Are You Getting “Real” DBT? 7 Questions to Ask

As a psychologist who specializes in dialectical behavior therapy (DBT), it hasn't been an uncommon experience for new clients to tell me that they hate DBT. Usually, the person explains that they have tried DBT before and it didn't work, but they're trying again because they're desperate and don't know what else to do. I'm always excited when this happens.

Of course, I'm very unhappy that the person is still suffering, but I'm thrilled that they found me. Because, almost every time, after a little conversation, we determine that they actually have not been in DBT before. Usually, they've been in what some call “DBT-informed therapy.” Often, their previous therapist had taught them DBT skills as a part of another type of therapy. But DBT is way more than those skills.

If you're even asking the question "How do I know if I'm getting ‘real’ DBT?" then you're ahead of the game in realizing not all DBT is created equal. By "real" here, I mean adherent DBT as described by DBT’s creator Dr. Marsha Linehan.¹

Adherent, comprehensive DBT is the form of DBT that has been used most frequently in the research that shows DBT is helpful for borderline personality disorder and some other mental health diagnoses defined by intense emotional dysregulation or impulsive behaviors.² While DBT skills and DBT-informed therapy can improve mental health for many people,³ some people will see the most benefit when receiving comprehensive DBT.

If it's important to you to ensure you're receiving adherent DBT, there are questions you can ask yourself and your therapist (or potential therapist) to be more confident. I've listed seven such questions below.

[Note: This post focuses on traditional DBT for adult clients.¹ Requirements for adherence differ for DBT for adolescents/children and several of the empirically validated adaptations of DBT, such as DBT-PE for posttraumatic stress disorder.]

7 Questions to Ask

While DBT has a lot of unique techniques and guidelines that differentiate it from other therapies, these questions cover some of the easiest things to confirm as a client:

1. Does your treatment include all three of the following: weekly individual therapy sessions, weekly DBT skills learning sessions (likely in the form of a DBT skills group), and occasional “phone coaching” with a DBT therapist between sessions? If not, it's not adherent DBT.
2. Do your individual therapy sessions focus on specific behavioral “targets” (e.g., behaviors you want to decrease or increase) that you and your therapist collaboratively and explicitly defined together? If not, it's not adherent DBT.
3. Do you use some form of a “diary card” to track your targets between individual sessions? If not, it's not adherent DBT.
4. Do you practice DBT skills every week and discuss these practices with a DBT skills teacher (either in group or individual learning sessions)? If not, it's not adherent DBT.
5. Does your therapist attend a weekly “consultation team” with other DBT therapists? Is this consultation team meeting entirely focused on discussing DBT cases or how the therapists can be the best DBT therapists they can be? If not, it's not adherent DBT.
6. Has your therapist received intensive training in DBT? If not, it may not be adherent DBT. (DBT is a very complex therapy that requires training to provide adherence. "Intensive training" may include a semester-long class, a 1-to-2-week-long clinical training, or something similar.)
7. Has your therapist received supervision for the duration of treatment for at least one of their clients in comprehensive DBT? If not, it may not be adherent DBT. (Again, DBT is a difficult therapy to learn without supervision. "Supervision" is a professional relationship in which your therapist would have attended weekly meetings with another licensed therapist who is an expert in DBT. During these meetings, your therapist would have discussed a current, ongoing DBT client with the supervisor in order to receive feedback about their application of DBT techniques. Ideally, the supervisor would have even been listening/watching real recordings of your therapist's sessions with their DBT client.)

If you're thinking, "Wait, can I actually ask my therapist about these things?"—yes! Many intensively trained DBT therapists would be thrilled to talk to you about adherent DBT and whether or not it’s a good fit for you.

One More Thing to Know

It can be tough to find adherent DBT. The frequency of people thinking they’ve been in DBT when they have not is partly what inspired the creation of organizations like the Linehan Board of Certification for DBT therapists and programs. These types of organizations help connect clients to clinicians with confirmed expertise.

Many excellent DBT therapists are not LBC-certified, however. The Psychology Today therapist directory is one option for finding therapists of all types, and the questions in this article can help you identify therapists who provide adherent DBT.

A version of this post also appears on kikifehling.com. The information in this post is for psychoeducational purposes, and it is not a substitute for the professional advice provided by your licensed mental health provider.