DBT-informed Art Therapy in Private Practice

Why DBT?

I have been in private practice since 2019, initially under supervision as a Resident in Counseling working toward my license as a Licensed Professional Counselor (LPC) and then while fully licensed as an LPC in the state of Virginia. Before founding CATS, the group practice I worked at had a fully adherent Dialectical Behavior Therapy (DBT) program. For those who are unfamiliar and new to DBT, fully adherent means that the therapists at the practice provided all four components of DBT that mimics the treatment supported by research (Linehan, 1993; 2015). (I write about DBT more in detail on this page here).

I became foundationally trained in DBT through psychwire to increase my skillset as a practitioner and feel competent to work with individuals diagnosed with Borderline Personality Disorder and individuals who engage in non-suicidal self-injury, suicidal ideation, and other behaviors associated with emotion dysregulation.

Part of what attracts me to DBT is the neuroimaging evidence that shows (with real pictures!) how consistently practicing the mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness, and walking the middle path skills changes the brain. Specifically, DBT results in a decrease in amygdala sensitivity, enhanced fronto-limbic connectivity, and an increase in dorsal lateral prefrontal cortex (dL-PFC) activation (Goodman, et al, 2014; Iskric and Barkley-Levenson, 2021; Schmitt et al, 2016).

Amygdala sensitivity influences our reactivity to the environment around us, so a decrease in amygdala sensitivity may result in an individual feeling less reactive, less “on edge” to stressors in the environment, and like they have more control over their emotions.

The amygdala is located in the limbic system, and enhanced fronto-limbic connectivity means that an individual may have better awareness, understanding, and regulation of their emotions.

The dL-PFC is responsible for planning and impulse control, so an increase in dL-PFC activation may result in a reduction of self-harm urges and an increase in ability to use non-destructive forms of problem-solving.

DBT and Art Therapy

I professionally identify as an artist-therapist, so with the evidence-based treatment approaches I specialize in, I’m always thinking of ways to incorporate and integrate elements of art therapy in my work.

The art-based mindfulness exercises in mindfulness-based art therapy (MBAT; Buchalter, 2015; Davis, 2015; Monti et al., 2006; Rappaport, 2014) and the mindfulness skills from DBT are both informed by Zen Buddhism (I talk about different forms of mindfulness in this post here). While I led DBT skills groups, I prescribed MBAT exercises in the mindfulness part of class. Not everyone enjoyed the art-based exercises, which was to be expected, as everyone has a different form of mindfulness—running, meditating, journaling, listening to music, or drawing—that works for them.

The DBT skills can be learned, reiterated, and enhanced through art therapy, especially if one communicates more nonverbally and has a kinetic style of learning. DBT-informed art therapy (Clark, 2016; Clark, 2021) is practiced in residential, inpatient, outpatient, and private practice settings, and I am excited to bring this approach to Coastal Art Therapy Services. The artwork and other creative forms of self-expression (Speigel, Makary, & Bonavitacola, 2020) can help clients develop the skills of core mindfulness, interpersonal effectiveness, emotion regulation, distress tolerance, and walking the middle path reiterating that creativity and DBT can change the brain.

Resources:

Dialectical Behavior Therapy

Read more about what DBT is and how it’s offered at Coastal Art Therapy Services

What is Mindfulness?

Check out this blog post on mindfulness and it’s impact on counseling and psychology.

References:

Buchalter, S. I. (2015). Raising self-esteem in adults: An eclectic approach with art therapy, CBT and DBT based techniques.

Clark, S. M. (2016). DBT-informed art therapy. Jessica Kingsley Publishers.Top of Form

Clark, S. M. (2021). DBT-informed art therapy in practice: Skillful means in action. Jessica Kingsley Publishers.

Davis, B. J. (2015). Mindful art therapy: A foundation for practice. Philadelphia, PA: Jessica Kingsley Publishers.

Goodman, M., Carpenter, D., Tang, C. Y., Goldstein, K. E., Avedon, J., Fernandez, N., Mascitelli, K. A., Blair, N. J., New, A. S., Triebwasser, J., Siever, L. J., & Hazlett, E. A. (2014). Dialectical behavior therapy alters emotion regulation and amygdala activity in patients with borderline personality disorder. Journal of psychiatric research, 57, 108–116. https://doi.org/10.1016/j.jpsychires.2014.06.020

Iskric, A., & Barkley-Levenson, E. (2021). Neural Changes in Borderline Personality Disorder After Dialectical Behavior Therapy-A Review. Frontiers in psychiatry, 12, 772081. https://doi.org/10.3389/fpsyt.2021.772081

Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.

Linehan, M. (2015). DBT® skills training manual (2nd ed.). New York: Guilford Press.

Monti, D. A., Peterson, C., Kunkel, E. J., Hauck, W. W., Pequignot, E., Rhodes, L., & Brainard, G. C. (2006). A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psycho-oncology, 15(5), 363–373. https://doi.org/10.1002/pon.988

Rappaport, L. (2014). Mindfulness and the arts therapies: Theory and practice. Philadelphia, PA: Jessica Kingsley Publishers.

Speigel, D., Makary, S., and Bonavitacola, L. (2020). Creative DBT activities using music: Interventions for enhancing engagement and effectiveness in therapy. Philadelphia PA: Jessica Kingsley Publishers.

Schmitt R., Winter D., Niedtfeld I., Herpertz S.C., & Schmahl C. (2016). Effects of psychotherapy on neuronal correlates of reappraisal in female patients with borderline personality disorder. Biological psychiatry: Cognitive neuroscience and neuroimaging, 1, 548–57. doi: 10.1016/j.bpsc.2016.07.003