This feature by Pablo Gagliesi, MD of DBT Iberoamérica is Part 1 of 3 in a series about DBT in Iberoamérica. In this first part, Pablo shares a look at the overall landscape of culture and DBT in this region.
The journey of DBT in Iberoamérica began in 2014 with Intensive Training in Buenos Aires with teams from nine Latin American countries. By 2019, over 100 teams had been established in the Spanish and Portuguese-speaking countries of Latin America. However, to put it this simply is perhaps too simple for a region so complex.
Do I live in Iberoamérica, Latin America, Hispanic America, Ñamérica (as Caparrós, a well-known Argentinean journalist says)? South America perhaps? Is the Caribbean part of it or not? Obviously, it is not a geographical region with clear borders. Some may include the Iberian Peninsula – Spain, Portugal, Andorra – which is the home of the European countries that colonized a large part of what we now call Latin America.
This vague region possesses a variety of cultural traits, making it a complex cultural territory in the DBT landscape. There are linguistic influences of Spanish and Portuguese and – to a lesser extent – English, French, Creole, and Dutch. Castilian – or Spanish – is a language spoken by some 600 million people. Some 270 million speak Portuguese. Also today, there are 522 native nations in Latin America that speak 420 different languages. If you include the Iberian Peninsula, ten million inhabitants speak five other official languages: Catalan, Valencian, Galician, Basque, and Aragonese.
We also do not share a common religion in this region. In addition to Catholicism and Christianity, there are the religions of the native peoples, the influence of African religious beliefs and the arrival of other religions that came with the migrations, such as Judaism and Islam.
The region has another characteristic: We are tremendously unequal societies. Social inequality can make the richest people on the planet live geographically side by side with extremely poor people. Unequal social stratification, especially as we see it within our megacities, correlates with unequal access to healthcare and mental health services.
Many countries, many governments – or subgovernments, many cities, many people. All of this complicates the process of coordinating activities. So how did DBT arrive here and take such firm root?
In 2001 we were working on a project of mental health emergency in Buenos Aires, a city of 15 million inhabitants, where there are many psychologists and a strong psychoanalytic current with all the political power in the state, universities, and hospitals.
I worked in a group that provided mental health assistance to state employees. We had a high hospitalization rate and scarce resources. We quickly became aware of the prevalence of clients with suicidal behaviors and borderline personality disorder and began to look for empirical treatments to work with. At the same time, without knowing us, another group was doing the same in Santiago de Chile. But that’s how our territory works. It is cheaper to call by phone to the United States than to the neighboring country. We ended up meeting years later.
The first attempt to put together a DBT team was accompanied by a colleague Sergio Apfelbaum, but soon the experiment was cancelled for financial reasons. Secondly, the university asked us to discontinue the DBT study.
Where was psychotherapy going? Psychotherapy was walking towards the cognitive fad and the integrative fad. I want to clarify here that I call fashion without derogatory intention but to illustrate the trends. So, we wanted to see how to integrate this evidence-based treatment into our cognitive practice. Integrative, cognitive. As you might imagine, this was another hurdle, but here we had invented it ourselves. “How to translate mindfulness…No way, you can’t. This therapy has an impossible jargon. This therapy is more a school than therapy.”
A Client started reading Dr. Linehan’s book along with me. She had been hospitalized for a long time. No therapist wanted to see her. The psychiatrists were apparently blacklisting her. She proposed that we read the treatment together. She was the daughter of an English family and her English was more impeccable than mine. Her improvement was substantial. She still comments: “I cured myself by reading a book.” When I proposed to her how we could integrate this treatment into what we were doing, she replied, “Integrate? No way, I want to do this treatment just like they did in Seattle. I want to have the same chances, the same opportunities”. She resolved the dialectic tension between adopting and adapting. It would be to adopt – against fashionable trends. Evidence-based, process-based therapy was years away.
We had the inescapable debate about translating a model of psychotherapy that would invent a jargon that Lady Gaga would write songs about many years later. Time and the clients showed us that the accuracy of the translation did not matter and that we had to get rid of fragilizing beliefs (“in our culture clients do not do homework, in our culture people want to tell the stories, in our culture we must intervene on behalf of the client, in our culture mindfulness is not understood”). We were wrong. The words found others and were defined by their functions not by their meaning. What good is translation, even of the Latin root, if you don’t understand what it looks like? We have turned imprecision into strength.
We were able to build a community of therapists who spoke DBT, and the team grew exponentially in five years. The institution that was the umbrella for this experiment was Fundación Foro. Thanks to Javier Camacho who opened the doors wide for us. The enthusiasm we had was such that we wanted to tell everyone what we were doing. The context was not very propitious. Psychoanalysis was waging a pitched battle against anything that would threaten its power, the cognitive scientists did not recognize us as members of the herd, the psychiatrists wanted to hold the power over the treatments. Nothing new under the sun.
The truth is that first we had been left without an institution where we could work and then without the university where our theories were not very accepted. Today, the universities give DBT classes as a matter of course. Fortunately, at the beginning, which seemed disheartening, many colleagues began to refer clients and their families to us.
A DBT team began to form in Buenos Aires. We worked in our homes, in our offices, or sometimes in corner bars that abound in Buenos Aires, where, for example, the first meeting of family members of people with Borderline Personality Disorder was held. The decision was to disseminate in congresses, conferences, lectures, initially in Argentina and then in Latin America. All this meant a lot of initial expenses, but the enthusiasm was greater. We traveled a lot – too much – and everywhere we met therapists who were desperate to help clients who were also desperate.
Read here for part 2 of this blog about DBT in Iberoamérica, in which Pablo shares the story of the introduction of DBT to this region.
Pablo Gagliesi, MD, graduated from the Catholic University of Cordoba and University of Buenos Aires. He is a specialist in Psychiatry at the National University of Buenos Aires, and graduated in Psychoanalytic, Systemic, and Cognitive-Behavioral psychotherapy. Dr. Gagliesi is DBT-LBC certified and certified in EMDR. He is the first official Trainer for Behavioral Tech in Latin America. Read his full bio here.
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