This feature by the Italian Society for DBT (SIDBT) Executive Board (Lavinia Barone, Donatella Fiore, Paola Pazzano, Monica Marchini, Lisa Polidori, Pietro Ramella, Ilaria Riccardi, Rossana Spotti, and Michele Sanza, with Past President Cesare Maffei) is Part 1 of 2 in a series about DBT in Italy. In this first part, they talk about the origin of DBT in Italy.
We are pleased to share through the BTECH blog the developmental pathway of DBT in Italy and the birth of the Italian DBT Society (SIDBT). We will show its dialectical tensions, problem analyses made, and problem-solving implemented.
The first Italian translation of a DBT manual came to Italy in 2001 by Lavinia Barone, who became familiar with DBT through a research fellowship at the New York Hospital in the 1990s. Starting from that moment, the dissemination has continued with an almost grassroots, “door-to-door” effort that lasted nearly ten years and created new awareness, confidence in care, and curiosity about its implementation. Then, the first Intensive Training in Italy occurred in Tuscany with Marsha Linehan and Katie Korslund in 2010. Our DBT practice was emboldened by visiting BRTC, which was Marsha’s DBT clinical centre in Seattle for over four decades, where Katie Korslund worked as associate director.
“It was amazing to watch skills training groups and individual sessions. I understood then that DBT was a synthesis of language, style, and method. I learned that different ways of communicating with patients could all be managed by a pattern of principles and techniques that allowed each communication to find a place and a way to be regulated, thus becoming dialectical and flexible. I understood how important dialectics and behavioral approach are in DBT,” Lavinia, DBT Trainer and SIDBT Current President, recalls.
In 2010, the first nine teams were trained in Italy, during the first Intensive Training. Marsha came to Milan a couple of years earlier and said to Lavinia, “I would like to be the one who will train you.” In addition to the pioneers, a major hospital of Milan joined the Intensive Training, thanks to the involvement of Cesare Maffei.
“We had read the various manuals on DBT and learned about DBT taught by Marsha and Katie. It was and is a significant human, clinical, and professional experience for my team and me – I would say revolutionary. It embodied synthesis between reciprocity and irreverence, validation and change, adherence and flexibility, acceptance of pain and joy, as well as participation, awareness, and change (when possible) of the contradictory aspects of life. Starting with us, the team was able to grasp this synthesis for our patients, in their context of belonging and in our system of care,” states Donatella Fiore, DBT Trainer.
However, another dialectical tension needed to be addressed and solved. Indeed, in Italy, training in behavioral psychology is lacking, and the psychodynamic model predominated in the field of personality disorders. Our commitment thus needed to accept innovation and work hard to address barriers to introduce changes.
After the first Intensive Training, the team leaders of the first nine participating teams met regularly to compare experiences related to their teams, an inspiring new-born Italian DBT community. The next step was to create the Italian DBT Society, which would substantially contribute to the implementation of DBT treatment and its dissemination by training clinicians and health professionals to implement an adherent evidence-based treatment in several contexts.
In 2011, The Italian DBT Society (SIDBT) was born with Cesare Maffei as President, and the Society began to develop along three key areas: 1. Clinical implementation with an increasing number of DBT teams working in clinical centres; 2. Training the first trainers with Marsha, Tony DuBose, and Katie as critical supervisors for keeping the first three Italian trainers “on track”; 3. DBT dissemination by implementing DBT continuous education, introductory workshops, Intensive Training, and international seminars, including with Lars Mehlum on adolescents, Melanie Harned on DBT and trauma, Mazza and Dexter-Mazza on DBT in School. In the meantime, all DBT manuals were translated into Italian and published.
Our Society began its work with 18 members. By the end of 2015, SIDBT members numbered almost 100, and twelve years later the number had more than tripled. An exponential increase, especially in the last few years, indicates the progress made. Today SIDBT – with its 400 members – offers high-quality training to newly established teams and constant updating for members. It is the point of reference for all patients and their families who wish to access DBT applied by the groups recognized by the Society.
SIDBT MEMBERSHIP GROWTH SINCE ITS START
In our view, it’s amazing that DBT comes to Italy through a bottom-up approach with pioneers disseminating it to a handful of clinicians from public and private settings, organized in small teams initially, then multiplying. In 2023, teams (public and private) will be present in many Italian regions. There are about 20 DBT teams in clinical centres (half affiliated with the public health system).
National Health System (NHS) network and mental health are a hallmark of Italian healthcare, and DBT has become an elective treatment in many public services. Our healthcare system offers many facilities, which is a strength for our country, as DBT could become a treatment for many people in need. One of the most relevant features of public service in Italy, and the one that differentiates it from other countries, is the free access and availability of the welfare system. For example, patients receive free treatment in our services for drug users. Beyond the clear advantages offered by this system, we have to say that pros and cons must be taken into account. On the one hand, this facilitates patients’ access to health care and, on the other, maintaining motivation could become one of the obstacles that need to be addressed; another dialectical issue to be dealt with. Given DBT implementation in our NHS represents the key pathway of how DBT came to our country, we would like to focus the second part of this blog to the several challenges we met; how and for whom a no-cost mental health system could help patients who are looking for a DBT treatment.
Read here for part 2 of this blog about DBT in Italy.
SIDBT Executive Board: Lavinia Barone, Donatella Fiore, Paola Pazzano, Monica Marchini, Lisa Polidori, Pietro Ramella, Ilaria Riccardi, Rossana Spotti, and Michele Sanza, with Cesare Maffei (Past President)
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