AM I GETTING DBT?

How to Choose a DBT Program/How to Know if You are Getting Comprehensive/Full Fidelity DBT

An extensive body of tightly controlled research on DBT suggests highly favorable outcomes for clients in a number of domains. For example, participation in a comprehensive/full fidelity DBT program has been associated with improvement in suicidal and self harm ideation and behaviors, substance abuse, depression, and utilization of crisis services (i.e. psychiatric hospitalization, emergency room visits).  It is important to note that the best outcomes come from adherent, comprehensive DBT programs with mental health providers that have significant additional training and supervision by experts in DBT. 

Some providers are versed in DBT; however, they are actually practicing DBT informed therapy, meaning they do not have all of the components of a comprehensive/full fidelity DBT program.  So what is full fidelity/comprehensive DBT?  Full fidelity/comprehensive DBT is based on the guidelines set forth by Marsha Linehan, Ph.D., the developer of DBT. 

Comprehensive/full fidelity DBT includes:

1.     Individual therapy (weekly) – As part of individual treatment, clients must fill out diary cards to keep track behaviors and emotions related to achieving their goals.

2.     Skills training in addition to individual therapy (weekly) – skills training must be separate from individual therapy (i.e. cannot be incorporated into weekly individual therapy sessions) and include skills in mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance.  For further information regarding the skills domains taught see: What is DBT?.

3.     Phone consultation (as needed, 24 hours a day and provided by the individual DBT provider) – Skills coaching is a necessary component of DBT, as it helps clients apply the skills learned in skills training to life outside of the therapy room. 

4.     Consultation team for the provider – DBT providers must be part of a DBT team to be practicing DBT. 

Questions to ask your provider (adapted from the work of Linda Dimeff, Ph.D. and the Portland DBT Institute)

Questions regarding provider training and credentials:

1.     What training have you received in DBT? Have you completed a 10 day intensive training in DBT?  If yes, was it led by an expert in DBT (for example, led by a trainer from the BTech, Linehan Institute, or Treatment Implementation Collaborative)?

2.     Have you been supervised by a DBT expert? For how long?  Did the supervisor view audio/video recordings of your sessions during supervision to ensure you were practicing adherent DBT?

3.     Are you a DBT Certified Clinician through the DBT-Linehan Board of Certification?  If not, do you intend to go through the certification process? When? You may also check whether or not your potential provider has completed this stringent certification process (requiring a written exam, review of credentials and training, and adherence coding of individual DBT sessions), by going to www.dbt-lbc.org.

Programmatic questions:

1.     Does the program include all of the components of DBT: individual therapy, skills training, 24/7 phone consultation, and DBT consultation team for the provider?

2.     Do you require clients to complete diary cards?

On going training questions:

1.     Do you continue to engage in continuing education regarding DBT and stay up to date on advances in DBT?

2.     Do you audio/video record sessions (with client consent) so that your DBT Team ensures you continue to do full fidelity/comprehensive DBT?

Why is it important to get comprehensive/adherent DBT?

First, people will say that they tried DBT and it was not effective; however, they did not know that they were not getting full fidelity/comprehensive DBT.  Second, research regarding DBT has focused on comprehensive/full fidelity DBT and providers that do not have the necessary specialized training or programs that do not provide all components may not be able to deliver the outcomes consistent with the research findings.  All of that being said, not everyone needs comprehensive DBT; however, if you are engaging in the behaviors/symptoms below, comprehensive/adherent DBT will be necessary to provide the best chance of a successful outcome:

·      Suicidal behaviors such as suicide attempts

·      Suicidal ideation

·      Self harm behaviors such as cutting or burning oneself

·      Addictive and/or compulsive behaviors

·      Eating disorders such as bulimia and binge eating

·      Problems with anger

·      Difficulties controlling emotions

·      Has multiple diagnoses

·      Chronic, treatment resistant symptoms that have not responded to other less intensive treatments

Here at CBH, the intake process is geared toward determining whether DBT, with all the components listed above, is necessary or if some other evidence based treatment may be a better fit. Dr. Kleiber never wants to provide more treatment than is needed (and who wants to spend more time at a doctor’s office than they have to!) AND it is her value to provide the highest quality treatment available matched to the specific set of problems and symptoms each client faces.  For more information regarding DBT or to determine if comprehensive/full fidelity DBT is the right choice for you, please fill out the contact form: CONTACT to set up a consultation with her.