DBT-informed Art Therapy in Private Practice
Why DBT for Borderline Personality Disorder?
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. It is crucial to consult a qualified mental health professional when considering DBT to ensure proper guidance and support.
DBT can also help manage bipolar disorder symptoms by providing tools to regulate emotions and behaviors effectively.
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).
DBT is effective for both bipolar I and bipolar II disorder, addressing the unique challenges of each condition.
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.
What is DBT-informed Art Therapy?
DBT-informed art therapy is a unique therapeutic approach that merges the principles of dialectical behavior therapy (DBT) with the creative process of art-making. This innovative method leverages the power of creative expression to promote emotional regulation, self-awareness, and personal growth. By engaging in art-making, individuals can explore and manage their emotions in a constructive manner, develop essential coping skills, and enhance their overall mental health.
This approach is particularly beneficial for individuals diagnosed with borderline personality disorder (BPD), bipolar disorder, and other mental health conditions. DBT-informed art therapy is especially effective for those who struggle with emotional dysregulation, impulsivity, and self-destructive behaviors. By combining the structured, evidence-based techniques of DBT with the expressive and therapeutic nature of art, this form of therapy offers a holistic way to address complex mental health challenges.
Dialectical Behavior Therapy 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. DBT-informed art therapy can also help manage depressive episodes by providing creative outlets to process periods of sadness and hopelessness.
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. DBT-informed art therapy can also help identify and manage manic and hypomanic episodes by recognizing and addressing the specific symptoms associated with these conditions.
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. Additionally, DBT-informed art therapy has been effective in treating post traumatic stress disorder, helping individuals address complex emotional and cognitive challenges.
DBT Skills and Art Therapy
DBT-informed art therapy incorporates the four core skills of DBT, each of which can be practiced and enhanced through various art-making techniques:
Mindfulness: This skill involves becoming more aware of thoughts, feelings, and bodily sensations. Through art, individuals can engage in mindful practices such as focusing on the texture of clay, the movement of a paintbrush, or the colors in a drawing, which helps ground them in the present moment.
Distress Tolerance: Learning to cope with difficult emotions and situations is crucial. Art therapy provides a safe outlet for expressing and processing distressing emotions, whether through vigorous brushstrokes, tearing paper for a collage, or molding clay.
Emotional Regulation: Managing emotions and reducing their intensity is a key aspect of DBT. Creating art allows individuals to explore and understand their emotions, leading to better regulation. For example, choosing colors that represent different feelings can help in identifying and managing emotional states.
Interpersonal Effectiveness: Developing healthy relationships and communication skills is essential. Collaborative art projects or creating art that represents relationships can enhance understanding and improve interpersonal interactions.
Art-making techniques such as drawing, painting, sculpture, and collage are used to help individuals practice these skills and develop greater self-awareness. This creative process not only reinforces DBT skills but also provides a tangible way to track progress and growth.
How DBT-informed Art Therapy Works
DBT-informed art therapy works by providing a safe and supportive environment where individuals can express themselves creatively. This therapeutic setting encourages exploration and self-expression, which are vital for personal growth and emotional healing.
The art-making process helps individuals:
Identify and express emotions in a healthy way: By translating feelings into visual forms, individuals can better understand and articulate their emotions.
Develop greater self-awareness and self-acceptance: Creating art allows for introspection and self-discovery, fostering a deeper understanding of oneself.
Improve emotional regulation and distress tolerance: Engaging in art-making can be a calming and grounding activity, helping to manage and reduce the intensity of emotions.
Develop healthy relationships and communication skills: Art therapy can include activities that promote empathy, understanding, and effective communication, enhancing interpersonal skills.
Reduce symptoms of mental health conditions: The therapeutic benefits of art-making can alleviate symptoms associated with various mental health conditions, contributing to overall well-being.
By integrating DBT principles with the creative process, DBT-informed art therapy offers a comprehensive approach to mental health treatment, addressing both emotional and cognitive aspects of healing.
Benefits of DBT-informed Art Therapy
DBT-informed art therapy offers a multitude of benefits for individuals seeking to improve their mental health and well-being. Some of the key advantages include:
Improved emotional regulation and distress tolerance: Engaging in art-making helps individuals manage their emotions more effectively and cope with distressing situations.
Increased self-awareness and self-acceptance: The creative process fosters introspection and self-discovery, leading to greater self-understanding and acceptance.
Enhanced coping skills and resilience: Art therapy provides practical tools for managing stress and building resilience, which are essential for navigating life’s challenges.
Improved relationships and communication skills: Through collaborative and expressive activities, individuals can develop healthier relationships and better communication skills.
Reduced symptoms of mental health conditions: The therapeutic benefits of art-making can alleviate symptoms of various mental health conditions, contributing to overall mental health.
Increased sense of creativity and self-expression: Engaging in creative activities allows individuals to explore and express themselves in new and meaningful ways, enhancing their sense of identity and purpose.
Overall, DBT-informed art therapy is a powerful approach that can help individuals develop greater self-awareness, manage emotions, and improve their overall mental health. By combining the structured techniques of DBT with the expressive nature of art, this therapy offers a holistic and effective way to address complex mental health challenges.
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
