This feature by Vinícius Guimarães Dornelles is Part 2 of 2 in a series about the history of DBT in Brazil. In the first part, he talked about the origins of DBT in Brazil, both informal and formal. Here in part two, Vinícius talks about the process of bringing DBT training to Brazil.
During our training period with Dr. Pablo Gagliesi, he informed us that there would be the first Intensive DBT training with Behavioral Tech Institute in Buenos Aires, Argentina. This training took place between November 2014 and March 2015, and we had the opportunity to learn about all the work that was already being carried out in Latin America in DBT, as well as the privilege of meeting Anthony DuBose, Andre Ivanoff, and Preston Thompson. Among the topics discussed, the idea of conducting an Intensive DBT training in Brazil emerged. I promptly embraced the idea and initiated discussions with the staff of Behavioral Tech Institute (at the time, Behavioral Tech) to develop the Intensive Training in Brazil.
After numerous email exchanges, the contract was signed with Behavioral Tech Institute (BTECH), and the Intensive DBT training took place in the second semester of 2015 and the first semester of 2016. At this point, DBT in Brazil went from having just one DBT team in one state with 12 people to having multiple teams in 8 different states of Brazil with 84 individuals who completed the intensive DBT training.
This is a significant milestone for DBT in Brazil for three major reasons: 1) During this training, a meeting was held between DBT Brazil, BTECH, and Artmed (the leading health publisher in Brazil). An agreement was reached in which Artmed would translate Marsha Linehan’s skills manuals into Portuguese. As a result, Brazil became one of the first non-English-speaking countries to have the main DBT book and DBT skills manuals in its native language, Portuguese. This was one of the most important factors for the intense and rapid dissemination of DBT in Brazil, as its key works for the development of standard DBT treatment were no longer restricted to Brazilians with English reading proficiency, but became accessible to any Brazilian. Additionally, following this initial agreement, efforts were made to translate several other globally significant works on DBT into Portuguese by Brazilian publishers (the list of translated works will be provided at the end of this blog).
The second crucial aspect that the first Intensive DBT training in Brazil brought was the expansion of therapist training interested in DBT, not only in the state of Rio Grande do Sul but in various states. This contributed to the formation of different DBT programs in Brazil, massively amplifying professionals’ interest in the approach, as well as the demand for DBT from patients. From this point on, DBT began to gain significant importance in the scientific universe of psychotherapy in Brazil. This was evident through the intense demand for DBT presentations at psychiatry, psychology, cognitive-behavioral therapy, behavioral psychology, and medical congresses overall.
The third aspect relates to an extremely complex decision I had to make after the first training. I am originally from Porto Alegre, the capital of a beautiful state called Rio Grande do Sul. The main issue was that my state is relatively small, without significant economic strength and very distant from other states in Brazil, as it is located in the southernmost part of the country. So, as happy as I was that the first Intensive DBT Training took place in Porto Alegre, it was evident that if DBT remained in Rio Grande do Sul, it could be limited as a “regional practice,” and it would not be possible to expand it to all corners of Brazil. Therefore, it was clear that DBT needed to move to the central region of the country. At the time, the options were either Rio de Janeiro or São Paulo (the two states with the highest economic power in Brazil). However, I did not know anyone in Rio de Janeiro. On the other hand, in São Paulo, I knew Edela Nicoletti, who had a highly established and respected work in CBT. So, I scheduled a meeting with her to discuss the future of DBT in Brazil and the Intensive Trainings. She loved the idea and agreed to form a partnership with me (I believe this was one of the wisest decisions of my life). Thus, DBT Brasil established itself in São Paulo, making the dissemination much easier and more attractive to professionals throughout Brazil. Additionally, I gained an amazing partner who has been tireless in qualifying and disseminating DBT in our country through DBT Brasil.
The fourth reason what was decisive for the expansion of DBT throughout our national territory was the team of mentors and trainers in training at DBT Brazil. In addition to their technical excellence, they have a great capacity for welcoming and providing support to all who seek DBT Brazil’s training. Thus, they serve as a model for everyone looking to join the DBT therapist community. Furthermore, the mentors and trainers in training play an extremely important local leadership role in ensuring the development of DBT in Brazil. Therefore, this team operates throughout the national territory as follows: Alexandre Tzermias (Campinas region in the state of São Paulo), Brisa Burgos Macedo (Ribeirão Preto and São Paulo capital region in the state of São Paulo), Carolina Ferreira and Monique Vardi Pinheiro (Amazonas state region), Débora Finkler Teles, Diego dos Santos Alano, and Tamires Pimentel (Rio Grande do Sul state region), Érica Panzani Duran, Eduardo Martinho Jr., and Fellipe Augusto de Lima (São Paulo capital region), Esequias Caetano (Minas Gerais state region), Marseylle de Assis Brasil (Rio de Janeiro state region), and Thyale Brizolara (Bahia state region and currently also the São Paulo capital region). I personally cannot express enough my admiration and gratitude to each of them for everything they have taught me over the years working together, as well as for all the mutual partnership, friendship, and support. Without a doubt, DBT Brazil would not have grown so much, nor so quickly, without the contributions of these very special individuals.
From that point on, we developed five more Intensive DBT Trainings, resulting in over 300 professionals who have completed the training and formed DBT teams and programs in all regions of our country. Moreover, we conducted one workshop, one training in DBT-A with Jill Rathus, and one training in DBT-PE with Melanie Harned and Annie McCall, providing even greater qualifications for DBT therapists in Brazil.
In addition to all this, DBT in Brazil is now involved in various research projects conducted in some of the country’s leading research centers, such as the University of São Paulo (USP). We have publications by national authors in scientific journals, as well as books and book chapters. DBT is undoubtedly the fastest-growing therapeutic approach in Brazil, and all of this has been achieved in less than eight years of work.
Lastly, DBT Brasil is currently engaged in its two most important projects to date. The first concerns the social outpatient clinic in DBT, which is being put into practice and will work in conjunction with the research division of DBT Brasil, providing affordable treatment for low-income populations and expanding the scope of DBT research. The second project is the most important and the great dream, both for me and my partner Edela. We are holding meetings with public sector authorities to try to implement DBT in our public healthcare system, which has guaranteed universal access to health services free of charge since 1989. If successful, this project will provide 214.3 million Brazilians with access to DBT regardless of their economic situation. Of course, these are still preliminary discussions, and it remains a big dream. At the same time, bringing DBT to Brazil was a significant dream that, with a lot of effort and dedication, has become a great and beautiful reality.
|DBT books translated into Portuguese in Brazil|
|Nº||Books in English||Books in Portuguese|
|1||Linehan, M.M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.||Linehan, M. M. (2010). Terapia cognitivo comportamental para transtorno da personalidade borderline. Porto Alegre: Artmed.|
|2||Linehan, M. M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press||Linehan, M. M. (2010). Vencendo o transtorno da personalidade borderline com a terapia cognitivo comportamental. Porto Alegre: Artmed.|
|3||Linehan, M. M. (2015). DBT skills manual. (2. Ed.). New York: Guilford Press.||Linehan, M. M. (2018). Treinamento de habilidades em DBT: manual de terapia comportamental dialética para o terapeuta. Porto Alegre: Artmed.|
|4||Linehan, M. M. (2015). DBT skills training handouts worksheets. (2. Ed.). New York: Guilford Press.||Linehan, M. M. (2018). Treinamento de habilidades em DBT: manual de terapia comportamental dialética para o paciente. Porto Alegre: Artmed.|
|5||Dimeff, L. A., Rizvi, S. L., & Koerner, K. (2021). Dialectical behavior therapy in clinical practice: applications across disorders and settings. (2. Ed.). New York: Guilford Press.||Dimeff, L. A., Rizvi, S. L., & Koerner, K. (2022). Terapia comportamental dialética na prática clínica: aplicações em diferentes transtornos e cenários. (2. Ed.). Porto Alegre: Artmed.|
|6||Stuntz, E. C., & Linehan, M. M. (2021). Coping with câncer: DBT skills to manage your emoticons – and balance uncertainty with hope. New York: Guilford Press.||Stuntz, E. C., & Linehan, M. M. (2022). Enfrentando o câncer: habilidades da terapia comportamental dialética (DBT) para lidar com suas emoções e equilibrar as incertezas com esperança. Porto Alegre: Artmed.|
|7||Koerner, K. (2012). Doing dialectical behavior therapy: a practical guide. New York: Guilford Press.||Koerner, K. (2020). Aplicando a terapia comportamental dialética: um guia prático. Novo Hamburgo: Sinopsys.|
|8||Swales, M. A., & Heard, H. L. (2017). Dialectical behaviour Therapy: distinctive features. (2. Ed.). London: Routledge||Swales, M. A., & Heard, H. L. (2022). Terapia comportamental dialética: características distintivas. (2. Ed.). Novo Hamburgo: Sinopsys.|
|9||Rathus, J. H., & Miller, A. L. (2015). DBT skills manual for adolescentes. New York: Guilford Press.||Rathus, J. H., & Miller, A. L. (2022). Manual de habilidades em DBT para adolescentes. Novo Hamburgo: Sinopsys.|
|10||Harned, M. S. (2022). Treating trauma in dialctical behavior Therapy: the DBT prolonged exposure protocol (DBT PE). New York: Guilford Press.||Harned, M. S. (2023). Tratando o trauma com a terapia comportamental dialética: protocolo de exposição prolongada em DBT. Novo Hamburgo: Sinopsys.|
Interested to know more about the worldwide community of DBT? Read here for this blog about DBT in Australia and New Zealand.
Vinícius Guimarães Dornelles – Master in Psychology – Human Cognition, DBT Specialist by Behavioral Tech, First native Portuguese speaking Dialectical Behavioral Therapy (DBT) Trainer, Specialist in Dialectical Behavioral Therapy by Universidad de Lujan/ARG, Specialist in Cognitive-Behavioral Therapy (CBT), Specialist in Evidence-Based Therapies for BPD by Fundación Foro Trainee-in-training at Behavioral Tech, Official reviewer of the translation of the skill manuals by Dr. Marsha Linehan. Read his full bio here.
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