Dialectical Behavior Therapy (DBT), developed by Marsha Linehan, is a structured, skills-based treatment grounded in cognitive-behavioral principles, particularly effective for individuals with emotion dysregulation and borderline personality disorder. At first glance, DBT’s focus on mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness appears to contrast sharply with the introspective, interpretive nature of psychodynamic therapy. However, a psychodynamic conceptualization of DBT reveals how DBT can be understood through a relational lens and enriches the understanding of how and why DBT works.
1. Emotion Regulation as Ego Strengthening
From a psychodynamic perspective, DBT’s emotion regulation skills can be seen as strengthening ego functions—particularly reality testing, affect regulation, and impulse control. Where psychoanalysis focuses on making unconscious content conscious and integrating split-off affect states, DBT provides clients with tools to tolerate, name, and manage overwhelming feelings. These are capacities traditionally attributed to a well-functioning ego. In this way, DBT may be viewed as enhancing ego resilience, enabling clients to confront previously defended-against material without decompensating. In this way, for clients struggling to manage their emotions, DBT can prepare them for increased emotional integration and insight.
2. Mindfulness and Observing Ego
Mindfulness, a cornerstone of DBT, aligns with the psychodynamic construct of the “observing ego”—the capacity to reflect on one’s internal experience with a degree of separation. This allows for the development of insight, self-reflection, and metacognition. DBT teaches clients to notice their thoughts, feelings, and urges nonjudgmentally. This can help the client let go of defenses against what they unconsciously have deemed as “bad” emotions or wishes. As DBT increases the client’s window of tolerance, they gain greater self-awareness and the capacity to pause before reacting, a prerequisite for lasting personality change.
3. Dialectics and Internal Conflict
The dialectical stance in DBT—balancing acceptance and change—can be understood psychodynamically as a process of integrating internal object relations or resolving intrapsychic conflict. Many DBT clients experience black-and-white thinking rooted in splitting, a defense mechanism rooted in object relations theory. DBT’s dialectical philosophy encourages synthesis, which supports the client as they slowly move from conflicted object representations toward more integrated, nuanced internal experiences of self and others.
4. Interpersonal Effectiveness and Transference Work
DBT’s interpersonal effectiveness skills target relational dynamics that have been shaped by early attachment experiences. Teaching clients to assert needs and set boundaries can prompt them to begin working through maladaptive internalized relational patterns. While DBT therapists don’t explicitly work with transference in the traditional sense, the therapeutic relationship is still a powerful medium for change. DBT therapists use appropriate disclosure and address ruptures in the therapy relationship directly. Clients’ interactions with DBT therapists reflect unconscious relational templates that are being gently restructured. Contemporary psychodynamic therapists recognize that direct experience may impact clients’ implicit relational models more powerfully than interpretations, and that in fact, many changes happen without being discussed or noted.
Conclusion
While DBT and psychodynamic therapy emerge from distinct traditions, they are not mutually exclusive. In fact, conceptualizing DBT through a psychodynamic lens allows clinicians to appreciate the deeper structural and developmental changes that DBT skills may facilitate. DBT can provide the scaffolding necessary for some clients to engage more deeply in psychodynamic exploration. For clients with deep attachment wounds and deficits in emotion regulation, a combined approach can lead to lasting transformation across both behavior and inner experience.