8 DBT Myths That Need to Retire

The Mythical DBT Jackalope

Let's put these misconceptions out of their misery!

Poor Dialectical Behavior Therapy (DBT)!

For a treatment that's backed by decades of research and used around the world, DBT has accumulated an impressive collection of myths. Somewhere along the way, "dialectical behavior therapy" became shorthand for “that treatment for borderline personality disorder where therapists never sleep because they're answering coaching calls at 2:00 a.m.”

I wish I were exaggerating.

I've heard these misconceptions from graduate students, seasoned clinicians, referral sources, and even therapists who describe themselves as "DBT-informed."

The good news? Most of these myths dissolve once you understand what DBT is actually trying to accomplish.

Let's clear a few things up.

Myth #1: DBT is only for Borderline Personality Disorder.

Reality: DBT was originally developed to treat chronically suicidal individuals who met criteria for Borderline Personality Disorder—but that's where the story begins, not where it ends.

Today, DBT has been adapted for eating disorders, substance use disorders, adolescents, PTSD, depression, bipolar disorder, emotional dysregulation, and countless clients who don't meet criteria for BPD at all.

At its heart, DBT isn't really about treating a diagnosis.

It's about treating problems of emotional dysregulation.

If someone struggles to manage overwhelming emotions, impulsive behaviors, chaotic relationships, or chronic avoidance, DBT often has something valuable to offer.

Take Angela, for example. Angela is a mother of three children under the age of 2, juggling a full time job, motherhood, and a history of childhood abuse that she does not want to see repeated. I know, your first thought is, “Of course Angela needs therapy, but why DBT?” DBT gave Angela concrete tools for handling her stress and recognizing her trauma patterns, plus, provided baked-in accountability partners thanks to her DBT Skills Class.

Bottom line: DBT isn't a diagnosis-specific treatment nearly as much as it's a principle-driven treatment.

Myth #2: DBT is a suicide prevention model.

Closely related to the “BPD Members-Only” myth is this gem that DBT is a suicide prevention model. Marsha Linehan, Ph.D., creator of DBT, would often correct folks who called her therapy suicide prevention.

Marsha insists that DBT is a “Life Worth Living” model.

It is about creating a life you want to stick around for — a life you can enjoy, find pleasure in, and yes, endure pain in.

She found that by building skills to better tolerate stress, improve relationships, find peace in the present, and regulate emotions, people naturally decreased behaviors bent on looking for the escape hatch every time things got tough.

Myth #3: DBT therapists have to be available 24 hours a day.

I blame Hollywood.

Or maybe that therapist everyone knows who proudly announces they answered coaching calls while on vacation at Disney World. (Ok, yes, that was me, but I totally regretted it afterwards and never did it again.)

The reality is much less dramatic.

Phone coaching is one component of comprehensive DBT—not unlimited access to a therapist’s personal life.

Clients learn how and when to request coaching, what coaching is for, and what it isn't for. Programs establish boundaries. Therapists create limits that are sustainable.

Ironically, coaching exists to increase independence—not dependence.

Done well, clients call less over time because they're learning to use skills before crises escalate.

Bottom line: Good DBT doesn't require therapist martyrdom.

Myth #4: DBT ignores the past.

This one always makes me smile.

Apparently, because DBT asks, "What keeps this problem going?" people assume it never asks, "How did we get here?"

Of course it does! DBT fully recognizes that trauma, invalidation, biology, and learning history all shaped the person sitting in front of you. It simply refuses to stop there. Understanding why a problem developed is important.

Helping someone build a life worth living requires also understanding what maintains that problem today. Those aren't competing ideas. They're both true.

(See? Dialectics.)

Myth #5: DBT is rigid and scripted.

Some clinicians picture DBT sessions as therapists robotically flipping through a manual.

"Page 47. Distress Tolerance. Please complete Worksheet C."

Fortunately, that's not how competent DBT looks. Yes, DBT has structure. Yes, DBT works within a prescribed hierarchy of targets. Yes, there are priorities. Yes, there are treatment agreements. Yes, there is a curriculum and worksheets and diary cards.

But within that framework is enormous flexibility. Think jazz, not karaoke. There's a melody, but the therapist still has to improvise skillfully. The therapist and the client still have the ability to change course go off-script.

(OMG! More dialectics.)

Myth #6: DBT is all about changing behavior.

This is probably my favorite myth because it misses the first word people should associate with DBT: Validation.

DBT is built on the dialectic of acceptance and change.

Not acceptance before change. Not change instead of acceptance. Both.

Clients who feel deeply understood are often far more willing to examine behaviors that no longer serve them.

Turns out people respond better to, "That makes sense..." than, "Stop doing that."

Who knew?

Myth #7: You have to become a Linehan-certified expert before using DBT.

Nope. Should you practice comprehensive DBT without proper training? Also no.

But many clinicians can begin integrating DBT principles, validation strategies, behavioral analysis, and skills into their existing practice while continuing their training.

You don't have to choose between "I know nothing" and "I'm running a fully adherent DBT program."

There's a lot of meaningful learning in between.

Myth #8: Teaching skills is the same thing as doing DBT.

Teaching mindfulness skills is wonderful. Running a distress tolerance group is helpful. Modeling the use of a DEAR MAN skill (formula for assertively setting limits) in a session is super awesome.

None of those things, by themselves, are comprehensive DBT. In fact, it’s a little like saying buying a stethoscope makes you a cardiologist.

Skills matter. But they're only one part of a much larger treatment model that includes foundational relational and learning theories, a slew of interventions, strategies, and protocols, and a comprehensive list of commonly held treatment agreements and assumptions.

DBT Fact:

Ok, so this is actually my opinion, but it sure does feel factual — The more I teach DBT, the more convinced I become that many clinicians don't avoid DBT because they dislike it.

They avoid the version of DBT they've heard about — the impossibly rigid version; the exhausting version; the "only for BPD" version.

The good news is that those versions aren't the real thing.

And once you understand the architecture behind DBT, the treatment becomes not only more effective—but also far more approachable.

Curious about what comprehensive DBT actually looks like in practice?

Our DBT Blueprint Workshop Series is designed to move beyond myths and help clinicians develop a conceptual understanding of DBT that they can immediately apply in session. Whether you're new to DBT or looking to strengthen your existing practice, you'll leave with practical tools—not just theory.

Learn more about upcoming workshops →

Blog by Casey Limmer, MSW, LCSW, DBT-LBC, founder and trainer at St. Louis DBT.