Is This Client Overcontrolled? When to Consider a Referral for RO DBT
As mental health providers, we’ve all worked with clients who seem “stuck.” They show up, do the work, and may even have insight into their struggles—but progress feels painfully slow. These clients may present with perfectionism, emotional inhibition, and chronic disconnection, often leaving both client and clinician frustrated.
If this resonates, it might be time to consider Radically Open Dialectical Behavior Therapy (RO DBT)—a treatment specifically designed for individuals who lean toward excessive self-control, also known as emotional overcontrol.
What Does Overcontrol Look Like in Practice?
Clients who struggle with overcontrol often:
Appear emotionally flat or hard to read
Avoid emotional vulnerability
Fear making mistakes or appearing “imperfect”
Overanalyze social interactions
Withdraw from others despite a desire for connection
Present as conscientious, responsible, and detail-focused but report deep loneliness or anxiety
You may hear things like:
“I always have a smile on, but no one really knows me.”
“I don’t like to share how I feel”
“I need everything to be just right before I can relax.”
“I feel invisible even when I’m around people.”
Diagnoses often include treatment-resistant depression, anorexia nervosa (restricting type), obsessive-compulsive personality disorder (OCPD), chronic generalized anxiety, and sometimes high-functioning autism with social difficulties.
Why RO DBT Is Different
Unlike standard DBT or CBT protocols, RO DBT targets maladaptive overcontrol, with a specific focus on:
Increasing openness to new experiences and feedback
Enhancing emotional expression (especially through nonverbal signaling)
Improving social connectedness
RO DBT helps clients learn how to authentically express themselves, take interpersonal risks, and build genuine connections. The work is often life-changing for clients who’ve spent years masking or managing behind emotional walls.
Why It Matters for You as a Clinician
“RO DBT isn’t a last resort—it’s the right intervention for the right client.”
Referring a client to an RO DBT program isn’t just a benefit to them—it’s a meaningful support to you.
Free up space on your caseload for clients who are a better fit for your therapeutic style and approach
Reduce burnout from the emotional fatigue of working with clients who struggle to open up or shift
Relieve the pressure of feeling like you’ve tried “everything,” especially when clients have high insight but limited flexibility.
Wondering If a Client Is a Fit? We Can Help.
RO DBT isn’t a last resort—it’s the right intervention for the right client.
We offer screening tools and quick, collaborative consults to help you assess goodness-of-fit and confidently determine whether RO DBT is the right next step for your client.
Let’s Connect
If you’ve got a client who might benefit from a different approach, or if you’re feeling stuck in your work with someone who seems “fine” on the outside but feels disconnected inside—let’s talk.
We're passionate about helping clients build lives of openness, authenticity, and connection. And we’re here to support you in getting them there.
