Disability Justice in DBT
Dialectical Behavior Therapy (DBT) is a therapy that centers dignity, validation, and building a life worth living in an invalidating and often oppressive world. Disability Justice (DJ) offers a powerful framework for deepening DBT practice by centering access, interdependence, and the leadership of those most impacted by systems of harm. Rather than being an add-on, DJ aligns closely with DBT’s biosocial model. It helps clinicians widen the lens on what constitutes an invalidating environment—moving beyond family dynamics to include ableism, racism, transphobia, sanism, and systems that demand constant productivity, compliance, and a lack of emotional expression.
Disability Justice: Activist Lineage
Disability Justice as a framework was articulated by disabled activists of color, most notably the collective Sins Invalid, building on earlier work in disability rights, Black feminist thought, and abolitionist organizing. Patty Berne, Mia Mingus, Stacey Milbern, Leroy Moore Jr., and other Sins Invalid members emphasized that disability cannot be separated from racism, colonialism, capitalism, heteropatriarchy, and state violence (Berne et al., 2018). Building on the earlier Disability Rights movement that focused on legal access and individual accommodation, DJ centers:
· Intersectionality
· Leadership of those most impacted
· Collective access and interdependence
· Anti-capitalism and rejection of productivity as worth
· Wholeness and dignity beyond cure or compliance
This lineage is especially relevant to mental health treatment, where disabled people, particularly those with psychiatric disabilities, have been historically institutionalized, incarcerated, excluded, and coerced in the name of care. The idea that there is one “normal” or “healthy” brain is a social construct created to oppress. DJ reminds us that neurodiversity is a valuable part of human diversity.
Applying Disability Justice Principles in DBT
Intersectionality
DBT skills do not exist in a vacuum. Identity, oppression, and access shape how emotions are experienced and regulated, and these factors impact who will be reinforced or punished for attempts to be skillful. Distress may be a reasonable response to systemic harm, not a skills deficit or emotion dysregulation.
Leadership of Those Most Impacted
Clients are experts in their own survival. Treatment goals should be collaboratively defined, with lived experience treated as meaningful data.
Collective Access
Rather than relying on individual accommodation requests, DBT can be designed with flexibility built in, including multiple ways to engage, variable pacing, and expectations that allow for fluctuating capacity.
Interdependence
DBT is not about radical self-sufficiency. Community care is essential and skillful. Reliance on each other can be explicitly framed as effective coping.
Rejecting Productivity as Worth
In line with DBT, success does not have to mean symptom elimination or increased output. Survival, harm reduction, rest, and boundary-setting are essential to building a life worth living.
Toward a More Just DBT
DBT provides structured, skills-based tools to help people cope with intense emotional experiences that build toward a life worth living. Disability Justice challenges us to ensure this work does not reproduce harm by centering access, dignity, and collective care alongside DBT’s acceptance and change.
References:
Berne, P., Morales, A., Langstaff, D., & Sins Invalid. (2018). Skin, Tooth, and Bone: The Basis of Movement Is Our People. Sins Invalid.
Mingus, M. (2011). Changing the Framework: Disability Justice. Leaving Evidence. https://leavingevidence.wordpress.com
Lewis, O. (2018). Mental health laws and human rights: The role of international human rights law in protecting the rights of people with mental disabilities. Health and Human Rights Journal, 20(1), 85–95.
Piepzna-Samarasinha, L. L. (2018). Care Work: Dreaming Disability Justice. Arsenal Pulp Press.