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I’m a three-time DBT dropout. 

DBT, or Dialectical Behavioral Therapy, is a therapeutic treatment that that aims to decrease the use of dangerous coping tools such as self-harm and substance use by tackling emotional dysregulation, analyzing the impact of these behaviors, and teaching healthier coping skills to use instead. Originally designed for folks with borderline personality disorder, DBT has become a go-to treatment for bipolar disorder, eating disorders, ADHD, and many other diagnoses.

DBT is evidence-based, but what sets it apart from other well-studied therapies like CBT is that it is rooted in a larger philosophy focused on the concept of a dialectic. In DBT, a dialectic is a seeming contradiction that is also true. One core dialectic in DBT is I am doing the best I can, and I can do better. DBT holds many seeming opposites in balance, such as facts and feelings, comfort and suffering, and acceptance and change. 

The dialectical framework is thought to be a particularly effective approach for people with a borderline diagnosis because without effective strategies to ground themselves in balanced truths, people with borderline move between extreme perspectives. DBT offers practical grounding strategies to quell the emotional turmoil underlying these extremes, as well as these new ways of thinking that synthesize them.

The transformative power of DBT is that its approach is systematic. In the DBT model, skills are taught in a combination of individual therapy and structured classes. In classes, trained therapists cover coping tools supportively and didactically through a structured curriculum. 

DBT teaches ways to cope, feel, and think that our brains and bodies would have internalized on their own if we grew up in environments that were kinder, more stable, or better suited to us. For many people, these skills kick in automatically when stress arises, but those who struggle with emotion regulation need to intentionally learn and practice them again and again until they become habit. DBT not only teaches the skills, but assigns homework to practice them, and holds DBT class members accountable for practicing between classes.

I knew the unpredictable rhythms of intense, destabilizing feelings, thoughts, and behaviors, so I felt drawn to the philosophy behind DBT. The first two times I tried DBT classes, I was privileged to find a trans-specific class with facilitators in the community who I felt connected to, but I struggled to afford and prioritize the classes. 

Once I found stable income and time, the trans class I had participated in before had dissolved. The only class that agreed to my sliding scale budget irked me. When I set aside the facilitators’ misgendering of me and how they ignored my requests to normalize sharing pronouns, I noticed my resentment felt broader. As they told us to breathe deeply or diagrammed at the white board, something in me revolted. I felt enraged. “How dare they?!” I thought. “They don’t understand my life!” I tried to raise my issues with the facilitators, but I didn’t really know what they were. The therapists’ calm voices wouldn’t soothe me.

It took me months to place the source of my rage.

I had been triggered.

People in positions of authority were telling me when and how to be present to my body, feelings, and thoughts. This relationship to someone in power was deeply, painfully familiar. And it felt like a profound violation. Yet this didactic approach, which caused me so much anguish, is also central to how DBT is taught.

My personal therapist told me I just needed to overcome these triggers, but they piled up like storm clouds, making it harder and harder to weather my own mind and defeating the purpose of DBT classes.

So I quit DBT again. 

For years, I searched for other ways to heal my emotional turmoil. I researched my own trauma and how to build a life that would house it comfortably, give it space to breathe and dream. 

Over time, I found the right meds and a more sustainable lifestyle, but my life still rocked out of balance every few months, out of my control. As far as I could tell from my research, only DBT taught how to steady it so systematically, thoroughly, and rigorously.  With so much instability within myself, the ordered nature of DBT’s was also itself soothing.  DBT offered so many of the tools I needed for the act of building a stable foundation, and yet it also drew me back into some of the most treacherous and unmapped parts of the landscape beyond the home I hoped to create within myself. 

After a crisis last year, I found myself circling the idea of DBT yet again, unable to balance this last dialectic. As much as I resented non trans- competent authority figures imposing DBT’s structure upon me, I valued— and even needed— the structure itself. 

So, I did what I have done so many times when I feel trapped between the jagged edges of my inner and outer worlds: I turned to my queer community, which buffers me, softening so much sharpness. I reached out to an old friend who had also tried DBT, but could no longer afford it, and we started our own study group. Not as experts, but as peers. 

Armed with a zoom room and digital copies of the official DBT manual and worksheets, we began working through the material week by week, just like we would in class. It was surprisingly straightforward. The manual, which was designed for the facilitators to use, would walk us through exactly what to do in each session. When it would say “ask participants about their experiences,” we would ask each other, and then we would answer. When it would say, “read worksheet 5,” we would read it. 

I felt empowered to see all the same notes my DBT group leaders had seen, as if we could look into our futures as experts of this material. With the answer key to the skills we needed to build resiliency, we were the teachers and the students, the sources and users of new knowledge. 

It felt like a new way to play with power. 

Our peer approach to DBT not only heals my relationships with institutions of power as a trans person, it also helps to heal my childhood wounds that DBT had re-activated. 

We have been studying DBT on Zoom for about 6 months now. We are about halfway through, and for the first time, I have begun to internalize the material.

Sometimes a dark thought comes over me, powerful and sharp, and a calm voice in my head says “Why don’t you try a coping skill?” And so I make tea. I eat a mandarin orange slowly. I go for a walk in a meadow. I submerge my face in cold water and stare at my wet face in the bathroom mirror. I breathe deep and full. And everything feels less sharp. 

I am grateful that the voice I have internalized is not the voice of an expert who doesn’t see my identity, but the voice of a friend who does. Slowly it builds a new home within me, level and balanced and still.