Dialectical Behavior Treatment Therapy

Dialectical Behavior Treatment Therapy is a cognitive behavioral treatment designed to help people learn and use new skills and strategies towards developing a life that they experience as worth living. DBT was originally developed to treat chronically suicidal individuals. With impressive outcomes, it is now recognized as the gold standard treatment for those who struggle with symptoms of borderline personality disorder (BPD). It is also effective in treating other disorders including depression, substance dependence, eating disorders, and in its prolonged exposure (PE) adaptation, post-traumatic stress disorder (PTSD).

Dialectical Behavior Therapy (DBT) is a complex treatment that requires thorough clinician training. All Families On The Line clinicians have been intensively trained in DBT and have completed a full year in the DBT intensive training program of the Yale New Haven Psychiatric Hospital.

More on DBT in our FAQ section.

Families On The Line is a fully DBT-adherent practice dedicated to helping improve our clients’ lives. Our clinicians are extensively trained and provide a range of evidence-based treatments to address various emotional, behavioral, relational, and lifestyle concerns.

DBT Skills Group

In addition to individual psychotherapy and coaching, a central component of DBT is skills training groups aimed at teaching our clients new competencies. DBT skills groups last about 2 hours. They are structured like a class where the group leaders teach skills and assign homework. The homework helps clients practice using the skills in their everyday lives.

There are four modules in skills training:

Mindfulness: the practice of being fully aware and non-judgmentally present in the mome
Distress Tolerance: how to tolerate crises without making the moment worse
Emotion Regulation: how to regulate emotions
Interpersonal Effectiveness: how and how strongly to ask for what you want and say no while maintaining self-respect and relationships with others; how to nurture or end relationships.


Cognitive Behavior Therapy

Cognitive Behavior Therapy (CBT) was developed by Aaron Beck in the 1960s. It is an evidence-based psychotherapy that is highly effective in addressing a wide range of internalizing and externalizing problems in children, adolescents, and adults, including mood disorders, anxiety and related disorders, problems of inattention, impulsivity or defiance (e.g., ADHD, oppositional defiant disorder, conduct disorder), habit disorders (e.g., trichotillomania, skin picking), procrastination, difficulties in problem solving or decision making, social skills problems, thought disorders, eating disorders, chronic pain, and interpersonal problems. Treatment is based on developing an understanding of how an individual’s current thinking patterns and belief system about themselves, others and the world influence emotions and problematic behaviors. There is a central focus on identifying, evaluating, and responding to dysfunctional thoughts and beliefs. Behavioral interventions are also utilized to bring about lasting behavior change.

Acceptance & Commitment Therapy

Acceptance and Commitment Therapy (ACT) is a variation of traditional CBT. It is another evidence-based treatment with substantial empirical support for a broad range of psychological difficulties across the lifespan. From an ACT perspective, psychological suffering is caused by attempts to control and escape painful emotions and other difficult experiences. The primary goal of ACT is to increase psychological flexibility – the ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior in order to foster a values-driven life. Psychological flexibility is based in acceptance, mindfulness, and behavior change strategies.

Cognitive Behavioral Analysis System of Psychotherapy

Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is an integrative therapy with strong research support for treating chronically depressed adults. The treatment combines components of cognitive, behavioral, interpersonal, and psychodynamic therapies. Chronic depression is viewed as the outcome of persistent disconnectedness from the environment and interpersonal avoidance. Problem solving techniques, exploration of past traumatic relationships, identification of healthy relationships, and behavioral skills are used to help chronically depressed individuals modify maladaptive behavior, understand problematic interpersonal patterns and relationships, and start achieving desired outcomes.

DBT & PE for Trauma-related Issues

Prolonged Exposure (PE)

Prolonged Exposure (PE; Foa, Hembree, & Rothbaum, 2007) is an exposure-based, time-limited therapy for post-traumatic stress disorder (PTSD). It combines both in-session imaginal exposure exercises and out of session practices to increase emotional processing of the traumatic events and break the cycle of avoidance that has been theorized to underlie many of the unwanted and often debilitating symptoms of PTSD. The average number of sessions for a round of PE is 8-15, but this may vary depending on number, type, and chronicity of traumas experienced. Sessions are highly structured, range from 60-120 minutes in length, and include homework and out of session exercises. There is a strong research basis for PE, with clinical trials demonstrating its efficacy across a number of populations and conditions (Foa, 2011).


DBT-PE (Harned, Korslund, Foa, & Linehan, 2012) was developed to treat PTSD among those with a diagnosis of BPD and/or related issues (e.g., suicidality, self-harm) who are also receiving DBT. DBT-PE is intensive as it includes both weekly comprehensive DBT programming (individual + group sessions) and weekly PE sessions (as described above). DBT-PE thoughtfully and comprehensively addresses PTSD in the context of high-risk behaviors and safety concerns. Research support for DBT-PE is mounting with studies demonstrating promising results (Harned, Korslund, & Linehan, 2014).

Cognitive Processing Therapy (CPT)

Cognitive Processing Therapy (CPT; Resick & Schnicke, 1993) is a time-limited, cognitive behavioral therapy treatment that operates under the premise that the modification of thoughts related to the trauma will produce improvements in emotions and behavior. Over time, the aim of treatment is to help individuals understand how their experience of the trauma affected their view of themselves, others, and the world, and then to learn new, more helpful ways of thinking. CPT sessions are 60 minutes long, highly structured, and include the assignment of out-of-session homework. The average length for a round of CPT is 6-24 sessions. Research support for CPT is strong, with a number of studies demonstrating efficacy (Cusak et al., 2015).

Grief Treatment/ Grief Counseling

Grief is a universal human experience and it is a privilege to share the journey with those who have suffered loss. Lives are permanently changed by the experience of loss, and yet still there is the capacity to proceed with a satisfying future, and even experiences of joy, following the death of someone we are close to.

The goal of Complicated Grief Treatment (CGT) is to release people from the pain that can dominate their experience and compromise their hope for a meaningful future. CGT is a 16-session evidence-based intervention with a 70% efficacy rate in helping people to integrate their experiences of loss. The process aims to restore their ability to experience joy and satisfaction in life while accepting the finality and consequences of their loss and maintaining a connection to the person who died. This treatment is intended and effective for those who experience yearning, longing and sorrow, frequent preoccupying thoughts of the deceased, difficulty accepting the loss, and persistent intense emotional or physiological activation when experiencing reminders of the loss.

It has been said that grief is the form that love takes when someone we care about dies. Complicated Grief Treatment can be a pathway to honoring the experience of grief, and is individualized to each person’s unique circumstances of loss.

Marie-Paule De Valdivia, Founder & Clinician Families On The Line

My experience is unique and multi-faceted. I am the relative of a family member who manages her BPD symptoms and with whom I enjoy a loving relationship.

As part of my MSW curriculum, I trained extensively in the DBT program of Yale New Haven Psychiatric Hospital. I have worked extensively with family members via phone or Skype; as well as in-person with clients who suffer from the symptoms of BPD and their families.

I have volunteered on the board of the National Education Alliance for Borderline Personality Disorder for 10 years, believing passionately in that mission and developing the Family Connections program in the US and around the world, as well as teaching it at home and overseas to hundreds of families and colleagues.

I am frequently invited to speak on the topic of families’ experience and treatment at conferences in the US and worldwide.

My Journey

When our child’s illness became evident a decade ago, we, her family, were very much overwhelmed and had no sense of where to turn. Despite the fact that they had been in intensive therapy; for about a year we floundered about, while their life which had been full of promise came to an abrupt stop, filled as it was with impulsive and dangerous behaviors. Yet no one brought up with us the diagnosis of BPD. And when they turned 18, of course no one discussed anything with us at all anymore. It is only when I discovered the description of BPD symptoms on the website of a well known psychiatric hospital, that all became clear.

Our child went into treatment. We took the NEABPD Family Connections class. Things improved vastly, both at home and for them. There were bumps in the road, but the progress was marked.

I started teaching Family Connections, I could see the profound effect on families and loved it. So I went back to school and earned an MSW. I was given the extraordinary opportunity to complete my second year practicum in the DBT program of the Yale-New Haven Psychiatric Hospital. This gave me a well-rounded view of BPD, from a parent’s as well as from a clinician’s perspective.

I have helped patients and continue to do so; I have been helping families for many years; and perhaps most importantly, our family is solid and our adult child has a kind of hope and a life journey we could not have imagined.

My DBT Experience

Founder & Therapist
Families On The Line

Assistant Clinical Professor of Social Work in Psychiatry (2015-present)
Yale University, School of Medicine
Along with supervising doctoral students in psychology, I also co-directed the Annual Yale –NEABPD conference in 2015 and 2016.

DBT Clinician
Yale-New Haven Psychiatric Intensive Outpatient Hospital
During my tenure at YNHH, I delivered group and DBT therapy to adults, adolescents and their families. During a part of that time I also co-directed the DBT program of the Yale New Haven Psychiatric Day Hospital.

Board member and (c) Family Connections Leader (2009-2018)
Executive Vice President (2017-2018)

National Education Alliance for Borderline Personalitydisorder
As part of this all-volunteer organization, I helped grow the Family Connections program from serving a few hundred families annually to serving thousands of families in over 20 countries. I facilitated classes for about 400 families; and trained class leaders internationally. I chaired the Family Connections committee on the board from its inception and for 7 years.

Julia Cardone M.ed, LMSW

Julia is a Licensed Master of Social Work who enjoys working with children, adolescents, and adults. She has extensive training in Dialectical Behavior Therapy and brings her experience in Motivational Interviewing and Cognitive Behavior Therapy to her work with individuals and families.

Prior to joining Families on the Line, Julia served as a practicum clinician within the Yale New Haven Hospital Intensive Outpatient Program, leading DBT skills groups, conducting mindfulness practices with groups, and providing therapy targeting emotional dysregulation. Julia also has experience working with children and adolescents and their families as a behavioral health clinician at Wellmore Behavioral Health in Waterbury, CT, where she engaged in both individual and family work. In addition, Julia has a strong interest in supporting those who grieve, and has received advanced training in providing Complicated Grief Treatment.

She is a Family Connections leader for the National Education Alliance for Borderline Personality Disorder and is passionate about bringing skills and support to families via NEA-BPD weekend intensive workshops and classes for family members of those with emotional dysregulation difficulties.

Julia received her undergraduate degree in Psychology from Brown University, followed by a Master’s in Counseling and Consulting Psychology from Harvard University’s Graduate School of Education. She received her Masters of Science in Social Work from Columbia University.

Alli Kalpakci, PhD

Alli has an expertise in working with individuals who experience intense emotions that often lead to problems in interpersonal relationships, risky or impulsive behaviors, self-harm and suicide, and intense self-criticism and hopelessness. She is passionate about working with individuals who have not previously found therapy helpful, and she is committed to genuinely and radically accepting her clients in order to help them experience real and measurable changes in their life.

Alli received her Ph.D. in Clinical Psychology at the University of Houston and completed pre- and post-doctoral fellowships at Yale University School of Medicine, specializing in using Dialectical Behavior Therapy (DBT) in her work with adults and adolescents with borderline personality disorder and their families. Her relevant clinical training includes intensive fellowships at Yale New Haven Hospital Intensive Outpatient DBT Program, The Menninger Clinic, The DBT Center of Houston, the Adolescent Diagnosis Assessment Prevention Treatment Center, and the West Haven VA Outpatient Addiction and Recovery Services program. Alli also has an extensive research background and is a published author in peer-reviewed journals and books on borderline personality disorder, social cognition, emotional sensitivity, and the development of personality disorders.

In addition to DBT, Alli is trained in multiple therapeutic interventions including Cognitive Behavioral Therapy, Prolonged Exposure [PE], DBT-PE, Cognitive Processing Therapy, Motivational Interviewing, CBT-SUD, and Mentalization-Based Therapy.

Hedy Kober

Hedy completed her doctoral degree in psychology at Columbia University, with a focus on cognitive and affective neuroscience. She is currently completing her respecialization in clinical psychology. Before Hedy joined Families on the Line, she trained at Yale’s Intensive Outpatient DBT program and at Shoreline Psychological Services. Hedy is also an Associate Professor of Psychiatry and Psychology at Yale, where she is the Director of the Clinical & Affective Neuroscience Lab.

Hedy’s research work focuses on the cognitive and neural mechanisms underlying emotion regulation strategies, and treatments for psychopathology more broadly (e.g., substance use disorders, eating disorders, mood disorders, and borderline personality disorder). Additional research focuses on the effects and neural mechanisms underlying mindfulness meditation and acceptance-based practices. In both areas, she has published extensively and has given national and international talks.

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