Frequently Asked Questions
Do you accredit your training courses ?
In terms of accreditation British Isle DBT Training does not accredit therapists attending our training courses. It is our view, and this is typical within psychotherapy training, that it is preferable to have a separate independent body to accredit therapists as training organisations have a vested interest in accrediting therapists on their own training programme. So, for the Therapists, the Society for DBT in the UK and Ireland (www.sfdbt.org) is the independent body that accredits therapists in DBT. The Society has strong links with the Linehan Board of Certification that fulfills a similar role in the USA.
If I can’t join an existing team or start a new team, can I still integrate DBT within my practice?
The majority of data on DBT’s effectiveness has tested the standard model of DBT (individual treatment, skills training, phone coaching, and consultation team). Since there has been very little research to examine the specific role of the DBT consultation team thus far, more research is needed before researchers can make an empirically supported case for the relationship between consultation team and staff, client, and programmatic outcomes. This means that in order to do DBT to fidelity, you must be on a DBT consultation team.
DBT is a team-based treatment in which Consultation Teams meet every week to assist each other in applying DBT. In the face of treating difficult cases, your DBT team is your resource for maintaining motivation to deliver effective treatment, enhancing your clinical skills, and monitoring fidelity to the treatment model. In fact, in a recent survey of Intensively trained teams, 90% of teams had a formal, ongoing consultation team, and “strong commitment, communication, and motivation amongst consultation team members” were identified as the top factors in helping teams reach their implementation goals. Through weekly meetings, your DBT consultation team provides you with the support you need to treat clients and develop your skills.
As I understand, DBT is delivered in a team format. Is it consistent with the model for a small group of psychologists to be working across wards and seeing patients for DBT, when the rest of the ward teams (nurses, OTs etc) are not DBT trained or working to that programme?
DBT is a team-based treatment and one possibility for delivery is that DBT is offered as a programme within a programme such that a team of therapists trained in DBT offer the intervention to a group of clients who are also in receipt of other interventions. In these circumstances, professionals offering the other services are not expected to be trained in DBT or to deliver DBT. If they have a general knowledge of the treatment and some understanding of the clients’ goals in treatment this can of course be helpful. The DBT team takes the stance of coaching the client in how to be as skilful as possible and maximise the benefits of their other treatment input. This can be especially helpful as it is isomorphic with the real world – there are no totally DBT environments. An adherent DBT programme must have a modality of treatment devoted to assisting clients in this task of generalising their skills. In outpatient programmes this would typically be by phone contact between the DBT individual therapist and the client. In inpatient settings this can be achieved by the same means – subject to the rules of the unit – but there are other options e.g. Training up specific members of the nursing team in DBT to act as generalisation coaches. If this option is chosen these nursing staff then become DBT staff and need to attend a consultation team.
I have enough colleagues to form a new team, but we can’t all afford to attend the Intensive training. What can we do?
We would recommend you consider staggering your attendance. For example, if you have a team of seven providers and none of you are Intensively trained, consider having four of the team members attend a Dialectical Behavior Therapy Intensive Training™. Then, the remaining members can attend a separate Intensive or Foundational training several months later. In the meantime, all team members can work together to enhance their DBT practice through other methods including manual-based self-study, online trainings, and workshops.
To be considered a DBT Programme, what is the % of group work compared to individual work that should be happening?
Currently there are no standards in relation to % of group and individual work. These are in development. What is more crucial is that the DBT programme has modalities fulfilling all five functions of the treatment – see our website for more information on Functions and Modes. What would likely be considered adherent would be at a minimum a single group a week lasting 2-2.5 hours (although in an inpatient setting you could offer multiple shorter groups a week e.g. three 1 hour groups); a weekly individual therapy session; access to between–session coaching with the individual therapist or trained DBT skills coach; and that all staff delivering DBT attend Consultation Team weekly for 2 hours.
After people have completed the 2×5 days intensive training – what are the on-going requirements for supervision/governance ensuring safe practice?
DBT is a psychological intervention and therefore we would recommend that in addition to weekly peer supervision in the Consultation Team, that novice teams access supervision from a more skilled practitioner. This is the same recommendation as for any psychotherapy. Often, however, organisations are unwilling to support teams to access this. Large components of DBT are based on cognitive behavioural problem-solving and each team is selected to have at least one team member with expertise in this area to support the team.
Can you clearly state what level of competence a supervisor is required to have attained.
Currently the standards for accredited therapists are in the final stages of development. These will include supervision requirements (e.g. weekly for 6 months or fortnightly for a year) and involve the use of audio and video tapes. Therapists will have to submit a case formulation and a tape or tapes for rating. Supervisors will have to be adherent therapists established by this route and to have had training in the rating of DBT adherence. Currently we have a small group of supervisors with this level of skill. As it is not always possible to access a specialist supervisor some level of supervision can be provided by someone who is an adherent therapist but who may not yet have had training in rating adherence.
As part of our DBT consult and supervision, I was wondering if there was available a criteria which we could access to aid adherence to the model when carrying out supervision. (Similar to the CTRS scale in CBT)
There is indeed an adherence measure that is used to rate therapy tapes. However in order to use the measure you need to have received training and calibration in the measure so that the measure is not freely available but only to those who train formally. In order to advance your skills there are two places to look to audit your developing skill in the model. The first are the tables of strategies in the Treatment Manual. We encourage therapists to copy all the tables from their own manual and keep these in a single binder and to review their own tapes against these strategies. The second option is to review the DBT competencies as listed on the UCL core website http://www.ucl.ac.uk/pals/research/cehp/research-groups/core/competence-frameworks
Do you offer Accreditation in DBT?
We do not offer accreditation in DBT as we feel it would be unethical to do so, as a training provider it would present a conflict of interests. However, we have done our utmost to support the Society for DBT in their efforts to set up an independent accreditation for DBT in the United Kingdom, further details can be found at their website here.