Using Art Therapy with DBT

Dialectical Behavioral Therapy (DBT) is a therapy that was initially created for clients with Borderline Personality Disorder (BPD). DBT has a foundation in CBT, however, it is also based on psychotherapy principles. While CBT focuses on identifying and changing maladaptive behaviours, DBT focuses on initial acceptance and validation of behaviours as they occur. DBT also focuses on the therapeutic relationship as an integral part of effective treatment.

DBT focuses on self-regulation of emotions which is especially relevant to clients with BPD. As BPD clients interact with their environment with high emotion reactions, DBT teaches clients to validate their original feelings and seek to self-regulate before engaging in escalating emotional reactions. When change occurs, DBT reinforces positive behaviours and specifically extends compassion and understanding to facilitate behavioural change.

It is integral to the therapeutic relationship in DBT that the therapist validates the client’s experience and accepts the client as functioning within the patterns of how they understand behaviour should be to best cope with their situation at the time.

The term dialectical refers to different points of view and in the case of DBT there is a link to the Eastern (acceptance and mindfulness) and Western (psychological cognition and behaviourism) view points that are used in conjunction to help the client embrace both acceptance of their situation along with assistance from cognitive and behavioural treatment.

DBT emphasizes that the process of treatment begins with the approach of acceptance so that the client can begin treatment without feeling judged or invalidated by their experiences.

DBT focuses on four main components including:

• Distress Tolerance – the ability to tolerate distress that the client may experience
• Interpersonal effectiveness – improving relationships through coping skills and effective communication
• Mindfulness – helps clients accept their emotional experiences with judgment
• Emotional regulation – developing skills to identify, label and regulate emotions

You can note the acronym DIME as a useful way to remember the 4 components.

DBT is helpful for clients who are experiencing emotional dysfunction such as clients with:

• Borderline personality disorders
• Substance dependence
• Eating disorders
• Clients who self-harm
• Anxiety
• Phobias
• Shame and guilt
• Depression

Adolescents as a general demographic also benefit greatly from DBT due to their stage of emotional development and the associated intensity of emotions as adolescents experience hormonal changes and development.

DBT is used in conjunction with art therapy techniques by many art therapists. Art exercises provide an avenue for exploring personal experiences without judgment or the need to filter experiences through to the art therapist.

Art therapy and DBT utilize psychotherapy principles which help form common threads between the two therapeutic approaches.

Art therapy also provides an avenue to engage in mindfulness art making to help regulate emotions and feelings of anxiety. As clients engage in art making they are developing creative skills that reinforce competence and personal connections that are not dependent on doing the art making ‘correctly’ or finding solutions to problems that may feel overwhelming at the time for the client.

The client and art therapist can also create art together as a means of developing a therapeutic alliance by working collaboratively. This can help reduce anxiety for the client as they begin a new relationship with the client. Clients who benefit from DBT often experience uncertainty within personal relationships within own social circle which can impact how clients develop future relationships including with a therapist.

Art therapy supports the important tenets of DBT by providing coping skills to clients. Coping skills help clients to identify emotions, implement grounding techniques, and use self-regulation strategies to reduce maladaptive behaviours.

Like CBT, DBT provides an element of structure for the client to work through in their therapy sessions. Art therapy can complement this structural approach by providing a more fluid approach to working with clients on what they perceive are their most pressing concerns around their emotional experiences.

The integration of art therapy and DBT can encourage clients to take a more fluid approach of connecting to their emotions which is then expressed through art. In this instance, DBT can help provide structure in treatment for those clients who are looking to develop a sense of security in therapy while also acknowledging the personal emotional experiences that originally brought the client to therapy.

Art therapists can implement structure in the art therapy process by establishing a series of protocols for working within the art room. Art therapists can also introduce clients to a series of art exercises that will help introduce clients to the use of art supplies and the creative process. By undertaking these steps the art therapist is helping to establish a sense of security in the art therapy process. This helps the client ground themselves and establish a feeling of safety in which they can further explore difficult emotions.

Clients who benefit from DBT such as clients with BPD often have a history of trauma in their past. If the art therapist can provide an environment of security, safety, and predictability, this can help the client feel comfortable in processing their trauma.

Art therapy has the advantage of connecting clients to their experiences through non-verbal expression that is not forced through potential censorship from the verbal mind that judges, criticizes, and over-analyzes.

This exercise was taken from the Developing Mindfulness guidebook that can be purchased from the store here.

ART EXERCISE:

What benefits do you think mindfulness can provide to you? Consider the impact on your thinking process, your emotional experiences and your physical health.

The below artwork is a response to the question of the benefits of mindfulness. The images used in the collage as a representation of what mindfulness symbolizes to the creator.

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