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Common Questions about DBT and DBT Training

Foundational Information about DBT

Training Questions

Further Questions

Foundational Information about DBT

Is DBT cost effective?

Accumulating evidence indicates that DBT reduces the cost of treatment. For example, the American Psychiatric Association (1998) estimated that DBT decreased costs by 56% – when comparing the treatment year with the year prior to treatment – in a community-based program. In particular, reductions were evident by decreased face-to-face emergency services contact (80%), hospital days (77%), partial hospitalizations (76%), and crises bed days (56%). The decrease in hospital costs (~$26,000 per client) far outweighed the outpatient services cost increase (~$6,500 per client).

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What is a DBT Consultation Team, and why do I need to be a part of a team in order to practice DBT?

DBT is a team-based treatment in which Consultation Teams meet every week to assist each other in applying DBT. In the face of treating difficult cases, your DBT team is your resource for maintaining motivation to deliver effective treatment, enhancing your clinical skills, and monitoring fidelity to the treatment model. In fact, in a recent survey of Intensively trained teams, 90% of teams had a formal, ongoing consultation team, and “strong commitment, communication, and motivation amongst consultation team members” were identified as the top factors in helping teams reach their implementation goals. Through weekly meetings, your DBT consultation team provides you with the support you need to treat clients and develop your skills.


What are my options for being on a DBT Team?

Start a new DBT team – Attend Dialectical Behavior Therapy Intensive Training

The Dialectical Behavior Therapy Intensive Training is a ten-day course designed for those who have begun learning DBT methods from self-guided study of the treatment manuals and introductory workshops. This training is intended for newly formed teams that are invested in learning DBT to a high standard in order to better implement the treatment in their settings.

Join an existing DBT team – Attend Dialectical Behavior Therapy Foundational Training

This five-day training is designed specifically for individual or group therapists who are members of an intensively trained team, but who have not completed intensive training themselves. It is not a substitute for Intensive training, but is meant to assist teams that have hired new staff or experienced turnover. This training allows newer team members to get trained up at a five-day training that will cover the standard content of DBT.

Let BTECH find you a team – Attend the Dialectical Behavior Therapy Team-Building Intensive Program

We understand that it can be difficult to find team members. Staff turn-over, taxing schedules, and remote treatment settings are just a few of the many reasons why it can be difficult to put together a team that is effective and sustainable. That’s what we are here for. The Dialectical Behavior Therapy Team Building Intensive is a comprehensive, two-year training program designed for independent practitioners to function as members of an ongoing, facilitated consultation team while learning to practice DBT to fidelity; this training is specifically intended for clinicians who want Intensive training but don’t have a consultation team.

Visit our training schedule to check current availability of these training opportunities.


If I can’t join an existing team or start a new team, can I still integrate DBT within my practice?

The majority of data on DBT’s effectiveness has tested the standard model of DBT (individual treatment, skills training, phone coaching, and consultation team). Since there has been very little research to examine the specific role of the DBT consultation team thus far, more research is needed before researchers can make an empirically supported case for the relationship between consultation team and staff, client, and programmatic outcomes. This means that in order to do DBT to fidelity, you must be on a DBT consultation team.

DBT is a team-based treatment in which Consultation Teams meet every week to assist each other in applying DBT. In the face of treating difficult cases, your DBT team is your resource for maintaining motivation to deliver effective treatment, enhancing your clinical skills, and monitoring fidelity to the treatment model. In fact, in a recent survey of Intensively trained teams, 90% of teams had a formal, ongoing consultation team, and “strong commitment, communication, and motivation amongst consultation team members” were identified as the top factors in helping teams reach their implementation goals. Through weekly meetings, your DBT consultation team provides you with the support you need to treat clients and develop your skills.


What are team members’ roles in a weekly DBT consultation team meeting?

Meeting Leader: The Meeting Leader is responsible for managing the weekly meeting agenda in an organized and efficient way.

Observer: The Observer is responsible for highlighting behaviors that interfere with effective consultation team functioning as the behaviors occur, including provider defensiveness, polarization, lack of participation, and “elephants in the room."

Note taker: The note taker takes weekly notes on the clinical and administrative agenda items that team members discuss and documents team member effective behavior, attendance, and group updates.

Team Leader: The Team Leader is an ongoing role separate from the roles in the weekly consultation team meetings. The Team Leader role is often held by a member with more advanced training than others and who helps to maintain fidelity to the DBT treatment model. He or she also typically serves as a liaison between the larger organization and the DBT team, and can communicate with other administrators to address and resolve programmatic tensions and/or decision-making that directly impact the DBT program.


How do you strengthen and maintain therapist commitment to a new or existing consultation team?

We recommend that you hold an orientation and commitment session with potential team members prior to members entering team, just as you do with DBT clients. A team member should take time to assess the potential team member’s level of commitment, identify factors that could interfere with a strong commitment, generate solutions to these obstacles, and troubleshoot what could interfere with these solutions. In this commitment session, it is important to clearly outline expectations and roles of team members, using DBT commitment strategies as necessary and linking team participation to their goals as clinicians. You might consider having the newest team member commit the next team member, or perhaps a senior team leader may conduct all commitment sessions.

Commitment ebbs and flows with team members, just as commitment fluctuates for DBT clients; you may have to re-establish team member commitment over time. Assessing or re-establishing commitment can take different forms; ideally; this would be addressed openly on consultation team, while at other times a team leader might decide to hold a private meeting with the team member.


If I want to run a DBT skills training group, do I have to be on a DBT team?

DBT assumes that effective treatment, including skills training, must pay as much attention to the behavior and experience of providers working with clients as it does to clients’ behavior and experience.  Thus, treatment of the providers is an integral part of any DBT program. DBT Skills Trainers are part of the DBT team.  The skills trainer must be on the team voluntarily, agree to attend team meetings, be committed to learning and applying DBT, and be equally vulnerable to team influence.

For more information on this topic, please see the DBT® Skills Training Manual: Second Edition (pp. 25-26).


What credentials are needed to run DBT skills training groups?

Skills trainers must have a very good grasp of DBT skills, practice the skills themselves, and know how to teach them.  They need to know basic behavior therapy techniques and DBT treatment strategies, as well as DBT protocols such as the suicide protocol.

For individuals with identified mental disorders, skills training can be conducted by psychotherapists, counselors, case managers, social workers, milieu staff, psychiatric nurses, prescribing psychiatrists, and nurse practitioners.

For individuals without identified mental disorders, skills training can also be conducted by anyone (e.g., teachers, parents, family members, volunteers, and professional trainers) who is well-trained in the principles of skills training and the skills themselves.  In some cases, individuals who themselves have gone through skills training and have overcome their own difficulties can also make excellent co-trainers and skills peer counselors.

For more information on this topic, please see the DBT® Skills Training Manual: Second Edition (p. 26).

Training Questions

What are my training options?

To begin learning about DBT, form a study group and read Dr. Marsha Linehan’s texts:

To learn about DBT® skills and other components of DBT, complete an online training course, attend a workshop or comprehensive training course, or purchase and view a DBT training video.

For more workshops on DBT and related topics, attend the annual ISITDBT and ABCT conferences.


Can I attend a Dialectical Behavior Therapy Intensive Training™ as a team of just two providers?

Teams must be at least three providers for Dialectical Behavior Therapy Intensive Training™. There are several reasons why DBT teams require at least three people:

Reason 1: Asking What is Being Left Out

Team members can often get polarized in the context of discussing difficult cases and administrative concerns. Creating a team with more than two members helps increase the likelihood that alternative perspectives are raised on team and helps teams identify what is left out during times of conflict or confusion. Having multiple ears on a difficult case is often a useful assessment tool.

Reason 2: Finding Dialectical Synthesis

When two team members are polarized, it is difficult to step back and see the truth in the other’s perspective. Having several team members available to point out polarization and help to create a dialectical synthesis between the two positions is central to a well-functioning consultation team.

Reason 3: Fulfilling Team Roles

Pragmatics dictates that more than two team members are needed; there is simply too much to do to run a well-functioning consultation team! A consultation team requires a meeting leader, observer, and note-taker. If you have ever sat on a consultation team, you know that trying to simultaneously fill more than one role is difficult, particularly if you want to increase the efficiency and undivided attention of your team members.

Reason 4: Modeling and Skill-Building

There is a great deal to be learned from other team members; your consultation team is a place to conceptualize cases, assess suicide risk, and address problems with openness, humility, and vulnerability. It is also a place to practice your DBT skills. Consultation team meetings are the perfect setting for behavioral rehearsal, chain analysis, using behaviorally specific language, validation, targeting team-interfering behaviors, and regulating intense emotions.


I have enough colleagues to form a new team, but we can’t all afford to attend the Intensive training. What can we do?

We would recommend you consider staggering your attendance. For example, if you have a team of 7 providers and none of you are Intensively trained, consider having three to four of the team members attend a Dialectical Behavior Therapy Intensive Training™. Then, the remaining members can attend a separate Intensive or Foundational training several months later. In the meantime, all team members can work together to enhance their DBT practice through other methods including manual-based self-study, online trainings, and workshops.


Can I be certified in DBT?

The DBT®-Linehan Board of Certification (DBT-LBC) launched its program for the Certification of Individual Therapists in July 2014. This certification is the one and only, treatment-developer-approved certification program in DBT® in the US.

The DBT®-Linehan Board of Certification is a non-profit organization whose purpose is to develop certification of clinicians and DBT® programs in order to promote the availability of competently delivered, effective DBT®. Certification will help to ensure programmatic and treatment fidelity for the delivery of comprehensive DBT. By maintaining a roster of certified DBT therapists and DBT programs, DBT-LBC hopes to assist consumers, mental health professionals, governmental agencies, and insurance companies in finding highly qualified DBT® providers.

All the information you need to prepare, apply, and track the entire process for certification can be found at the dbt-lbc.org website. It is also where the subsequent list of certified providers and programs will be found. The DBT-LBC are taking applications effective immediately for the certification of individual therapists. http://www.dbt-lbc.org.

Learn how training from Behavioral Tech can prepare you for DBT Certification.


Further Questions

If you still have unanswered questions about practicing DBT, please consider consultation from a DBT expert.

 

Sources

Swales, M.A. (2010). Implementing DBT: Selecting, training, and supervising a team. The Cognitive Behaviour Therapist, 3, 71-79.

Dubose, A.P., Ivanoff, A., Miga, E., Dimeff, L., Linehan, M.M. (2013, April). DBT teams in training 2008-2011: Implementation follow-up in 2012. Presented at the meeting of the Seattle Implementation Research Collaborative (SIRC), 2nd Biennial Conference: Solving Implementation Research Dilemmas, Seattle, WA.

Linehan, M.M. (2015). DBT® Skills Training Manual: Second Edition. New York: Guilford Press.