This feature by Fragiskos Gonidakis, MD, PhD is Part 1 of 2 in a series about DBT in Greece. In this first part, Fragiskos shares the journey so far. DBT is a worldwide community, and we are excited to shine a light on how DBT has developed in different regions and countries.
The Journey So Far
Our journey to the world of DBT started in 2009, when a group of three psychologists (Efi, Dafni and Evelyn) and one psychiatrist (Fragiskos) decided to make an effort to travel to Seattle to participate in an Intensive DBT Training by Marsha Linehan and her colleagues from BTECH. So, our little dialectical odyssey started in March 2010. The eruption of Volcano Eyjafjallajökull in Iceland caused enormous disruption to air travel across Western Europe and led to our frantic effort to find an alternative air route from Athens to Seattle. Our success was mainly based on effectively utilizing DBT skills that we had not yet even heard of at this point in our journey.
After six months of training and applying DBT, a fifth member (Aimilia) was added to the original team. We were working with our patients both in private setting and in the Eating Disorder Unit of the 1st psychiatric clinic of National and Kapodistrian University of Athens. When we approached the head of the psychotherapy unit in order to incorporate DBT to the treatments that were already offered in the clinic, the reply was negative due to the fact that “DBT is not psychotherapy but an assortment of behavioral techniques.” Needless to say, this reply came from a professor of psychiatry trained in psychodynamic therapy and running the outpatient clinic for people suffering from BPD. Inspired by the stories that Marsha told us during our DBT Intensive Training, we came back and negotiated again and again. In the end, DBT was included in the Eating Disorders Unit therapeutic activities as a specialized intervention for people suffering from both eating disorder and BPD.
It was an original minor victory which gave us a foothold so that we could get more and more people into treatment. At that point in our journey, we were all “suffering” from extreme adherence anxiety. We were constantly wondering whether what we were doing was actually DBT. Our team supervision by Cedar Koons provided us with the knowledge and the courage to keep going with our clinical work, applying DBT to the best of our ability. We observed and accepted our mistakes while constantly trying to improve ourselves as therapists.
In 2012, Efi and Fragiskos participated in advanced DBT training in Seattle. The two trainers were Marsha Linehan and Tony DuBose. Our meeting with Tony and his long lasting mentorship and friendship since then was a transformative experience. He helped us grow from a sole DBT team to a community of therapists, trainers, and trainees. Another hallmark in 2012 was the establishment of the DBT section of the Greek Association for Behavioral Research, one of the oldest and most prominent scientific associations for the dissemination and training in behavioral therapies. From that point most of the DBT training in Greece would be carried out through GABR.
In 2014, a second DBT team was formed as six psychologists (Konstantina, Maria, Vasso, Valia, Christiana and Froso) and one psychiatrist (Zoe) were also trained by BTECH in the United States. Most of this second team, together with Efi and Aimilia, are now the backbone of trainers and researchers in the Greek community of DBT. We were growing slowly but steadily. DBT was discussed more and more in various psychotherapy forums and presented in workshops, congresses, and university lectures in Athens, Thessaloniki, and Heraklion (three of the four major cities in Greece).
In 2017, we had the first DBT training in Greece with Tony and Fragiskos as trainer and co-trainer, respectively. We had teams coming from Greece and Poland. In 2018, we had the second training with Tony and Fragiskos as trainers. Efi, Vasso, Konstantina, Valia, Maria and Christiana also participated in the training. This time, the teams of trainers came from Greece, Cyprus, and Poland. The model of training was something that BTECH applied for the first time, a hybrid event consisting of one week of in person training in Athens followed by six months of applying the treatment under mentorship and then weekly consecutive consultation meetings with the teams through teleconference.
Ιn 2018, we published in Greek a book on BPD named Discussing Borderline Personality Disorder. The book has been well received and so far has sold close to 1500 copies, a number that is quite satisfactory for a Greek scientific book on mental health. What makes this book so special in our hearts is that each chapter incorporates three elements: the scientific data, the personal experience of the therapist (most of the therapists named so far contributed to the book), and the experience of the person that has been struggling with BPD. Based on the book, Maria and Fragiskos created an e-learning course in 2019 on BPD and DBT that is offered through the National and Kapodistrian University of Athens distance learning platform. In 2019, the DBT section of GABR created a site specifically dedicated to DBT (www.dbt-greece.com).
In 2018, Efi and Fragiskos participated for the first time in the BTECH trainers’ meeting held in Seattle, an absolutely stunning experience for a person that has gradually become part of the greater DBT community around the world. In 2019, Vasso, Konstantina, Maria, Valia, and Fragiskos participated again in the trainers’ meeting and also had the privilege of attending Marsha Linehan’s farewell speech at the University of Washington.
Then, in 2020, we along with the whole world were faced with the COVID-19 outbreak. Everything had to change, adapt, and go online. The 2020 training was postponed until the beginning of 2021. That was our first 100% online training experience, and everything was conducted remotely. The first and second part of the training, mentoring, consultation, even individual therapy and skills training were all online. At that training, we had teams in attendance from Greece, Cyprus, Serbia, and South Africa. Our reach was expanding. After two years of consecutive lock down and precaution measures, we were at last able to actually meet in person and in some cases meet with each other without wearing a mask for the first time.
Read here for part two of this blog, in which Fragiskos will share the journey ahead for DBT in Greece!
Fragiskos Gonidakis, MD is Assistant Professor of Psychiatry in National and Kapodistrian University of Athens (NKUOA) Medical School. He is currently the Head of Eating Disorders Unit and Dialectical Behavioral Therapy service of NKUOA 1st Psychiatric Department at Eginition Hospital. Dr. Gonidakis has trained in Cognitive Behavioral Therapy, Systemic Family Therapy and Dialectical Behavioral Therapy. Read his full bio here.