Psychodynamic Therapy and DBT: A Pretty Sweet Match

Since I work with attachment trauma, lots of folks who come to see me have intense emotions that can feel like they're coming out of nowhere and wreak terrible havoc.

Like Daenerys' dragons:

Major HAVOC! Photo: HBO.

Major HAVOC! Photo: HBO.

These intense feelings can be so overwhelming to your body and your mind that you can't think anymore. All you can do is feel. And when all you can do is feel, you want to do something, anything, to make the feeling go away.

So maybe you cut. Or you drink. Or you call your ex over and over again until she blocks you or refuses to pick up. Maybe you check out, numb out, binge out, freak out– whatever you do,  you're just trying to get rid of the intensity of the emotion that feels like it's going to overtake you.

Dialectical Behavior Therapy (DBT) is one treatment approach for addressing these intense emotions.

DBT skills development can help you regulate your emotions and tolerate your distress, and has been helpful for many people I work with and for myself personally. There are several DBT centers in the East Bay and San Francisco, all of which have their own personality and style but go through the same training through Behavioral Tech.

While I highly recommend DBT for many, it is one part of a multifaceted treatment plan. If you are experiencing overwhelming emotions and subsequent impulsivity, I highly recommend you try a concurrent DBT treatment with your psychodynamic or analytic talk therapy. With DBT or another mindfulness practice such as body movement (like dance, lifting, stretching), meditation, being in nature, or spiritual prayer, you can learn to regulate the overwhelming feelings so that you are able to take in in more of the deep work you're doing with your therapist, which can help you feel more connected to others and to your joy and desires.

Maybe we can think of it this way: If we can imagine your psyche and soul as an fruit tree, I see DBT as shaping and pruning the limbs of your tree. In order to get the sweetest fruit, i.e. your joy and hope coming to fruition, it's important to prune the limbs of your tree so that those fruits can grow and ripen. Any master gardener will tell you that pruning is one of the most important elements of harvesting amazing fruit.

That said, as with anything growing in the ground, the roots also need constant and consistent tending. This is where dynamic and analytic therapy comes in. While DBT is excellent at giving you tools and boundaries for your emotions so that you can stay present, there must be something you are staying present for. That is where the deep work with your unconscious and your history come into play. Folks who experience this kind of emotional overwhelm tend to have attachment traumas from childhood, and if we don't address those traumas– the roots– your tree will not fruit at all, regardless of how much you prune.

Here's the juice: It's highly likely that the reason you didn't learn these skills as a child is because someone in your life was not able to teach them to you. It's also possible that you had a parent who was preoccupied, or misattuned to you, and couldn't reflect back your feelings when you were an infant and so couldn't help you develop these self-regulating skills. For the sake of your own heart, it's important that you learn these skills– they do work, and they can help.

It's also incredibly important that you also address the wound that's opened up from being "missed" or misunderstood in the first place by your primary caregivers. This is where dynamic and analytic therapy can be an excellent complement to DBT. Analytic and dynamic therapists are trained and willing to get connected to you through a deep relationship that's unparalleled. It's the kind of relationship that can help you learn what you need in your other relationships; what you need from your life, your work, your dreams, and yourself.

I have a sense for what it can be like to feel awash and overwhelmed by your emotions; to feel like what you think/feel right now is what you will always think/feel; to feel trapped and underwater by the intensity of your internal world. I work with people who live in this realm with great frequency. I, too, have felt like this in my life. These treatments can help you feel more integrated and settled, and help calm your inner dragons.

Together, you and I can find the right mixture of pruning and deep root care to help your tree come to bear juicy, delicious fruit that brings you joy and satisfaction.


(While this post is about DBT, I also will share an innovative treatment out of the UK called Mentalization Based Treatment (MBT), which is a short-term treatment that helps you learn how to mentalize: That is, how to think about thinking. This helps you stay mindful of your own thoughts and impulses so that you can better attend to them and your relationships. MBT also focuses on attachment, knowing that as infants we discover ourselves through our parents keeping us in mind.)