Therapy approach
DBT was built for people whose feelings can feel too big to handle, who hurt themselves to cope, or who have thoughts of suicide. It teaches concrete skills for getting through the hardest moments and building a life that feels worth living.
DBT is short for dialectical behaviour therapy. Dialectical means holding two opposite ideas at once. The core dialectic in DBT is: I am doing the best I can, and I can do better. Both are true at the same time.
DBT was developed by Marsha Linehan in the 1980s to help people who were not getting better with standard talk therapy, especially people with intense emotions, self-harm, and suicidal thoughts. It is now used for a wide range of concerns where strong feelings get in the way of daily life.
DBT teaches four sets of skills: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. You practice them in session and in your day-to-day life. Over time, the skills become things you reach for automatically when a hard moment hits.
Imagine you get into an argument with your partner. Inside half an hour, you are sobbing, your chest is tight, and you have the thought, "Maybe everyone would be better off without me." You feel like you have to do something to make the feeling stop, right now.
DBT teaches you what to do in exactly that moment. You learn distress tolerance skills like cold water on your face, paced breathing, and grounding through your five senses, which can pull the feeling down from a 9 to a 6 in a few minutes without needing to act on the thought.
Later, when you are back to baseline, you and your therapist look at what happened. Together you map the argument, the feeling, and the urge. You build an emotion regulation plan so the next argument is easier to ride out, and you practice interpersonal effectiveness skills so you can ask for what you need without the conversation spiralling.
DBT was originally built for borderline personality disorder, but the skills are useful for anyone whose emotions feel hard to manage. Our clinical team uses DBT skills with clients across a range of concerns.
A full DBT programme has several pieces. Saalvio offers DBT-informed individual therapy and skills coaching; comprehensive DBT (individual plus group plus phone coaching plus consultation team) is offered through specialised programmes we can refer to.
You and your therapist look at the diary card from the week (a simple log of urges, behaviours, and skills used). You pick the most important moment to focus on, usually anything involving self-harm, suicidal thoughts, or a behaviour that got in the way of therapy.
You map the chain of events from the trigger to the behaviour. You name the feelings, the thoughts, and the urges at each step. The goal is not blame. It is understanding the chain so you can interrupt it next time.
You and your therapist pick the skill that would have helped most in that moment and rehearse it together. You might practice cold water for distress tolerance, opposite-action for emotion regulation, or the DEAR MAN script for asking for what you need.
You decide what to track on the diary card, what skill to keep practising, and what to do if the same situation comes back. Your therapist is honest about what comes next; vague plans are not safe plans.
Pay attention to what is happening right now, including the painful parts, without trying to push them away or make them bigger. Most DBT skills start here.
Get through a moment that feels unbearable without making it worse. The goal is not to feel good. The goal is to survive the moment and have options later.
Understand your feelings, reduce vulnerability to the worst ones, and change the ones you can change. This is the long game of DBT.
Ask for what you need, say no when you mean no, and keep your self-respect through hard conversations. DBT teaches scripts you can actually use.
DBT has the strongest research support of any therapy for borderline personality disorder and for people with chronic self-harm and suicidal ideation. Marsha Linehan and colleagues have run multiple randomised controlled trials since the 1990s showing reductions in self-harm, hospitalisations, and dropping-out-of-treatment rates.
DBT skills training (without the full programme) has good evidence for emotion dysregulation in eating disorders, post-traumatic stress, depression, and substance use. The skills appear to help anyone whose emotions are loud enough to get in the way of daily life.
Several of our clinicians draw on DBT in their practice. The right match for you depends on more than just the approach, so we encourage you to read the profiles and pick whose voice and focus feels closest to what you are looking for. The first session with any Saalvio therapist is free, and you can switch if it is not a good fit.
Yes. DBT was built for the hardest cases, which is why the research is concentrated there, but the skills are useful for anyone whose emotions feel out of proportion to the situation. Plenty of our clients use DBT skills for anger, anxiety, or relationship patterns and do not have a history of self-harm.
Saalvio offers DBT-informed individual therapy and skills coaching. Comprehensive DBT (individual therapy plus weekly skills group plus between-session phone coaching plus a therapist consultation team) is delivered through specialised programmes. If you need the full programme, your Saalvio therapist will help you find one and stay with you in the meantime.
Not all at once. DBT acknowledges that even painful coping (self-harm, substance use, restriction, anger) is doing something for you in the short term. The work is building enough new skills that the old ones become optional. You and your therapist set the pace.
DBT grew out of CBT and shares its focus on thoughts, feelings, and behaviours. The key addition is acceptance: DBT holds that you can be doing your best AND need to change at the same time. DBT also has a heavier focus on skills training (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness) and tends to be longer than a standard course of CBT.
Saalvio is not a crisis service. If you are in immediate danger, please call 911. If you are in mental health crisis, please call 988 (the Suicide Crisis Helpline of Canada) or visit your nearest emergency department. Comprehensive DBT programmes offer phone coaching between sessions; Saalvio does not currently offer 24/7 between-session coaching, so we lean on the crisis lines, your nearest emergency department, your support network, and a safety plan we build together.
Yes. Studies of telehealth DBT during and after the pandemic show outcomes comparable to in-person DBT for most clients. Some skills (like cold-water distress tolerance) are easier at home than in an office.
DBT is a structured talk therapy that teaches four sets of practical skills: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. It was developed by Marsha Linehan in the 1980s for people whose emotions feel too big to handle, including people who self-harm or have thoughts of suicide. The skills are useful far beyond that original group.
A DBT session usually opens with a brief check on the past week using a diary card, then moves to a specific skill or behaviour you and your therapist want to work on. Skills are taught, then practised between sessions. The "dialectic" is the idea that two opposite things can both be true: you are doing the best you can, and you can do better.
Often yes. DBT delivered by a Registered Psychotherapist or Registered Social Worker is treated the same way as other psychotherapy on most Canadian extended health plans. Saalvio does not bill insurers directly; we send a detailed receipt for you to submit to your extended health plan for reimbursement.
Full comprehensive DBT runs six months to a year. DBT-informed individual therapy, which is what Saalvio offers, is more flexible: many clients see real change in the skills they use most often within twelve to twenty sessions. Your therapist will check progress with you every few weeks and adjust.
Yes. DBT was originally developed for borderline personality disorder and remains the most-studied treatment for it, with strong evidence for reducing self-harm, suicide attempts, hospital visits, and emotional intensity. DBT-informed individual therapy at Saalvio can be one piece of that picture; for the full programme, your therapist will help you find a comprehensive DBT service.
Book a free first session with one of our therapists or join the waitlist if you are outside Ontario. There is no obligation to continue after the first session.
Saalvio psychotherapy is live in Ontario today. Other provinces are coming soon.
