist dbt would help me but I'm concerned not to throw away my money on a bad one. I'm 42 and had mostly bad therapy. On the positive side I am feeling good right now.

Charles Mistretta
February, 19 2013 at 4:14 am

Bipolar people are puppets whose strings are strands of DNA, social outcome, and personal courage. Cutting any of the stings is a gross error. We must learn to following our guide and know when to pull back on the urge to delight disaster. How we feel in control is our choice even when guided by the best health professionals. ...and sometimes the sorriest, which is another comedy to live with.
There are brave souls who care. If you're reading this you have found one in the blogger who battles our uncertainty. Have faith.

February, 12 2013 at 12:50 pm

I found some skills I learned in a mini DBT class to be helpful (not for the depression itself), but that's not what the post is about. It's the idea that a treatment will work if you want it to. When I was in some groups, there were so many people who wouldn't even TRY stuff, so maybe that is what the commenter was really bothered over. I would think, why are they bothering to come? Of course, it's not necessarily best to get down on their lack of apparent effort, since there is learned helplessness and also the hopelessness of depression itself, and folks' IQ's varied a lot, too. Who knows what anyone had been thru? Not me.
I get this type of comment all the time about medications. People say folks with bipolar are selfish, dangerous, in denial if they won't take these drugs that supposedly would work if the patient took them properly or just kept trying things.
For me, an eclectic approach has worked best too. I dunno what type bipolar I supposedly have. My therapist says bipolar 1. I think the only full blown mania was on antidepressants, though.

Irma Rios
February, 10 2013 at 2:27 am

I apologize for the mistakes in my grammer It"s 430 a.m
in the dark reading glasses and in my phone.

Irma Rios
February, 10 2013 at 2:19 am

Hi At age seven or eight my son had a routine every morning prior to going to school he would make tantrums and said his socks bothered him I would have to cut the corners of every sock in the little toe area it took about two hours to get ready for school it got so bad that after watching a movie movie of this one girl who couldn't stop washing her hands I took my son to the pediatr suggesting my son had an attention disorder or something The doctor's words were..."Your son is a smart kid" he is outsmarting you...He is a healthy kid nothing to worry about. He did no tests and ai was young and naive to have claimed more testing or I heard what I wanted to hear. Since then and growing my son has worsen for xmasvwhen he was 18 years old we got him the guittar he had mentioned he wanted and to our surprise he was very upset and dissapointed and had a breakdown and xmas was ruined...whuch until this day he says"we ruined for him" he suddenly gets mad at anything and starts yelling..or sometimes his in his room and I hear his loud laughter...he cant hold a job he quits or gets fired..and lately he says hes looking bug I see no effort in him finding a job ..when I bring it up he gets very emmotional and cries and says how bad it feels to be unemployed and heblames society. A xouple if nights ago he asked me to go fet him a burger we both drive there and when we were at the drive thru he said nevermind lets go I had to drive my car in reverse in the drive thru cause he was desesperate to leave.. I offered alternative eating places he said let's just go home NOW...we got home he laud in the couch and cried himself to sleeo..but vefire fallung asleep he told me that when he dues he wants us to make a duamond with his ashes..I told him that'll be a ling time from now and I might be too old or not around..and he said it might be sooner than I think This of course worried me and strangely yesterday he accepted an invite to the movies with his sister, his dad and I ..We decided to see Silverlining because of the actors in the movie..we didnt have a clue what the movue was about...and to my surprise I saw our future in the movue uf we don't get help for my son. My son is y son is now 23years old he is a very loving and nuce person and I know he deels dissaponted and upset after every breakdown he has. He has not veen diagnossed bipolar but the more I read about this the more at fault I feel for not realizing it sooner and getting him help for all thise many breakdowns he has had and just now when we don't have medical health coverage or the economical sourse to seek professional help. Any suggestions as to how to approach my son aboutt the condition I belueve ge suffers from? and where to seek help if he accepts it? Thanks..

February, 8 2013 at 8:31 am

Agree with Laurie. Our will and desire to get better are our most powerful weapons in the fight to get better. And supportive people in our lives help. . And it is a fight and a battle for sure.
We become what we think if we don't find a way to counter/control/change negative thought patterns. DPT and other therapies help with this. Praying and using positive mantras regularly helps too.
It is never because someone doesn't want to get better is it....??
Can't have too many tools in our get healthy tool box!!

February, 7 2013 at 4:13 pm

Hi Natasha,
It's not your fault. You have suffered a lot, and are deserving of compassion. Your writing gives a lot to many people. Well done!

Kerstin Stephenson
February, 7 2013 at 3:24 pm

I have bipolar 1 but also have issues from my younger years involving physical and mental abuse. I've tried DBT, CBT and ACT with psychologists a number of times but none have helped me at all even though I entered each with an open mind and a willingness to work. Each time I felt like a failure because the method was not working for me when it seemed to be working for others. In some cases I had psychologists get quite annoyed with me when I failed to 'improve'. What has worked for me is talk therapy with a psychiatrist. Talking through problem areas has been a 'magic bullet' for me. My psychiatrist does occasionally use some CBT techniques when appropriate but not exclusively.
We are all different and we may need to try a number of approaches before finding one that works for us and it is counterproductive to blame the patient.

February, 7 2013 at 10:41 am

I respectfully disagree. In my experience it wasn't until I realized no one or nothing could help me without a great deal of effort on my part. When I felt like a victim of my illness I also acted like one. The brain is very powerful and possibly even more powerful in the mentally ill. You have to use your own will to find your way.

February, 7 2013 at 4:46 am

I know many people who have had success with DBT. I am not one of them. I have tried it several times and it's just not the right therapy for me. Some aspects of it are a bit helpful but the full blown model does nothing for me. I do better with expressive therapies, as well as supportive therapy, talking things out and holistic components. I think DBT doesn't acknowledge the entire person. I do better with an eclectic approach. Honestly, I think most people do best with an eclectic approach. Even if we have the same diagnosis we are different people with different symptoms and experiences and there is no one size fits all treatment for mental illnesses. I find it alarming when people decide that because you have diagnosis X then treatment Y is the only one that will work for you. Yeah, life and mental illness doesn't work that way.

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