DIALECTICAL BEHAVIOR THERAPY (DBT)

Dialectical Behavior Therapy is different than your past counseling experience.

DBT and is a structured treatments based on proven research outcomes with the goal to reach identified goals set in therapy. DBT has between 20 to 30 “randomized control trials” (the gold standard in clinical research) and studies continue to be published).  It is excellent in treating a variety of problematic behaviors, severe emotional difficulties, multiple diagnoses, and has a holistic approach.  It treats problems that are often ruled out by other providers including suicidal behavior and thinking, self-injurious behaviors, complex trauma with numerous traumatic and often severe events, and more. 

DBT treatment is comprehensive to treat individuals who have a complexity of problems, needs, symptoms, and diagnoses. Those who usually seek treatment, have multiple diagnoses and problems that are serious enough to negatively effect their lives on a moderate to severe level.  DBT therapists treads where other therapists may fear to tread.  It often is utilized when CBT or other short term treatments are exhausted as it is a longer term treatment and a higher level of care.  The ultimate goal is to build a life you want to list in an effective and healthy way to live it.  The rest of the goals are to support building a life worth living.

Individual therapy in DBT is weekly which ensures clients and therapists to stay on top of difficulties in their lives.  When therapy is provided less often, progress can be slowed.  Those in DBT present with a complexity of difficulties and weekly therapy ensures problems that occur are attended to and not missed.

DBT skills training is a structured package of skills so individuals can learn more coping skills while also attending individual therapy.  Skills taught are fall into categories to help individuals increase distress tolerance, regulate emotions, manage relationships, and when you want to be more effective and skillful in place of utilizing the problematic behaviors that brought you to therapy.  The purpose is to ensure clients are learning skills while preserving individual sessions to attend to DBT clients’ personal needs.  

DBT skills coaching is unique in that DBT clients can contact their individual therapist in between sessions for assistance to apply DBT skills they are learning in between sessions.  DBT is purposely more supportive to help those with more needs apply skills with help in place of being on their own to figure it out.  It is also a service that can be utilized during a crisis or when there isn’t a crisis and individuals just want assistance on utilizing skills in every day life.  It is an added support which can help individuals progress more quickly in a skillful manner. 

DBT consultation team is mandatory for DBT providers to ensure treatment is provided to the highest standard and ability.  It is a support system for the therapists to keep therapists on target.  It is a confidential meeting and team members only learn what is needed for therapists to get the assistance they need.  Identities are typically kept anonymous.  This is "behind the scenes" and clients aren't usually aware about this process unless the therapist says "I consulted with my team and they suggested....."

DBT practitioners, like me, are typically passionate at doing DBT to "fidelity" based on research and the treatment developer protocols.  It combines doing DBT as proven to be effective while individualizing to clients in treatment.  This is different from therapists who pull from various treatment models which can affect outcomes.

Doing a little DBT is more harmful than no DBT.  

 

People in need of DBT who end up with "a little DBT" or what we say in the field, "DBT-informed", think they are receiving DBT and unfortunately are getting a watered down version of it.  Outcomes might be impacted and many think DBT wasn't helpful when in may have been if the treatment was done to fidelity, as per protocol based on the treatment developers research.

 

When finding DBT services, know what the elements of DBT are and interview potential clinicians on what services they provide.  DBT practitioners will be impressed by your research.  See below for some questions to ask and potential answers to consider using my answers as a guide.  

 

Those who aren't doing DBT to fidelity, meaning doing elements of DBT or DBT informed, may be decent therapists but may not provide you the services you may really need.  And, choose who you think it the best fit for you.

Curious on if this is the potential treatment for you?  Contact me for more information.  See below.

Searching for other provider options?  Interview potential therapists and skills trainers.  Below are questions to ask and typical answers.  This can help to be sure you are seeing a DBT provider.  Many market themselves that they provide DBT and often that means they utilize parts of the treatment as needed.  Why don't you deserve the best chance of success doing DBT as tested in research?  

WHO IS DBT DESIGNED FOR?

  • Common issues that individuals in DBT have are suicidal behavior, non-suicidal self-injurious behavior, substance abuse and dependence, disordered eating, unstable relationships, interpersonal conflict, black and white thinking, high stress due to daily life problems, and a background that includes traumatic experiences, and difficulty to understand and feel emotions effectively which may often resort to some of the listed behaviors. 

  • Individuals who have a complexity of diagnoses and difficulties in various categories including:

o   Borderline Personality Disorder

o   Post-traumatic Stress Disorder

o   Depressive disorders

o   Anxiety disorders

o   Eating disorders

o   Substance abuse and dependence disorder

  • Individuals who exhausted other treatments or were referred by other therapists due to the complexity of presenting problems or inability to effectively treat them.

 

It is known to be a treatment for those with Borderline Personality Disorder (BPD), which for the first time gave this diagnosis treatment proven to work and helped with reducing stigma of BPD.  It is considered the standard of care for those who struggle with suicidality and have BPD.  It’s known for treating difficult-to-treat problems and diagnoses, with BPD is not a required diagnosis.  It is proven to treat many diagnoses and is often considered when other treatments didn’t work.  DBT can gives hope of recovery when other treatments have not been effective.

HOW TO IDENTIFY A QUALIFIED DBT PROVIDER

Here's a list of questions you can ask while searching for a DBT provider.

After each question is my own answer or a sample answer.

Answers don't need to match but are listed as a guideline.

WHAT IS YOUR TRAINING IN DBT?

There are various training programs thus various answers.  Answers should include “Comprehensive series”, “intensive training”, or something similar.  The original training program was Behavioral Tech and since its development, many others have built training packages that meet the requirements for DBT training.  For example, I off a two-part training series each year that provides training in all components of DBT.  Many may now be trained on-site as previous to my current jobs, I trained clinicians internally as the Director of DBT Services at The Bridge of Central Massachusetts, Inc.

My answer: I attended a 10-day "Intensive Training" hosted and presented by Behavioral Tech, LLC, the original training company created by Marsha Linehan, Ph.D., the developer of DBT.  I also attended a 5-day advanced intensive with Dr. Linehan and numerous DBT workshops and conferences throughout my career.  I attend the International Society for the Improvement and Teaching of DBT (ISITDBT) yearly which keeps me updated in the latest research and application of DBT.  In addition to my training qualifications, I’m a DBT Certified Clinician by the DBT-Linehan Board of Certification.  This certification is only 5 years old so if a clinician is not certified, don’t consider then an inadequate DBT clinician. Also if they say they are certified another way, it is unofficial and not approved by the DBT community, experts, and the developer of DBT.

WERE YOU SUPERVISED IN DBT POST-TRAINING?

WHAT IS YOUR SUPERVISION IN APPLYING DBT? 

WHAT WAS YOUR SUPERVISOR'S QUALIFICATIONS?

Many may not have an answer like mine and instead immediately joined a consultation and on occasion met with a DBT expert for advancement in knowledge and application.  Sometimes the supervisor obtained training at the same time as the clinician you are interviewing.  Don’t consider less than my answer a rule out.

My answer: Yes, I was supervised by the Clinical Director at Devereux Massachusetts for multiple years.  I also participated on a weekly DBT team which included team leader, specializing in DBT who had previous training in DBT and was actively overseeing DBT within the agency. In addition, I’ve self-monitored by video recorded sessions, when clients agree as well as had colleagues, also DBT certified, monitor and give feedback.

DO YOU PROVIDE 24-HOUR COACHING OUTSIDE THERAPY SESSIONS?

As previously mentioned, DBT coaching is a mandatory mode of treatment.  Remember coaching doesn’t involve a therapist answering all the time.  It means making themselves available to assist in suggesting potential skills to try pending the presenting problem and actively problem solving with the client to create a skills plan.  Availability may vary, for example, some might cap at night to ensure adequate important self-care of sleep in addition to usual exceptions mentioned above. 

 

My answer:  I am essentially "on call" for skills coaching 24/7.  This means I'm available when not training, in consultation with other DBT providers, in sessions with others, when out of cell range, in the middle of something I can’t interrupt, or incapacitated in some way.

ARE YOU ON A CONSULTATION TEAM?

All DBT practitioners are required to be on a DBT consultation team. 

 

My answer:  I am currently on a consultation team with 4 other DBT clinicians in the area.  Previous to this, I was a team leader overseeing multiple DBT consultation teams both clinician-only and multidisciplinary.

DO YOU ENSURE YOUR INDIVIDUAL CLIENTS ARE IN SKILLS TRAINING?

Yes.  Some continue with me after graduating from DBT skills training.

 

My answer:  Yes.  Some continue with me after graduating from DBT skills training.

HOW DO YOU MONITOR PROGRESS WHEN MEETING INDIVIDUALLY AS THE DBT THERAPIST?

Diary cards are a required part of DBT therapy, completed daily by the client, and tailored to the client’s goals.  This isn’t a written diary but instead a chart to track intensity of urges and any actions of the target behaviors based on client goals and created collaboratively.  In addition, emotional intensity is monitored daily, what skills are practiced as well as effectiveness of skills used. 

 

My answer:  I use DBT diary cards to track intensity of urges related to target behaviors based on client goals and created collaboratively.  Included are tracking any actions of target behaviors that occur, emotions experienced and its intensity, and skills practiced as well as effectiveness of skills used.  intensity of urges and any actions of the target behaviors based on client goals and created collaboratively.  In addition, emotional intensity is monitored daily, what skills are practiced as well as effectiveness of skills used.  I also use standardized assessment pending diagnoses, to monitor changes in symptoms.

IF SCREENING THE SKILLS TRAINER: WHAT IS YOUR TRAINING IN DBT SKILLS AND DO YOU PROVIDE SKILLS TRAINING AS DESCRIBED BY APPROVED SOURCES LIKE DR LINEHAN, DR MILLER, OR DR. RATHUS AS WELL AS DESCRIBED IN THEIR MANUALS?

Yes.  I teach adult DBT groups using Marsha Linehan’s latest DBT manual. 

 

OR

Yes.  I teach adolescent DBT groups using Dr Rathus & Miller’s adolescent manual. 

 

FYI: The ideal is a multifamily group based on the authors’ research and most teach adolescent only groups.  Parents often have difficulty finding skills training to complement what their child is learning in skills training.  Be mindful this is based on what the community is providing and in response to limitations of insurance.  Do not rule out those who do not do multifamily groups.

 

My answer:  I teach a young adult DBT skills training series using Dr Linehan’s manual.  Due to my location, I divide the segments with breaks in between, attempting to line up series with college semesters.  My hope is to be comprehensive for college students, including those who live out of the area, as this is a unique approach to the area.  I have extended my young adult age range (usually 18-25) to 18-29 and now 30 to target the clients signing up.  The excluding factors are in high school, married with children, or without sufficient treatment support (an individual therapist) to keep the group having some similarity.