What Is DBT?
Dialectical Behavior Therapy is the most rigorously validated treatment in existence for problems of emotion regulation. Developed by psychologist Marsha Linehan, DBT began where other treatments had failed: with people whose emotions were so intense, and whose reactions so fast, that standard therapy couldn’t hold them. What emerged was something more comprehensive than a therapy — a complete technology for regulating emotion, tolerating distress, and acting effectively when your nervous system is screaming at you to do otherwise.
The “dialectical” in DBT names its central tension: acceptance and change, held simultaneously. You are doing the best you can, and you need to do better. Your emotions make sense, and they cannot keep running your life. This isn’t philosophical decoration — it’s the engine of the treatment, and it’s why DBT works for people who experience validation-only approaches as useless and change-only approaches as invalidating.
DBT is unapologetically skills-based. Its curriculum covers four domains: mindfulness (controlling your attention rather than being controlled by it), emotion regulation (understanding, naming, and changing emotional responses), distress tolerance (surviving crises without making them worse), and interpersonal effectiveness (getting what you need from others while keeping relationships and self-respect intact). These are trained systematically — taught, practiced, and coached in real time — not discussed abstractly.
The Evidence
DBT is among the most studied psychotherapies ever developed, with dozens of randomized controlled trials across three decades. It is the first-line, guideline-recommended treatment for borderline personality disorder — the condition it was built for and transformed from “untreatable” to treatable. The evidence base extends to suicidal and self-injurious behavior, substance use disorders, binge eating, and — most relevant to my practice — transdiagnostic emotion dysregulation: the intense reactivity, impulsivity, and mood instability that appear across conditions and in people who meet criteria for none.
That last point matters. The research increasingly supports what clinicians have long observed: emotion dysregulation is a dimension, not a diagnosis. It shows up in people running companies and courtrooms — and DBT’s skills work regardless of whether a diagnostic label is attached.
DBT for High-Functioning People
Here’s the gap I built my program to fill: DBT was designed for severely impaired populations, and most DBT programs still assume that population — the pacing, the examples, the group composition, the clinical tone. High-functioning people with serious emotion regulation problems get a treatment that talks past them, or they’re told, implicitly, that DBT isn’t for people like them.
It is. Emotional intensity doesn’t check your résumé. I work with executives, attorneys, physicians, and founders whose dysregulation is invisible at work and corrosive everywhere else — the surgeon whose irritability is dismantling her marriage, the litigator whose anger wins cases and loses relationships, the founder whose impulsivity is a superpower until it isn’t. High capability often masks dysregulation, and frequently makes it worse: you’re skilled enough to contain the storm publicly, so it discharges privately, and no one believes you need help.
My DBT program keeps full fidelity to the model — weekly individual therapy, weekly skills training, between-session coaching — while calibrating everything else to this population: the pace assumes intelligence, the examples assume high-stakes professional lives, the skills group is composed of peers doing equally serious work, and the coaching component fits the concierge standard the rest of my practice runs on. Adherent DBT, built for people who are used to being the most capable person in the room — and are done being ambushed by their own emotions.
Ready to look at the program itself?
The Comprehensive DBT Program page covers structure, components, and admission.