Every therapy operates with a certain set of basic assumptions, and DBT is no different. However, in DBT assumptions are clearly articulated and consistently reviewed in a consultation team and with clients at appropriate times, especially at the onset of therapy.
By definition, assumptions are beliefs that are held without being proven as facts. It’s funny because we are often warned not to make assumptions, so why encourage it? Because it’s important to get them out there, for clients and for therapists. Here are the basic DBT Assumptions:
DBT Assumptions About Clients
- People are doing the best that they can.
- People want to improve.
- People must learn new behaviors both in therapy and in the context of their day-to-day life.
- People cannot fail in DBT.
- People may not have caused all of their problems, but they have to solve them anyway.
- People need to do better, try harder and be more motivated to change.
- The lives of people who are suicidal are unbearable as they are currently being lived.
DBT Assumptions About Treatment
- The most caring thing a therapist or treatment provider can do is help people change in ways that bring them closer to their own ultimate goals.
- Clarity, precision and compassion are of the utmost importance.
- The treatment relationship is a real relationship between equals.
- Principles of behavior are universal, affecting clinicians no less than clients.
- Treatment providers need support (AKA Consultation team)
- Treatment providers can fail. (They are human and fallible.)
As a DBT therapist, the first assumption we make about clients is “People are doing the best they can”. This keeps us from concluding that no progress means a lack of effort on the client’s part. For a client who grew up being labeled as lazy or self-sabotaging or who has experienced many treatment failures, it is critical to hold this assumption as a universal one and to work hard at understanding what is maintaining the problematic behavior or symptoms.
Despite clients themselves admitting to not trying or doing their best, therapists are encouraged to hold that assumption as true while at the same time holding another assumption that “People need to do better, try harder, and be more motivated to change” also to be true. Although these two seem to be in conflict, they are actually the perfect dialectical tension that is present in therapy and in people’s lives. By holding both as true at the same time, the therapist avoids the tendency to polarize (seeing only one as true), and therefore can better assist the client in understanding what gets in the way, what needs are unmet, and what skills may be needed or tweaked to experience success or progress toward mastery. Together, therapist and client seek the middle path when they hold opposing truths as true and they discover that when compassion and understanding meets pain and suffering, there is truly hope in a life worth living blossoming for those once living in hopeless despair.