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Are You Receiving “Real” DBT? 7 Key Questions to Ask Your Therapist
Dialectical Behavior Therapy (DBT) has gained substantial recognition as an effective evidence-based treatment, especially for conditions like Borderline Personality Disorder (BPD), PTSD, and other emotional dysregulation issues. While DBT has grown in popularity, there’s a common misunderstanding between “adherent DBT” and “DBT-informed therapy.” This distinction matters because only adherent DBT follows a structured, research-backed protocol, while DBT-informed therapy may incorporate elements of DBT but doesn’t fully adhere to its proven framework.
In this blog, we’ll walk through what makes DBT “adherent,” why it’s essential, and the questions clients can ask their therapists to ensure they’re receiving genuine DBT. With these questions, you’ll gain clarity on whether your therapy aligns with the full DBT protocol and how to advocate for a truly therapeutic experience.
Understanding Adherent DBT vs. DBT-Informed Therapy
Adherent DBT strictly follows a multi-component model developed by Dr. Marsha Linehan, which includes individual therapy, skills training, phone coaching, and team consultation. Research demonstrates that this comprehensive model yields the best outcomes, helping clients develop skills to manage emotions, handle interpersonal conflicts, and enhance mindfulness.
On the other hand, DBT-informed therapy may include some DBT skills or concepts but lacks the structured model of adherent DBT. While these practices may still be helpful, they may not provide the same level of support and accountability critical for those with severe emotional and behavioral challenges.
7 Essential Questions to Ask Your Therapist to Determine If You’re Getting Real DBT
Here are seven questions designed to help you evaluate whether you’re receiving adherent DBT or DBT-informed therapy.
What Components of DBT Do You Include in My Treatment?
An essential feature of adherent DBT is its multi-component structure, which consists of:
- Individual Therapy: Weekly one-on-one sessions.
- Group Skills Training: A structured setting where clients learn and practice skills.
- Phone Coaching: Access to your therapist between sessions for crisis support and skill reinforcement.
- Consultation Team Meetings: Therapists meet regularly with other DBT providers to ensure fidelity to the model.
Without these components, the therapy may lack the support network and depth of skills necessary for maximum benefit.
Are You DBT-Certified or Have You Received Formal DBT Training?
A well-trained therapist is essential for effective DBT. The Linehan Board of Certification (DBT-LBC) offers rigorous certification for DBT therapists, but other DBT training programs can also provide quality instruction. Ask about your therapist’s training background and if they’ve undergone formal certification to deliver DBT.
What to Look For: A certified DBT therapist or one with formal training from an accredited program is more likely to adhere to the complete DBT framework, offering reliable treatment.
How Do You Integrate DBT Skills Training?
Skills training is the heart of DBT, teaching core skills in four main areas:
- Mindfulness: Enhancing self-awareness and staying present.
- Distress Tolerance: Coping with intense emotions without resorting to harmful behaviors.
- Emotion Regulation: Managing overwhelming emotions in a healthy way.
- Interpersonal Effectiveness: Navigating relationships and asserting needs.
Therapists should provide structured skills training through a workbook or similar resources. If your therapist doesn’t prioritize skills training, they may be offering a less robust, DBT-informed approach.
Do You Offer Between-Session Coaching?
A hallmark of adherent DBT is phone coaching or other support between sessions. This coaching allows clients to contact their therapist during emotional crises, where they’re guided to use specific DBT skills instead of turning to impulsive or harmful behaviors.
What to Ask: If your therapist doesn’t provide any form of crisis support or coaching between sessions, this may indicate DBT-informed therapy rather than adherent DBT.
Do You Participate in a DBT Consultation Team?
DBT therapists should be part of a consultation team, which allows them to discuss cases, stay motivated, and avoid burnout. This collaborative approach ensures that therapists maintain fidelity to the DBT model, receive constructive feedback, and enhance their skill application.
Why It Matters: A consultation team helps therapists stay grounded in DBT’s principles, offering consistent and high-quality treatment to their clients.
What Approach Do You Use to Set Goals?
In DBT, therapy goals are prioritized based on a “hierarchy of needs.” For example:
- Life-threatening Behaviors: Reducing any suicidal thoughts or behaviors.
- Therapy-interfering Behaviors: Addressing any issues that hinder the therapeutic process.
- Quality-of-life Interfering Behaviors: Improving areas such as relationships, employment, and health.
If your therapist doesn’t have a structured approach to setting priorities, they may not be following the DBT model closely.
How Do You Measure Progress in DBT?
Adherent DBT involves clear metrics to track progress, such as monitoring the frequency of harmful behaviors, tracking skill usage, or utilizing assessment tools like the DBT Ways of Coping Checklist. This quantitative approach ensures that both you and your therapist can see tangible improvements over time.
What to Ask: Does your therapist discuss specific indicators of progress, or do they rely on general conversation? Metrics-based assessment is a core element of DBT.
Why Adherent DBT Matters: The Evidence Behind Comprehensive Care
Adherent DBT is highly structured because it addresses both immediate emotional regulation and long-term behavioral changes. Numerous studies confirm that adherent DBT leads to better outcomes than DBT-informed therapy, especially for individuals with complex mental health needs, like those with BPD. Real DBT’s multi-component model allows clients to have the skill support they need in all areas of life, promoting holistic, sustainable change.
Practical Tips for Finding Adherent DBT
- Research Providers: Look for DBT-certified providers or therapists with comprehensive DBT training.
- Ask About Group Skills Classes: Most adherent DBT programs offer group classes. If none are available, it’s worth inquiring why.
- Clarify Goals: Ensure your therapist uses DBT’s structured hierarchy of goals.
- Prioritize Regular Coaching: Real DBT often involves between-session support, so seek providers who offer this component.
- Confirm Consultation Team Participation: This team-based approach benefits both you and your therapist, ensuring the best DBT practices are applied.
Frequently Asked Questions (FAQs)
What’s the difference between DBT and DBT-informed therapy?
DBT-informed therapy uses some DBT skills but doesn’t adhere to the structured DBT protocol, which includes individual therapy, skills groups, phone coaching, and a consultation team.
Why is a DBT consultation team important?
A consultation team supports DBT therapists, helping them stay motivated and aligned with the therapy’s principles, which improves treatment quality.
Can DBT be effective without skills training?
Skills training is central to DBT’s success, as it equips clients with coping mechanisms essential for managing emotions and interpersonal issues.
What are the main skills taught in DBT?
DBT focuses on mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness to help clients manage emotions and relationships.
Does DBT work for issues other than Borderline Personality Disorder?
Yes, DBT is effective for a variety of mental health conditions, including PTSD, depression, anxiety, and eating disorders, due to its focus on emotional regulation and adaptive skills.
References
- Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.
- Lynch, T. R., Trost, W. T., Salsman, N., & Linehan, M. M. (2007). Dialectical Behavior Therapy for Borderline Personality Disorder. Annual Review of Clinical Psychology, 3, 181-205.
- Rizvi, S. L., & Steffel, L. M. (2014). DBT in clinical practice: Applications across disorders and settings. Guilford Publications.
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