DBT was developed by Dr Marsha Linehan, in the 1970s. She was at the time trained as a behaviourist (behaviourism is the theory that human behaviour is based on mental training and the influence of habit, rather than being explained by thoughts and feelings) and was applying standard CBT to adult women who had histories of chronic self-harm, suicide attempts and suicidal ideations.

Eventually, she concluded that some of these woment met the criteria for borderline personality disorder, and she was keen to know whether CBT was helpful for women who had suicidal tendencies due to extremely painful problems – in the 1970s CBT was prominent for use as psychotherapy for a multitude of mental health problems.

As she and her research team applied CBT to these patients, they noticed numerous problems – many clients responded to the treatment by withdrawing from treatment altogether, or becoming angry and frustrated. There was a high drop out rate.

The volume and severity of problems presented by some clients made it almost impossible to use the standard CBT format. Therapists didn’t have time to address the problems presented by complex clients and didn’t have time in session to help the client learn more adaptive skills.

Dr Linehan and her team made significant changes to standard CBT, adding in new strategies and modifications, and making changes to the structure of the treatment. Adding in ‘validation’ strategies allowed patients to accept themselves, and discover they could learn how and to trust themselves and their judgment. The addition of the notion that acceptance didn’t have to exclude change is where dialectics came into play.

There have been ongoing development, changes and studies of DBT over the years since Dr Linehan and her team first developed DBT, and it is now recognised as an effective treatment for people living with borderline personality disorder.