When is DBT not DBT?

We discuss the difference between Comprehensive DBT versus therapy that integrates the DBT skills, and why it matters to understand the difference.

Transcript

SPEAKER_00 0:03

Welcome to the Inner Solutions Podcast. We are your hosts, Donna Hughes and Jessica Heil. We own and operate Inner Solutions, a private practice clinic located in Calgary, Canada. We seek to understand and help our clients by providing empirically supported treatments and evidence-based practices with compassion and expertise. This podcast will provide you with information regarding complex psychological conditions as well as treatments that are available.

SPEAKER_01 0:39

And we're going to talk a little bit about something we know very, very well. For over 20 years, we've been specializing in dialectical behavior therapy. So the question that's happening now over the course of 20 years is when is it DBT and when is it not really DBT? And I think we can answer that pretty well.

SPEAKER_00 1:01

I think so too. And you know, I think that the neat thing about the evolution of therapy over the past couple of decades is that DBT has gone from being something that was really not well known. There were very, very few clinicians who were treating people using dialectical behavior therapy or who were trained in DBT. And now DBT is popping up everywhere. You look at many different profiles of clinicians all over the country, and lots of them say that they're using DBT now. So I love that because it means that there's this therapy that is very, very effective that people actually know about now.

SPEAKER_01 1:39

You know, I want to bring this back to the medical model. You know, your family doctor is a doctor, and so is a neurologist, and so is an orthopaedic uh specialist. They're all doctors. So it's important to know that your therapist, psychologist, social worker, everybody has their licensed credentials. But when you say that you are a DBT dialectical behavior therapist, then the public should assume that you know that you that they can assure you've been fully trained. And in order to actually get trained in DBT, there's a lot of information that has to be learned. There's an exam to be written. And most important, in order to be sure you got a DBT-trained therapist, they need to have been supervised by a DBT-trained clinician and somebody who knows this protocol. So it's important to know that you can have a therapist who does DBT and they may not really have been trained. They might have taken a workshop, they might have taken an online course. This is okay. It's not gonna hurt. But if you're going to be trying to get full DBT for all the very important, serious reasons people do the full program, then be sure that your therapist knows what they are doing full credentials. So comprehensive program requires DBT certified or trained and supervised therapists.

SPEAKER_00 3:10

Yeah, so DBT is much more than just DBT skills. And this is, I think, so for everything I said before, in terms of the benefits of seeing how DBT has exploded within the psychological community, I mean that I think it's wonderful. And the downside is that now what I'm noticing is happening is that there's a lot of talk of people offering DBT, but really what it means is that it's the skills that are being offered and not the full therapy. And Donna, like you said, skills are beneficial. There's there's no doubt about that. Skills will not hurt anybody, they can help us learn all sorts of different ways to regulate and be just more attuned with our emotions and our experiences. And that in itself is not DBT therapy. And if somebody is requiring DBT because they are experiencing really intense emotions, if they're experiencing things like suicidality, self-harm, they have a diagnosis such as borderline personality disorder or bipolar, or they've got chronic depression, any of these things probably require having a more comprehensive program than what can be offered through simply DBT skills.

SPEAKER_01 4:25

That's that's the big conundrum out there. People want to get well soon, they want to get well fast. I know I in my work over the past 20 years, the Alberta Health Services program that I used to work in, they know those skills. They teach them. And they teach them in hospital, they teach them in hospital outpatient programs, some of the other community services program for adolescents, they're teaching these skills. And as we say, this is helpful. The problem with learning those skills is the practice, practice, practice and integrate, integrate with a therapist who can help you actually use them in real time in your real problem area. That's what therapy is really about. So there's the intellectual learning part, and then there's the internalizing, integrating, practicing and make it second nature for you. We like we have a motto, learn it, live it, and that means use it day to day and lending it by being an example or just sharing it with how you function or how you go. So this is important. Is when is DBT not DBT? Well, when we say DBT, we mean a comprehensive program, targeted, structured, measured. We have an overview of how is this happening, how is it helping? And if it's not getting anywhere, why not? This is part of a dbt process. The skills, they're there, they're interesting, they make really good sense, and we try them and they might work, and then we forget them. So that's the trouble with saying you've had DBT when you've learned some of the skills and you actually haven't had time to integrate them, um, make them part of you so that you know you're got them for the rest of your life.

SPEAKER_00 6:21

That's right. So to be to say you've done DBT means that you have done those four components that we talked about last episode, which is individual therapy, it's that DBT skills class, you've received phone coaching and you know that your therapist is part of a DBT consultation team. If you have had those four components, then you have had DBT. If any of those are missing, then it's not DBT. And that means that there's no research to back that this is going to be an effective protocol, especially when it comes to having some of those more complex psychological problems. Now, that being said, there is a time and a place to receive just simply DBT skills or having elements of DBT. There's lots of times where somebody might come in for, say, cognitive behavior therapy, and I'm going to integrate some of that DBT skill into their therapy because I know that's going to be helpful. So I'm not saying that we shouldn't ever do that, but we need to have a plan of action as to why we would do that, as opposed to be just simply throwing skills at a person and then calling it DBT. There is there needs to be a method as to why we're choosing the model that we're choosing.

SPEAKER_01 7:40

This could take us into the wild blue yonder to try and explain it's complicated. And I'm wondering if that's where we should leave it. Uh understanding that sometimes DBT is called DBT when it's not, and sometimes it's needed, a full comprehensive program, and sometimes it's not that you need a full comprehensive program. We'll leave it there. Bye for now.

SPEAKER_00 8:11

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