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The Only Thing Constant in Life, is Change and Join us in Welcoming our Changes to the Board Of Directors at DBT-LBC™

As we all know, change is the only constant in life, and that change can be both exciting and scary. I want to share some changes that have occurred within DBT-LBC Board of Directors as we are moving rapidly through 2022. While there is a dialectic within change that can make it both scary and exciting, the change I am going to talk about within DBT-LBC™ falls on the exciting side of that dialectic.

First, I want to recognize Dr. Suzanne Witterholt, MD. Suzanne has been a key player in DBT-LBC™ since inception. Don’t worry, she isn’t going anywhere; however, she has stepped down from the Vice President position at DBT-LBC. She will remain a member-at-large on the Board of Directors. Words cannot express the support that she has personally provided me as I transitioned into the presidency role back in 2020, so I will not try and come up with the words that will only marginally represent her level of support, THANK YOU SUZANNE. I am excited to announce that Dan Finnegan from Cadence - Child & Adolescent Therapy has been elected the Vice President of DBT-LBC™. Dan’s expertise in both the delivering of DBT and his knowledge of the research supporting DBT has been invaluable to DBT-LBC™, and we are excited to have him in the role of Vice President. Congratulations and thank you for all you do, Dan!

With Dan moving into the Vice President position, it left open the Treasury position and I am pleased to announce that Chris Kallas, our public member on the Board has been elected to the Treasury position. Chris not only brings a perspective from the public lens, she also brings experience from a legal perspective as she is an attorney in New York.
Thank you for all you do, Chris. Your perspective, insight, and passion are invaluable to not only DBT-LBC but to the entire DBT community.

As many of you probably have read some of Chris’ newsletter articles, she has a passion for DBT that has a personal connection which she shares below.

As the parent of an adult child with a primary diagnosis of BPD, I spent years trying to understand this disorder. However, my child was very clear from early on. Having done her research, she informed us that DBT was the treatment that “would save her life”.

Once we became involved with NEA BPD it was clear why she said that. And it became clear that DBT was helping to save our family as well.
It was also clear that not everyone who “did DBT” really did DBT in an adherent manner. So when the opportunity to serve on the DBT-LBC Board as the Public Member was presented to me, I decided that I would take the leap. As family members, it took us a while to find a therapist who understood BPD. It also became very clear that DBT practitioners were far more understanding and validating of the concerns of family members, which was helpful to the entire family, than your ‘average’ clinician. I wanted to help family members find effective treatment for their person with BPD, and certification is the gold standard for clinicians who treat this disorder. I also wanted to be able to weigh in on certification questions from the perspective of those family members.

Serving on the DBT-LBC Board has given me an opportunity to do just that, for which I am very grateful.

Join us in Welcoming our Newest Board Member, Dr. Erica Tan

In addition to some of the changes within the current board of directors, we have elected 1 new member to the Board. Please join me in congratulating Dr. Erica Tan from Portland DBT Institute to the DBT-LBC Board of Directors as a Member-at-Large.

We are honored to have Dr. Tan join us and share not only her energy and enthusiasm but her wisdom, knowledge, and expertise with us so that we can continue to grow and improve. Welcome aboard Dr. Tan!

Below she talks about her experience with DBT-LBC and certification.

It's an honor to be a part of the DBT-LBC Board of Directors. I had started volunteering just last year when a friend asked if I would co-chair the DBT-LBC Diversity board meeting with Kim Skerven, PhD, and I thought it would be a fun experience! Since then, I've attended a few meetings with social media, the Equity/Diversity committee, and the larger meeting for volunteers and I appreciate the passion about DBT everyone has.

For me, a personal goal is to help diversify and increase representation of marginalized and underrepresented folx in the DBT community at large and in DBT-LBC. DBT-LBC certification was very personally meaningful for me as I felt I had "stagnated" as a DBT clinician and the preparation for certification brought me back to the basics and helped me to become more incisive and intentional with stylistic strategies and commitment to the treatment. I feel I am providing this life changing treatment much more effectively now and it has helped to increase my passion for working with our clients even more!

Please join me in welcoming the changes to the DBT-Linehan Board of Certification, Board of Directors.

With gratitude and thanks to each one of you that remain at the heart of DBT-LBC™. Your generosity and support have been insurmountable to our growth and success. We are continuing to work to improve so please be on the lookout for updates and future live webinars.

“Success is a Journey, not a Destination” and we are on a constant journey to continue to keep Marsha’s legacy alive. Change is the only constant in life, and we are choosing to embrace that change with welcome arms and look forward to what the future holds.

With love to all,

Dr. Kimberly Vay
President, DBT-Linehan Board of Certification™

3/28/22 Nystrom and Associates, LTD, MN-Team Lead: Donna Pattie

In his honor, here is a tribute written by Andrea Gold, PhD, and Suzanne Decker, PhD.

Seth Axelrod, PhD was a DBT clinician, teacher, mentor, scholar, and friend. He directed the Dialectical Behavior Therapy track at the Yale-New Haven Hospital Intensive Outpatient Program, serving some of the highest-risk and most deeply suffering individuals who receive mental health care. He was Associate Professor in the Department of Psychiatry at Yale School of Medicine and a trainer and consultant with Behavioral Tech, LLC. He taught and mentored over 100 mental health care providers in DBT. Seth took tremendous joy in connecting members of the DBT community to one another, whether it was by "let me introduce you to..." at a conference, an email sent on a trainee's behalf, or co-developing the annual Yale-National Education Alliance for Borderline Personality Disorder conference with the late Perry Hoffman, PhD, a conference now in its 17th year. As a clinician and mentor, Seth embodied the dialectic of total acceptance of a person exactly as they are, and, total and unrelenting push towards their life worth living. He was honored with the ISITDBT Cindy Sanderson Outstanding Educator Award in 2019, an experience he described as deeply humbling, as he considered the other award recipients to be 'the giants that [he] looked up to'. Seth had a contagious laugh, an incredible generosity of spirit, and both a half-smile and a winning full smile. He truly lived DBT, pushing for change, encouragement, cheerleading, while grappling with cancer and deeply accepting its effects. He practiced his skills actively and publicly while undergoing treatment, as described in his interview with Charlie Swenson, MD, on his podcast To Hell and Back Seth is survived by his wife, Rebecca, and children Emma and Eli, and will be deeply missed by his clients, colleagues, and the entire DBT family.

In Memory of Seth Axelrod – a Tribute from Emily Cooney

Seth was an Associate Professor at the Yale School of Medicine, and the Director of the Yale-New Haven Psychiatric Hospital DBT Intensive Outpatient Program.  He had a local and national reputation for his expertise on Dialectical Behavior Therapy, suicidality, self-harm, and borderline personality disorder.  He mentored and taught numerous students, colleagues, fellows, practitioners, and investigators, assisted Marsha in the 2nd edition of her DBT skills manual, and has been a tremendous resource both nationally and internationally for the DBT community. He was a tireless advocate for individuals and families affected by emotion dysregulation and BPD, continuing to engage in activities such as participating in the annual Sashbear Foundation walk, and spearheading the development of a DBT treatment directory, even when experiencing the limits of a life-threatening illness.  With his friend and colleague, the late and dear Perry Hoffman, he founded and co-directed the annual BPD conference at Yale in partnership with the National Education Alliance for Borderline Personality Disorder that is now moving towards its third decade.

He was also a devoted husband and father, a collaborative and encouraging colleague, an astute and incredibly generous therapist and mentor, and my dear friend.  He brought warmth, humanity and mutual respect to his unerring focus on clinical excellence.  In doing so, he asked for, in his words: “full commitment to success balanced by full openness to failure, with the synthesis of the freedom to do one’s best”.  This was nowhere exemplified so strongly as his valiant commitment to a life of meaning, joy and service, in the midst of living with cancer.  In this he embodied the application of DBT skills to transmute suffering to the full catastrophe of pain and delight that is life.  With his beloved wife, Rebecca he contributed to Charlie Swenson’s superlative podcast where they described how DBT principles and skills guided their response to Seth’s illness in interviews that were inspiring and uplifting.

In 2019, Andrea Gold suggested nominating him for the ISIDBT Cindy Sanderson award, and we invited members of the DBT community who had experienced his teaching and mentorship to provide letters of support.  The outpouring of messages describing his impact on people’s lives and careers was overwhelming and incredibly moving.  It is similar to the gratitude, affection and respect in the messages that have been posted on the DBT listserv from those who have been affected by him.  I know that this represents a miniscule proportion of the people whom Seth has touched with his wisdom, enthusiasm, and compassion; the individuals living with BPD to whom he dedicated his working life are legion. 

I am very grateful to have known him.

2/09/22 Hennepin Healthcare, Minneapolis, MN-Team Leader-Mary Souder

12/21/21 Trinitas Institute for DBT and Allied Treatments-Team Leaders-Essie Larson, Ph.D. and Atara Hiller, Psy.D.  

See below for some strategies for obtaining treatment with a DBT-LBC Certified clinician or program covered by your insurance

We at the DBT-Linehan Board of Certification™ (DBT-LBC™) are committed to helping all individuals receive quality DBT services regardless of financial situation. We understand that the process of identifying high fidelity providers and programs who accept insurance can be an extremely difficult task, in the midst of what is already an incredibly overwhelming time. If you are unable to find an in-network provider and/or program or are struggling to assess whether a provider is actually qualified to provide DBT as designed and researched, we have created the following to help you in that process. There are clinicians and programs that provide quality DBT that may not be certified by DBT-LBC™, but those that have been certified by DBT-LBC™ have met certain high certification assessment standards and that often helps in getting your insurance company to agree to cover the treatment. If there are no DBT-LBC™ certified clinicians or programs within your physical vicinity, we encourage you to make sure that any clinicians who claim to provide DBT meet all of the other criteria stated in this document before proceeding with getting an SCA.

Often if a client is seeking specialized therapy and there is no provider or program in-network who offers it, they are entitled to receive the service out-of-network with the in-network copay/deductible.

Many clients have been able to get a “Single Case Exception” or a “Single Case Agreement” for DBT in order to go out-of-network and still only pay their normal in-network copay. The insurance company covers the remainder of the therapist’s normal full fee. This makes out-of-network therapy the same cost as in-network therapy for the subscriber.

Your insurance company may tell you that they have a specialist on their panel/in-network who can meet your needs. However, it is very unlikely in most situations, that you will actually be able to find a DBT-LBC™ certified clinician (or even a trained DBT therapist) or certified program who is in-network. What we suggest is that you call any therapist or program who your insurance company says provides in-network DBT and ask a few questions. Included here are some guidelines to help you determine whether or not the provider is actually offering comprehensive DBT.

Dialectical Behavior Therapy (DBT) consists of four components:

1. Weekly individual therapy with a DBT-trained clinician, (a minimum of 40 DBT specific hours of training from a reputable training provider) and preferably a DBT-LBC™ certified clinician or a clinician within the DBT-LBC™ certified program. The structure of each individual session should be created by a client’s recorded answers on a form called a “diary card” which is filled out daily.

The highest standard in assessment of DBT delivery is the DBT-Linehan Board of certification™. To confirm certification of your DBT provider or program by the DBT-Linehan Board of Certification™, go to the website of the DBT-Linehan Board of Certification™: https://dbt-lbc.org/index.php.

2. Weekly DBT skills training--usually conducted in a specialized group, but on rare occasion done individually in a separate session focused solely on skills training.

Adherent skills training requires that both teaching of new material AND a review of assigned weekly home-work is conducted. Research indicates that outcomes for clients are best if they complete 2 full cycles of the program’s skills training curriculum.

3. In between session phone coaching--needed to help the client use skills in daily life and avoid higher levels of care.

4. Clinician Consultation Team meeting--DBT requires that the therapist participate in a weekly consultation team meeting with only other DBT trained therapists.

***Note--in DBT continued participation in treatment requires that clients are improving on structured assessments like the diary card. This is different than many other treatments where clients stay longer in the therapy if they are NOT improving.

Without every one of the above components, it’s not DBT

It is worth asking the following specific questions to any providers that the insurance company has given to you to make sure that they are actually providing comprehensive DBT.

1. Are you or your program certified by the DBT-LBC™?
2. Do you provide DBT treatment?
3. What was your training for providing DBT?
4. Do you provide both the individual therapy component of DBT and the skills component?
5. If so, is the skills training offered in a group setting and how long does group last each week?
6. How long does your program take to complete 1 cycle of skills training?
7. Do you allow a client/family to complete the skills training curriculum 2 times?
8. Is continued participation in your DBT services based on some type of ongoing assessment of symptom improvement?
9. Do you provide phone coaching between sessions as needed? Are there any limits placed on phone calls or between session contacts?
10. Do you belong to a consultation team that meets weekly and includes only other DBT trained therapists?
11. Do you use a daily diary card?
12. What adaptations have you made to the research supported methods of providing DBT? Why were those adaptations necessary?

Very often when clients ask “DBT in-network” clinicians the above questions they have found that the clinician:

• Does not do DBT and does not claim to do DBT
• Has minimal training in DBT, incorporates a few DBT skills into non-DBT therapy, but does not claim to be a DBT therapist.
• Claims to “do DBT” but, in fact, has minimal training, doesn’t separate out the skills component of DBT from the individual therapy session, does not offer all 4 components of DBT, does not offer research supported methods for meeting the 4 required components, and/or is not part of a DBT therapist consultation team.

If you find that the therapists or program whose names you have been given by your insurance company are not DBT therapists, go back to your insurance company and ask for them to authorize out-of-network treatment under a single case exception or single case agreement. Some states actually have laws that will help support you in these requests. Our clients tell us that they are most successful when they appeal and act assertively. Do not expect to get an immediate “yes” or approval for your request. It may take going up the chain a bit to find someone who is familiar with DBT.

Here is a possible script for you to use when calling your insurance:

First say, “I would like to request a Single Case Agreement/Exception to see an Out-of-Network provider and/or program who is certified by Dialectical Behavior Therapy-Linehan Board of Certification™ (or specializes in Dialectical Behavior Therapy).” (It is best to say the whole name of Dialectical Behavior Therapy instead of DBT because insurance companies often think people are saying CBT).

Second say, “I have tried to find a Dialectical Behavior Therapy- Linehan Board of Certification™ program/clinician who is in-network with (name of insurance plan) and have not found any. I cannot afford to see an out-of-network provider without a single case agreement because I do not have out of network benefits/I have out of network benefits with a high deductible and co-insurance.”

This may be the point where the insurance company gives you names of providers in-network who “do DBT.” You will then need to call those names and ask the questions that were discussed above to assess whether they really are trained DBT clinicians providing DBT therapy. After you call the names given to you and you do not find a DBT clinician in-network, call the insurance company back and continue with the following:

Third say, “I have called the clinicians and programs that you provided to me on (say the date of your initial call) and upon speaking with them discovered that they are not certified by DBT-Linehan Board of Certification™ or trained in Dialectical Behavior Therapy and/or do not follow the researched and evidence based model of Dialectical Behavior Therapy in their practices.”

Fourth say, “Through my own research I found a clinician and/or program who is certified by the DBT-Linehan Board of Certification™. I have asked if (name of clinician referred to in previous statement) will consider a single case agreement and they have said yes. What is the next step I need to take?”

Once you start the process for getting a single case agreement/exception you may be asked by the insurance company to “justify” why you need this specialized treatment in order for them to agree to cover it. Many insurance companies will require that you have the symptoms or behaviors associated with Borderline Personality Disorder, emotional dysregulation and/or behavioral dysregulation (e.g. self-harm, suicidal behavior and thoughts, psychiatric hospitalizations, etc.). That is because DBT has been shown by research to reduce these issues and reduce the need for other higher levels of care (e.g. partial hospital). As a result, DBT is a therapy shown to reduce overall expenses for the insurance companies in the long-term. This cost reduction has been confirmed by research on ADHERENT DBT PROGRAMS ONLY that deliver all four components discussed above in a manner that is consistent with the design and research of the treatment.

Many insurance company representatives are not familiar with different types of therapies and do not know the difference between them. If you are running into roadblocks with a particular insurance company representative it may help to say the following, “Is there a representative or supervisor I can speak with who has specific experience and knowledge of Dialectical Behavior Therapy?” It is common that once a person knowledgeable about the treatment modality becomes part of the process that things start moving along more smoothly.

Please know that the process of getting an SCA differs widely between states and from insurance company to insurance company. If you are having difficulties or have questions after trying these steps, please ask a DBT-LBC™ Certified provider in your state or contact DBT-LBC™ for assistance in identifying a provider who might be able to answer your questions.

The legislative committee of the DBT-LBC™ would like to share our greatest appreciation for those organizations and clinicians who have gone before us in helping to support patients and their families in getting Single Case Agreements for DBT! These include Emotions Matter Inc. https://emotionsmatterbpd.org/resources2 and their publication “Utilizing Single Case Agreements to Access Treatment for Borderline Personality Disorder: A Strategy to Support Health Care Consumers and Clinicians" (2017), and Judi Sprei, PhD, Britt Rathbone, LCSW-C, Brian Corrado, PsyD of the DBT Metro Consortium www.dbtmetro.com

Expressing Gratitude: DBT-LBC Certification Discounts

The past 2 years have really given the term ‘new normal’ a whole new meaning. How can you find gratitude in this ‘new normal’? As an organization of volunteers, DBT-LBC is forever grateful for everyone in the DBT community working to help those struggling the most.  With so many continuing to struggle and settle into this ‘new normal’, there has never been a better time to apply for DBT-LBC certification. Clinicians deserve to be acknowledged for the hard work of delivering DBT and certification through DBT-LBC will do just that. It will provide confidence to those seeking out a treatment that they so desperately need.  In an effort to continue encouraging clinicians to achieve the highest level of DBT, DBT-Linehan Board of Certification is pleased to reinforce attendance at ISITDBT for the 2^nd year by offering financial incentives for individuals or programs who also apply now for certification.

DBT-LBC is offering a discount for applications, for both clinician certification and program certification, submitted between October 1, 2021 and January 31, 2022.  You can find all of the details in the newsletter as well as at www.dbt-lbc.org and 2021 CONFERENCE | isitdbt.net.

When I find myself stuck in fighting the reality of this ‘new normal’, I find it helpful to think about something Marsha has said, “DBT is not a suicide prevention program, DBT is a life worth living program” and how easy it is to skip the life worth living and just focus on keeping the client alive because it is too scary to think they are going to die. Yes, I know this is a totally different situation; however, we can look at this ‘new normal’ in a similar way. It can be hard to focus on what we are grateful for when the uncertainty of everything going on is too scary to not consume us and become the focus. Well, as we all know rabbit holes are real and they will suck the best of us in before we even know it, at least I have found myself in the rabbit hole more than I would like to admit.  I am grateful for my team to lend a hand to pull me out of the rabbit hole and be willing to take my hand when they need pulled out. What are you grateful for?

While no one has the magic wand to make things go back to our ‘old normal’ we are all well equipped with skills to be able to look at that rabbit hole and say “nope, not today” and practice radical acceptance and work to find the meaning in this ‘new normal’. I know that this is not new information to any of us; however, the reality is that we are more human than anything else and we all need reminders and support when we trip and fall into that hole. In addition to practicing our own skills, expressing gratitude towards others has been proven to improve our overall wellbeing and sense of happiness. Keep in mind that our ‘new normal’ has not taken away our ability to practice skills or express gratitude towards others.

We are grateful for ISITDBT.  It is a time when we can all come together and network and connect with the DBT community both near and far. Making connections along with personal and professional friendships that are sure to last a lifetime. We are grateful for the efforts of the organizers of ISITDBT. They have worked hard to adapt and still bring us all together in a way that we are all too familiar with these days, through a screen.

While we, at DBT-LBC, will definitely miss seeing so many of you in person again this year, we join with the organizers with confidence that this will be once again an amazing conference. And for that we are grateful!!

With love and gratitude to all,

Dr. Kimberly Vay

President, DBT-Linehan Board of Certification

Beginners Mind by: Christina Kallas J.D., Esq.

It can be daunting to write a regular column, in any publication. It can be particularly daunting to write for this publication. The audience is people who have studied DBT, who are ‘experts’. I have been learning about DBT for almost three decades, but I haven’t ‘studied’ it the way you readers have. I have no idea if I could ‘pass’ the certification exam myself.

And yet, as I was reminded this week, I could think of myself as having ‘Beginner’s Mind’. No statistics, no textbooks, but plenty of lived experience in my family, and by extension, the lives of the family members I’ve worked with in Family Connections. I’ve even taught DBT skills to a professional audience of other lawyers. I called my talk, “How to deal with difficult clients.” I didn’t mention DBT, but one of my colleagues said to me afterward, “You know, Chris, I could use all of these tactics with my in-laws.” And she was right, of course.

DBT skills aren’t just for people with a diagnosis. DBT skills work for all of us in our everyday lives, at work and in our communities. Since I started learning DBT skills, I have become a much more effective person: in my marriage, in my friendships, in my community at large, with my clients. People who knew me as a younger person have remarked: “Boy, you sure are different now.” And I am. Part of that growth has been from spending so much time with people who are involved in the mental health community, especially those of you who teach your clients DBT skills. I believe that’s because you can’t really teach DBT skills effectively if you aren’t using them.

Many years ago, when I first became involved in NEA BPD, and I spoke with people like Perry Hoffman and Alan Fruzzetti, I would think to myself, “What planet did these people come from?” They seemed so different from the family of origin I started with. (Okay, not fair - I picked two of the most special people on the planet Earth! And as one of my colleagues has said, when I was growing up they hadn’t invented validation yet.) The more I spent time with people who treat others using DBT, the more I realized how much it changes people, for the better.

So keep doing what you are doing, you practitioners out there. You are very special to the rest of us. Thank you for giving us hope, in a time when hope seems to be in short supply. In addition to the benefits that you provide to your individual clients, you are helping to reduce the stigma of mental illness, which is such a powerful impediment to improving our society.

ISITDBT 2021 is Thursday November 18, and this edition of the research corner serves as a backdrop for some of this year’s scheduled workshops. Read on to refresh your memory with what’s already out there, as well as get a sneak peek at what’s to come at ISITDBT 2021. 

We know that DBT treatment has been effectively adapted with suicidal adolescents and their families, high conflict couples and parents.  Data show that DBT interventions increase family members’ ability to express emotions accurately, increase regulation of strong feelings, and help families find a middle ground for addressing conflict (Rathus, et al., 2018, Fruzzetti, A.E. & Iverson,K.M., 2006). A morning ISITDBT 2021 workshop sets the stage for change with families from first contact onward titled “ Preparing the Environment for Change: Pretreatment for Families.” Any clinician working with couples, adolescents, and families will be well served by attending this presentation!

Last year’s “DBT and Social Justice” presentation was one of the most lauded of the conference, and effectively broke ISITDBT ground for ongoing conversations about equality, race, and justice. While there are publications supporting DBT applications to LGBTQ populations (Skerven, K., et al. 2019, Cohen, J.M., et al., 2021), there is only one pre-print publication available on the cultural responsiveness of DBT to the presenting problems of Black / African American client (Pierson,A.M., et al., 2021). ISITDBT hosts two afternoon workshops addressing adaptations of DBT to minority populations:  “ You Didn’t Cause Racism and You Have to Solve It Anyway: Anti-racist adaptations to DBT for White Therapists”, and “ Doing DBT with Sexual and Minority People.”  We could not be more honored to attend and promote these sessions provided by our DBT colleagues.

Finally, mounting data support the efficacy of DBT Skills only interventions with a variety of diagnoses, including but not limited to eating disorders, emotion dysregulation with anxiety and depression,  borderline personality disorder, and ADHD (Telch, C.F., Agras, W.S., & Linehan, M.M. 2001; Neacsiu, A.D., et al., 2014; Linehan M.M., Korslund K.E., Harned M.S., 2014; Valentine, S. et al., 2020).  A highly anticipated workshop titled “DBT Skills Groups for Clients on a Wait List” shares the efficacy of providing a skills only offering for clients on a wait list for full services. While the limited amounts of DBT services are unable to match the high demand for care, this workshop offers concrete help for providing interventions to clients while they wait.

This year’s ISITDBT conference looks to be even more fantastic than the last, and we hope to see you there. If you haven’t already, please register for your seat at ISITDBT 2021 at https://www.eventbrite.com/e/2021-isitdbt-conference-tickets-168639789149.

Don’t miss this opportunity to combine attendance at ISITDBT and discounted clinician or program certification!

DBT-LBC Clinician Certification Discount – Free Video Coding

DBT-Linehan Board of Certification will waive the video coding fee for all ISITDBT attendees who complete their application and pay the initial application fee between October 1, 2021 and January 31, 2022. The 32% discount ($270) will be applied when the applicant successfully passes the DBT-LBC Knowledge Exam and submits videotaped individual sessions for review. Applicants who complete the steps and submit videotapes for review by December 31, 2022 will be awarded the discount.

DBT-LBC Program Certification Discount – Save over 50%

DBT-LBC Certified Team Leads who attend ISITDBT, complete the DBT-LBC application and pay the application fee for Program Certification will receive a 51% discount! The 51% discount, or $2000 will be applied/waived for the site review portion of Program Certification. Site reviews are currently being done virtually. All programs completing their applications between October 1, 2021 and January 31, 2022 will receive the discount. Programs have until December 31, 2022 after applying to complete the process and receive the discount.

Chicago DBT Institute (CDBTI)

The owner of Chicago DBT Institute (CDBTI), Dr. Kay Segal, started her DBT journey while being supervised by one of Marsha’s former students, Eunice Chen, PhD. She was fortunate enough to get to hang around some of the OG DBTers at ISITDBT meetings every year and recalls listening to Marsha speak about certification, her vision to grow the family tree of DBT, and her goal to inspire others to practice evidence-based treatment with fidelity in an effort to help people suffering with emotional dysregulation and self-destructive coping. The Clinical Director of CDBTI, Dr. Allison Mauro, met Kay at the Autumn in Chicago: Advanced Topics in DBT training during the fall of 2016. Kay was the only DBT-LBC Certified Clinician in the state of Illinois at the time. Allison was inspired by her and they immediately connected on their passion for DBT and adherence to the model. Allison joined the team at CDBTI soon after and started on her own path to clinician certification, which she completed in the summer of 2019.

The road to program certification began with a nudge from Joan Russo, who Kay had gotten to know as a fellow midwesterner over the years at ISITDBT. Kay’s small team of four clinicians rallied to gather documentation to support their adherence in individual sessions, skills group, phone coaching, and Team. The most exciting and rewarding part of preparing for the certification process and site review was the enthusiasm and eagerness of patients to help.

When it came time for the site review, Joan enlisted the help of Sarah Stelzner and Mandy Hyland. The certification process was still in its infancy, and CDBTI’s site review served as an opportunity to train future site reviewers. Following CDBTI’s certification, Sarah and Kay joined the DBT-LBC program certification workgroup and began volunteering to review other programs.

CDBTI was ecstatic to become the first DBT-LBC Certified program in the state of Illinois. In the Chicagoland area there are many programs that offer elements of DBT. We knew that becoming a certified program was necessary to ensure we were delivering comprehensive, adherent, and evidenced based outpatient DBT treatment to our patients and their families. The even greater joy came from how the process positively impacted our patients. One of the patients that Joan interviewed was abusing alcohol at the time. The patient distinctly recalls Joan asking her why she was not engaging in more skillful ways of decreasing her use. Today, the patient is sober and still comments, “If only Joan could see me now.” CDBTI’s patients really felt that they had a part in “moving DBT forward” and were so invested in the process and the treatment. Finally, we are beyond honored to have been a part of Sarah’s journey and dedication to DBT.

The CDBTI team has grown since our humble beginnings, and now has ten clinicians, hundreds of patients, and countless success stories of building a life worth living. We continue to pride ourselves on our fidelity to the treatment and are honored everyday to be part of such a wonderful DBT community!

10/13/21 Triangle Area Psychology Clinic (TAP)-Team Lead-Lorie Ritschel, PhD

9/29/21 DBT Center of Lawrence KS-Team Leader-Juliet Nelson, PhD

With so many struggling amidst the pandemic and current climate, there has never been a better time to apply for DBT-LBC certification. Clinicians deserve to be acknowledged for the hard work of delivering DBT and certification through DBT-LBC will do just that. It will provide confidence to the consumers.  Certification will be an indication, for those who are researching their treatment options, that they will find in you a professional who meets high national standards. In an effort to continue encouraging clinicians to achieve the highest level of DBT, DBT-Linehan Board of Certification is pleased to reinforce attendance at ISITDBT by offering financial incentives for individuals or programs who also apply now for certification.

DBT-LBC Clinician Certification Discount – Free Video Coding!

DBT-Linehan Board of Certification will waive the video coding fee for all ISITDBT attendees who complete their application and pay the initial application fee between October 1, 2021 and January 31, 2022. The 32% discount ($270) will be applied when the applicant successfully passes the DBT-LBC Knowledge Exam and submits videotaped individual sessions for review. Applicants who complete the steps and submit videotapes for review by December 31, 2022 will be awarded the discount.

DBT-LBC Program Certification Discount – Save over 50%!

DBT-LBC Certified Team Leads who attend ISITDBT, complete the DBT-LBC application and pay the application fee for Program Certification will receive a 51% discount! The 51% discount, or $2000 will be applied/waived for the site review portion of Program Certification. Site reviews are currently being done virtually. All programs completing their applications between October 1, 2021 and January 31, 2022 will receive the discount. Programs have until December 31, 2022 after applying to complete the process and receive the discount.

As a reminder – you can find more information about DBT-LBC certification here: http://dbt-lbc.org.  While we partner with other organizations who also support certification, we receive no financial benefit from ISITDBT or any other DBT training organization. We have always relied on donations, in addition to fees, to support the work we do. Please consider donating to help us reach more clinicians and provide comprehensive DBT to every community. You can donate at the link provided above, or via our new GoFundMe campaign: https://charity.gofundme.com/o/en/campaign/help-prevent-suicide-a-growing-crisis-support-dbt-lbc2

Click here to register

DBT-LBC has the honor of promoting a tremendous learning opportunity that is not to be missed! Dr. David Jobes, Ph.D., ABPP, David A. Jobes, PH.D., ABPP - Creator of CAMS | About CAMS-care is a renowned clinician, professor, suicidologist and the creator of the evidence-based treatment Collaborative Assessment and Management of Suicidality. 

Dr. Jobes has partnered with the DBT-Linehan Board of Certification (DBT-LBC) to livestream this timely and critical presentation "A Crash Course on Suicide Prevention.” His presentation will air on September 10th, 2021 from 12-1pm Eastern Standard Time - World Suicide Prevention Day. Let’s all come together and bring our attention and awareness where it truly counts.   

Suicidal behavior remains a significant public health problem in the United States. With 47,511 suicides in 2019, suicide is currently the 10th leading cause of death among all ages and the second leading cause of death among those 10-34 years old in the U.S. In addition to those who die by suicide and the estimated 1.4 million adults who attempt suicide, another 12 million American adults have serious thoughts of suicide (2019 SAMHSA survey data). Suicidal behavior and ideation are treatable, as a number of evidence-based interventions and policies have been developed to help prevent suicide.

Dr. Jobes, from his unique vantage point of involvement in suicide prevention efforts worldwide, will provide a crash course on contemporary suicide prevention, as well as recent innovations in suicide-specific clinical care.

Learning Objectives | By the conclusion of this event, participants will be able to:

1. List two approaches in suicide risk assessment
2. List two innovative approaches to suicide-focused care
3. List two emerging trends in suicide-related policies
4. List two features of a Stepped-Care approach to suicide risk reduction

Instructor | David Jobes, PhD ABPP is Professor of Psychology at The Catholic University of America where he directs the Suicide Prevention Laboratory. An internationally recognized suicidologist, he has received numerous awards for his contribution to suicide research and treatment and he is the treatment developer of the Collaborative Assessment and Management of Suicidality (CAMS). Dr. Jobes has numerous peer-reviewed publications as well as six books. Dr. Jobes is a past President of the American Association of Suicidology (AAS) and was a recipient of that organization’s 1995 “Shneidman Award," the 2012 AAS “Dublin Award” (career contributions), and the 2015 AAS “Linehan Award” (for groundbreaking clinical research). Dr. Jobes has served as a research consultant to the Centers for Disease Control and Prevention, the Institute of Medicine of the National Academy of Sciences, the National Institute of Mental Health, the FBI, the National Security Agency, the Department of Defense, and the Department of Veterans Affairs. Dr. Jobes is a on the Board of Directors of the American Foundation for Suicide Prevention (AFSP) and also serves on AFSP's Scientific Council and the Public Policy Council. Board Certified in clinical psychology (American Board of Professional Psychology), Dr. Jobes is also a Fellow of the American Psychological Association.

Our Intention.  100% of your registration cost ($30) will be directed to support DBT-LBC, a non-profit and mostly volunteer agency, whose members tirelessly work to educate, promote awareness of standardized DBT treatment for suicide, and increase affordability and availability of standardized DBT, including trying to make inroads at the state legislative level. DBT-LBC also provides scholarships to clinicians, agencies and programs needing help with certification costs.  

There are decades of research demonstrating DBT as a gold standard treatment for those struggling with chronic suicidal thoughts, feelings and behaviors for all ages. Still, affordable and standardized DBT is hard to find. The sad reality is that there are not enough therapists providing comprehensive and standardized DBT. The overarching aim of the DBT-Linehan Board of Certification is to provide to the public at large and to relevant stakeholders a source that clearly identifies providers and programs that reliably offer DBT in a way that conforms to the evidence-based research.  

CEUs. This event is being co-sponsored by Portland DBT Institute, who will issue the CEs from NBCC.  Participants will earn 1 CE for attending this presentation.  

So Much Has Changed all While So Much Has Remained the Same: Living in a World of Dialectics

I hope you all are doing well amidst the ongoing challenges that we all continue to face. It is hard to believe that a year has come and gone and so much has changed while so much as remained the same. Despite the challenges that continue to get put in front of us, a few things remain the same, 1) clinician dedication to delivering DBT as supported by the research and 2) DBT-LBC volunteers’ dedication to the organization and overall efforts to the certification process.

We have several areas that we are currently working on within DBT-LBC in an effort to continue to provide and enhance a value-added service to the DBT community. This would not be possible without the work and dedication of the volunteers that are behind the scenes working with us to improve and grow as an organization.  THANK YOU!

Be on the lookout for announcements on these new developments via email and social media. If you have not already followed us on social media, please do as you will find some new and exciting content each and every week.

DBT- Linehan Board of Certification | Facebook

DBT-LBC (@dbt_lbc) • Instagram photos and videos

In addition to the volunteers, I want to also give a shout out to the clinicians and programs that we are honored to get to know through the program certification process. The feedback that we hear about when we do site visits for program certification never ceases to amaze me. Clinician interviews and client/parent interviews alike often share sentiments of compassion, non-judgmental environments, and the desire to provide the treatment that the client needs but most importantly the treatment that they deserve. On multiple occasions, we have heard clients say “DBT has saved my life”, “I would not be here to share my experience without DBT”. The Program Certification process is rigorous AND rewarding. It is a time to tighten up areas that will make your team stronger AND a time to shine and showcase all of the work that your team puts in day in and day out. We applaud your efforts and the efforts of everyone else that have started the certification process during these everchanging times. 

We are here to answer any questions that you may have about the process. We are always looking for new volunteers, so if you or someone you know would like to volunteer with DBT-LBC we would love to hear from you.  

I will leave you with a mantra that I try and live by (try is highlighted here 😊), “If you can control it, why stress about it and if you cannot control it, why stress about it”.

With Love to All,

Dr. Kimberly Vay

President, DBT-Linehan Board of Certification

Using DBT Skills not with my BPD Person

Sometimes things don’t go as we planned.  Often, actually. At those times, it’s good to have resilience. Skills are helpful too.

When I sat in front of Marsha and learned DBT, I thought I was doing it for my child. I never thought I would be using the skills for me, to survive a pandemic. (Really; who would have gone to see that movie? The plot is so - unimaginable.)

Distress Tolerance is not something I would have thought of as a ‘skill’ in those days. Initially the concept of Distress Tolerance was really foreign to me. If life is unfair, why would I tolerate it? Of course, life is often unfair. I’ve wasted a lot of mine complaining about this unfairness, instead of using my energy to do something about it. (It may not be entirely by accident that I became a lawyer.) The idea that I would reduce my suffering by radically accepting reality was something I really had to work at, initially. Well, to be honest, I’m still working at it. But now I know why I need to work at it, and how it will help me to be more effective.

I’ve wasted a lot of my time worrying about my child. Now I realize that I can’t change her. I can’t change what happens to her. Having accepted that reality, I have freed up space in myself to solve MY problems. Ironically, that has made me a more effective mother. I realize that I have a lot of strengths that I developed in parenting her. I learned a lot about human interaction, and that has helped me in all of my endeavors and all of my relationships.

I have been practicing law for 45 years. No client comes to a lawyer without a problem. It may be a hopeful problem, like buying a family home. But often it has to do with something the client perceives to be unpleasant, or distasteful, or infuriating. I wish I had a nickel for every client who has spoken to me about needing a will, and not followed up to write it. I really wish I had a nickel for each one of my friends and colleagues whose child turns 18, and to whom I’ve said, “A wonderful birthday present for your child would be to send her to me and I’ll prepare a health care proxy for her.”  I get it. People don’t want to think about their own death (talk about where we need radical acceptance!) They certainly don’t want to talk about the death of a child in his 20s or 30s, who thinks death is for old people. I do get it. And I also sat with parents of young people who died on 9/11, trying to help them figure out how to gain access to the apartment of a grown child, or insurance proceeds, without a death certificate, when they had no body and couldn’t prove death.

Radical Acceptance, and all the Distress Tolerance skills, often come in handy when you are a lawyer.

Learning to really listen, by developing a mindfulness practice, has also made an enormous difference. I’ve had clients say to me, “Writing my will was a lot easier than I thought it would be; you made it so easy.” I’ve had clients call me screaming complaints, and when they stop to take a breath, I’ve asked, “What is it you would like me to do to help you?” Then they stop screaming, because they don’t know the answer to my question! They were just angry - oftentimes for perfectly valid reasons. So I validate them. Then the smart ones start to think, and we can begin to collaboratively problem solve.

Problem solving when you are a lawyer is always collaborative; I can’t make my clients take the action I suggest. The client has the final decision. Sometimes the client chooses an option I think is by no means optimal. No matter; it’s not my call. But again: learning Distress Tolerance Skills has been enormously helpful to me. All of the DBT Skills have been enormously helpful. As I have said to my child, I wish I could take away her illness. (No, I have not radically accepted her diagnosis.) But I am enormously grateful that, as a result of her illness, I have learned - and continue to learn - DBT Skills. And I am by no means the only family member who feels that way. So thanks to all of you who teach us those Skills.

As DBT practitioners, we know the research on the effectiveness of DBT outcomes. Delivered to fidelity, DBT treatment remains the number one evidence-based intervention for treating Borderline Personality Disorder symptoms. Still, what about those clients that don’t show improvement with the comprehensive model?

An observational study  (Salamin, Virginie & Kratzel, Armin & Gothuey, Isabelle & Guenot, Florence. (2021). Compliant patients with borderline personality disorder non-responsive to one-year dialectical behavior therapy: Outcomes of a second year. Journal of Behavioral and Cognitive Therapy. 31. 10.1016/j.jbct.2021.01.001.) followed 55 clients enrolled in a comprehensive one year DBT program. A review of clinical progress at the 12-month mark found that 43 participants showed clinical improvement, while 12 did not. While at the study’s onset clients symptoms had no significant clinical differences, the pace of improvement for those who did respond was consistent and substantial. Those 12 non-responders were then followed through another year of DBT treatment. At the 18-month mark, those clients began showing clinical improvements as well. This progress also largely matched the improved functioning noted in the initial responding treatment group.

What might this mean for day-to-day clinical practice? Certainly, more studies are needed to examine controlling variables. Still, we can use this data to inform our thinking while working with those clients who continue to struggle with progress at the one-year mark. Perhaps proposing an additional round of skills training can be framed as a standard treatment option. As DBT clinicians, how might you consider using this information? Please let us know your thoughts via email at [email protected].

Hello, DBT Friends 

IS your DBT program considering certification? If so, you may be eligible for the 

Michael Chambers Memorial SCHOLARSHIP worth $2000! 

The DBT-Linehan Board of Certification is pleased to report that there are currently 24 DBT-LBC Certified programs across 14 states: California, Florida, Georgia, Illinois, Maryland, Michigan, Minnesota, Missouri, New Mexico, New York, Oregon, Tennessee, Washington and Wisconsin. Additional programs from states already mentioned and including: Canada, Kansas and North Carolina are still in process. 10 programs have been awarded the $2000 Michael Chambers Memorial program certification scholarship which is applied to cover the entire cost of the, now virtual, site visit. 

There are still scholarship funds available for qualifying programs. 

We are excited to see a broadening geographical representation of quality programs that will make comprehensive DBT more accessible, and invite more programs to begin the DBT-LBC Program Certification. 

https://dbt-lbc.org/../index.php?page=101170

I was in the thick of learning about DBT when I worked as an outpatient professional counselor at the Center for Child and Family Traumatic Stress (CCFTS) at Kennedy Krieger Institute, located in Baltimore City. I was lucky to have attended a Foundational DBT training provided by Adam Payne, PhD and Francheska Perepletchikova, PhD through BTECH. As the training wrapped up, we discussed certification and the process. After a week of intense learning, certification seemed like another Mount Everest. I was interested in becoming a more effective DBT therapist but didn’t know if certification was the right path for me.

Fast forward some years, and the world turned upside down due to COVID-19. Given the newfound stay-at-home orders, I devoted a portion of my day to studying (now that I had so much home-based time on my hands). I re-read the recommended materials, reviewed copious notes and handouts, and watched every video I could about DBT. I listened to lectures from the giants in the DBT field, mainly when I was driving or running errands. I lived, breathed, and ate DBT. All of this, by the way, was during quarantine and managing the stress that comes with living during a pandemic. So, my family and I found a way to cope.

My fiancé and I brought home a husky puppy, Chilli, to join her big husky brother, Beric. Raising a puppy seemed like a great idea given how much available time we were forced to spend at home. Word to the Wisemind: Husky puppies will eat everything in sight. This includes the book jacket of Dr. Linehan’s 1993 text you might have left unguarded in your living room.

So after experiencing the timeless excuse, “my dog ate my (DBT) homework,” I started to notice some changes in myself. First, I practiced mindfulness more regularly and in varied ways. For example, I mindfully cut the grass observing my emotions, thoughts, reactions… I never did that before. Next, I found myself self-validating how hard I was working to study, balance (virtual) work, relationships, and stay afloat during a pandemic. I was paying attention to my sleep, appetite, and exercise a bit more intently, to make me less vulnerable to Emotion Mind. When I was stuck in traffic, I found myself observing the option to curse the world and stress out, or I could radically accept the drive.

One day, Chilli (the most adorable blue-eyed, red, and white husky puppy – I’m aware of my bias and positive judgements) decided to dig for buried treasure in our backyard and it hit me. I said aloud, “She is both an adorable puppy and a hellion.” I was thinking dialectically… about my dog. It happened on autopilot. Studying for the Knowledge-based exam and the video recorded sessions had finally done its job: I was overlearning DBT Skills and principles. I was applying them to man’s best friend. I was no longer simply book-learning but living the book-learning.

The certification process acted as a sort of DBT infusion for my life. The vast DBT training resources were not only for scientific purposes, but artistic. I realized that DBT core concepts functioned as artistic materials to be used on the canvas of acceptance and change. This Eureka! moment did not just apply to my clinical work, but my personal life. I came to a place where I could creatively think about life’s problems and triumphs from a dialectical perspective.

Certification is more than a bright blue emblem after your email signature. It is a symbol that represents a community of therapists working to help a community of clients. A symbol of a clinician who recognizes that DBT is both a science and an art form. And lastly, a symbol of a clinician who understands DBT’s applications both during the therapeutic hour and during the hours of one’s personal life.

I am indebted to my family, friends, and colleagues who supported my journey toward certification. Joan Kaufman, PhD, the director of research at CCFTS, is a major champion of clinical excellence whose cheerleading I will always value. My clinical supervisor, Alyne Hall, LCSW-C, for continuously challenging and supporting my growth as a DBT therapist. And finally to my business partner and friend, Gloria Seo, LCSW-C, for her support and nonjudgmental stance, especially in regards to my study flash cards. Somehow as the certification process ended, I got the sense that another process began: a commitment to living what I’ve learned.

6/24/21 Inner Solutions Ltd.-Team Leader-Jessica Heil

 Hello all and Happy Spring,

I want to take a moment to wish our treatment developer and distinguished leader, Dr. Marsha Linehan a Happy Belated Birthday (May 5^th). She has been an inspiration to so many and has provided hope to those suffering the most. Marsha, Happy Birthday and THANK YOU!  If you haven’t already visited our social media, head over to either our Facebook page or Instagram and leave her a message, as we know she will be grateful to hear from all of us. The links to the post are below:

Facebook post -https://www.facebook.com/DBTLBC/photos/a.1171334149931228/1296553867409255/

Instagram post

https://www.instagram.com/p/COf9W8KjIDJ/

This past year has provided challenges that none of us could have ever imagined or planned for. As challenging as it has been and may continue to be, this is also an opportunity to practice our own DBT skills and recognize more than ever the challenge that our clients have in staying present and mindful. It is so easy to go down the rabbit hole of “What If” thoughts, that then paralyze us with fear, and thus cause us to lose sight of those things that we do have control of. Connection is so important in challenging times and times of uncertainty as DBT clinicians we hold worries that many would never be able to fully comprehend.  We all find connections in different areas of our life and for me, this past year has allowed me the opportunity to find even closer connections within DBT-LBC and connections that not only support and validate me but also challenge me to do better, both inside and outside the therapy office.

We continue to make improvements to the certification process and have updated our Applicant Handbook. It is available for download and provides the answers to your questions about the certification process. If you have any additional questions, please don’t hesitate to reach out to us at [email protected].

May is Borderline Personality Disorder (BPD) Awareness Month and DBT-LBC remains committed to providing support to the community and clinicians to ensure that we all have the resources needed to provide such vital treatment to those who are suffering.  DBT-LBC depends on the expertise and dedication of volunteers. Our volunteers are the pillars to the organization. If you would like to volunteer with us, we would love to chat with you.

Individually, we are one drop. Together, we are an ocean. Ryunosuke Akutagawa

With Love to All,

Dr. Kimberly Vay

President, DBT-Linehan Board of Certification

"Using My DBT Skills in New Places"

We adopted our dog from the New Skete Monastery, which is renowned for breeding its German Shepherds. And we receive their monthly newsletter via email, which I read today. In it, Brother Christopher, the Prior and head dog trainer, says at one point, “Reality is a relentless instructor.”

Certainly reality affords the opportunity for learning. The pandemic is perhaps the all- time best ever opportunity for all of us to practice radical acceptance. There is nothing we can do about it; it’s here, it’s going to stay here until it goes away (if ever). So we need to accept it and then adapt to it. Period. Move on.

The best way to learn, of course, is to have the skills to learn with. Brother Christopher knows this; he teaches dog training, and he has been training dogs for years. (He has a lot in common with Marsha.) Each dog - and each trainer - has a different temperament. some approaches will come easily to the pair, and some will require more effort, and more practice, or even a different approach. Just like learning and applying DBT skills.

When he teaches dog owners how to work with their dogs, he teaches us skills that are very similar to many of the DBT skills. Starting with the basics, he teaches us to work on our relationship with our dog, just as DBT teaches us to use our relationship mindfulness skills. It’s a bit different, since I have much affection for my dog, but I must be the “Alpha” in the pack. Much of our work with our dogs depends upon trust, so there’s a lot of - guess what? - validation!!! How I validate my dog when she has learned a new skill, or when she does something I want her to do, is different from how I validate my daughter; I don’t give my daughter a treat, or play ball with her. But I might cook her favorite meal, or spend time with her engaging in an activity that she enjoys: that’s how I validate her. And the result is (we hope) similar: my dog trusts me. I know this because when I walk around the house, even when she is lying in the doorway, she doesn’t move; she knows I won’t step on her. (My daughter doesn’t always remember that.)

When my dog starts to do something that I judge to be dangerous, I will correct her with a quick and emphatic “No!”, or a short tug on her leash. Would that it were so easy with my child! Both my dog and my daughter sometimes act as if what they want to do is more important than what I think, notwithstanding my concern about their safety (or anything else). It takes a lot more time to talk to my daughter, doing a DEAR MAN: describing what is going on, expressing how I feel, making my ask, and (hopefully) finding something that will reinforce her willingness to do what I’m asking, all with a proper tone and manner. When she was younger, this was a challenge. Now that she is an adult, and supports herself, I do the best that I can, knowing that I have very little leverage, other than the value of our relationship to her. Unlike with my dog, whose affection never wains, that value fluctuates for my daughter, depending upon whether I am aligned with the forces of darkness or the forces of light. So I have learned to do my best DEAR MAN, and then prepare to radically accept the outcome of my request, whatever it is. I try to remember to self-validate, if I’ve expressed myself accurately and

with caring. And then I try to let it go and live my life, which I believe is worth living. I might even take my dog out for a walk; she loves that. I watch her sniff everything, and play with other dogs, and watch children come up to pet her and enjoy their delight when she unexpectedly licks their cheeks.

No wonder Marsha had us read Edna Foa’s book, Don’t Shoot the Dog, before she started our DBT training. Now, I get it. Those DBT skills sure come in handy.

Anyone else curious how we are evolving as DBT clinicians practicing telehealth? Overall, online sessions presented their own dialectic, with therapists both lauding its ability to reach clients as never before, as well as lamenting the difficulty of a virtual therapy setting. Transitioning to virtual platforms has required quick thinking, additional expense, and an ever-present focus on principals over protocols. In honor of BPD awareness month, we would like to highlight the most recent experiences of DBT clinicians practicing via telehealth. We will review both the collective concerns voiced by DBT clinicians , as well as shared and new suggestions for a telehealth platform. Our frame for this will be the modes of DBT. As always , we welcome comments for further discussions!

Our communications committee would like to thank the authors of the following papers for their comprehensive assessment of DBT treatment provided via telehealth. First , an article was reviewed authored by K.A. Hyland, J.B. McDonald, C.L. Verzijl, D.C. Faraci, P.F. Calixte-Civil, C.M. Gorey, E. Verona, U. of South Florida, Telehealth for Dialectical Behavioral Therapy: A Commentary on the Experience of a Rapid Transition to Virtual Delivery of DBT, Cognitive and Behavioral Practice (2021). Additionally, we read the piece by M. Zalewski, C.J. Walton, S.L. Rizvi, A.W. White, C. Gamache Martin, J.R. O'Brien, L. Dimeff, Lessons Learned Conducting Dialectical Behavior Therapy via Telehealth in the Age of COVID-19, Cognitive and Behavioral Practice (2021).

Individual therapy sessions
Most providers were concerned about establishing a rapport with a new client, especially one they had never met in person! DBT explicitly relies on the strength of the therapeutic relationship to keep a client alive. Could this be done via telehealth? Risk assessments also felt risky over a video session, as without physically knowing a client’s location , where could a first responder be sent if needed? Confidentiality of sessions was another built in concern with telehealth. Where were our clients sitting, and who else might be in the room? And how do we define virtual therapy interfering behaviors? Therapists reported that client TIB’s seemed much more “ at the ready”, with clients either switching off their cameras or even abruptly ending a video call in the face of strong emotion. Younger clients proved especially distracted by their immediate environment. It also proved tricky to re-engage a client that left or retreated from a session, with clients easily choosing to not respond to outreach. Observing emotion focused content proved difficult at times, as in session non verbals and shifts in expression translated poorly over a computer screen. This proved especially challenging when addressing extreme dysregulation or client dissociation. Lastly, therapists shared that collecting written assignments was difficult at times, as handing a client a blank diary card was not quite as straightforward on a screen as it had been in an office setting .

Suggestions
Structural
Building in a specific telehealth orientation early in the treatment can help with technology issues, as well as help establish a shared willingness to troubleshoot connection issues. This also could establish the “ new normal” of virtual therapy sessions. To address potential risk assessment issues, consider adding a routine location check at the start of each session each session. A written “ In Case Of Emergency “ form can also be required that is specific to telehealth concerns. Help a client define confidential space to meet for sessions , such as a car, a closed room , and consider asking clients to purchase headphones to add privacy to a session. This also reflects a therapist’s willingness to help and take a client seriously. Sharing the importance of client input on structural concerns also helps build rapport, and often teaches the therapist tricks of navigating online platforms! Following established DBT agendas includes asking for diary cards, which some clinicians now request prior to the sessions start . This reflects interest , expectations, and a therapist’s commitment to client goals. Some therapists advise working in the physical office, allowing better access to materials, as well as helping draw a line between the workday and life at home .

Clinical
Suicide risk is approached “in the same way as always” ( M. Zalewski, et. al ) , supporting the use of existing risk management strategies within the DBT protocol (e.g., tracking urges for suicide, use of crisis survival skills). After all, DBT therapists have been doing risk assessments via skills coaching contacts since learning the treatment. For example, if a client reports engaging in self-harm behavior over the previous week, a clinician may request to see the site of injury on the screen, as they would in person. An early and ongoing orientation to the energy and increased expressiveness required during a telehealth session might also help with session content. Validating a clients’ experience on a video screen requires lots of demonstrative gestures and deliberate facial expressions from the therapist. Also, both individual and group session norms can be openly discussed, with an evolving definition of what appearing engaged looks and sounds like to both the therapist and client.
Consider sharing the data that suggests that some clients experience disclosing information easier in telehealth sessions. Lastly, use self-involving self-disclosure that includes the frustration of virtual sessions! This can go a long way towards building rapport with a client who also struggles with the technology and format.

DBT Skills Groups

Structural and clinical concerns with group skills telehealth loomed large, with group facilitators naming several technological and clinical challenges. Clients calling in from smart phones often were unable to see all group members, and handouts proved difficult to see on a small screen. Internet connection quality was variable across each client’s connection, leading to visual and audible delays that were distracting. Opportunities to chat with co facilitators and group peers prior to groups and during session breaks dropped off sharply. Clients often signed into group late, disrupting session flow, kept cameras off, or simply “ hung up” during skills training sessions. Background distractions were plentiful, including pets, siblings, children, and package deliveries. Concern for confidentiality spiked as well with telehealth groups, as clients often called in from home with peers off camera in the same room, from the passenger side of a car, or from a college dormitory common area.

Suggestions
Structural
Open discussion of the pros and cons of signing on to group via a smart phone versus a larger screen could be built into a telehealth group orientation. Discussing options for internet access that included ethernet connection, or a stronger Wi-Fi signal at a local library or isolated corner of a facility could improve connectivity. Establishing group norms, such as arriving on time, removal of distractions such as cell phones, and avoiding side conversations verbally or via the chat box could reduce potential interfering behaviors. Make sure to use the waiting room feature , so late comers do not sporadically interrupt an ongoing session. Also, be sure to include telehealth tools to keep clients engaged, such a white board, video clips, emoji “ reactions”, quiz features, or power point presentations heavy on graphics.

Clinical
Like in individual sessions, a concrete orientation to what effective skills group participation looks like can be included at a client’s introduction to the group. Have a reference sheet for the online platform in use that shows clients where the emojis are, how to mute themselves when observing, and the fastest way to answer quiz questions. Orient repeatedly to the rules about silencing cell phones and side conversations. Mindfulness exercises focusing on the Participate skill may also help focus group clients at the start of session, as well as increase engagement with members. Some group facilitators have reached out and asked clients to turn in homework ahead of group, allowing a quick review ahead of time. This allows a bit more time for creative engagement during the review section of group. Directly asking clients to volunteer their thoughts versus waiting for a response can also contribute to an interactive group culture. To mimic the opportunity for casual chat, clients can be given the option to join sessions early, as well as “ hang around” during the group break. Lastly, therapists need to anchor themselves to the skills manual’s structure for group leaders and co leaders, with an emphasis on a co-leader spending additional time on helping clients join and remain in group the entire session.
Skills coaching contacts.

Here it seems that DBT providers have the edge on other treatments, as clinicians have extended themselves beyond individual and group sessions since the inception of DBT. As providers, we draw on a wealth of experience at risk management over a telephone, skills coaching via messaging apps, and generalizing skill practice via voice, video, or text. Some might say in this area, DBT clinicians are conducting business as usual! For future thought, perhaps a survey of ways clinicians may or may not use smart phone apps for coaching calls could be up for consideration.

Consultation Team
What is DBT treatment without a weekly consultation team? Moving the team meetings online was a necessary transition, and there were similar themes across all telehealth sessions. Naturally , technology issues presented themselves in Consultation Team. Physical and emotional isolation was cited as a primary source of burn out, as “ chatting in the break room” was no longer an option. “Doing the best we can” with online Consultation meetings translated into tending to children at home, keeping the family pets quiet, and distraction from other devices while in team. Some consultation teams ended up meeting less often due to conflicts, which unfortunately, took time away from therapy for the therapists.

Suggestions
Structural
How many of us struggled to open a client attachment, share our screens, or give a “ thumbs up” at the onset of telehealth practice? Use part of consultation team to troubleshoot technical issues and teach team members how to use features of online platforms. This can help decrease provider anxiety and avoid technology burn out. Also, consulting with veterans of telehealth can provide expert translation in a foreign land, which also might provide therapists a common connection and opportunity to commiserate as needed!

Clinical
Try and find time to connect with team members, even for five minutes following a team meeting. Sending the occasional funny text, email, or meme to each other can go a long way in tending to relationship. Also, remind yourselves that having weekly consult meetings is highest on the priority list for each therapist. Consider reviewing Team culture in this new online format, using textbooks or articles that discuss issues around DBT Teams, telehealth in general, or online burn out. Consider creating an additional task for the Observer in Consult Team that highlights specific online areas of drift. Work to establish a virtual culture that sets aside cell phones, closes tabs on browsers, and shuts the door on curious pets. As always, team roles should lean heavy on nonjudgmental stances, and a reminder of the fallibility agreement might lighten what is heavy!

Effectively practicing DBT takes determination. Adding in the requirement of telehealth sessions cast a complicated light on an already complex treatment. We would love to hear responses from our members on what has specifically helped you and your team make the transition, as well as any additional ideas on expert practice via an online platform. Please send your experience to [email protected]. We look forward to further discussions!

DBT was not on my radar until after I was out of grad school. I’m not even sure it was covered in any of my graduate classes, and if it was, it was brief. However, I was fortunate enough to land my internship at New Hanover County’s Behavioral Health hospital where my then, supervisor and now longtime friend and DBT mentor, Jane St. John was running a DBT partial hospital. Immediately this style of therapy made sense to me. Help our patients change their behaviors while also helping them accept who they are, and the way things are. All while validating them. There was also this convergence of everything I learned about in grad school all bundled into one therapy modality: Freud’s theories of how history effects our patients today, Rogers unconditional positive regard for our patients, Skinner’s behavioral change theories, Ellis’s irreverence and focus on current behaviors. We have a running joke in our office that DBT is if Skinner and Rogers had a child and Ellis was the uncle that would come over and baby sit from time to time. During my internship, I was also fortunate enough to have Jane encourage me to go to a weeklong training with Dr. Linehan in 2004 at the New England Education Institute.

After internship I took an adjunct teaching position for a year or two, then received a card in the mail from Jane one day that she left the hospital and started her own practice. She was wanting to offer DBT to the greater Wilmington community (I was in!!!). I joined Jane’s practice, Delta Behavioral Health in Wilmington, NC. I helped her with traditional weekly skills groups and helped her start up a DBT outpatient partial hospital program, and then later, an Intensive Outpatient program. Jane and I ran groups, saw individual clients, and started taking on interns to train in DBT. Delta has since grown from the 2 of us to about 10 DBT clinicians working in all these settings: outpatient (traditional DBT), weekly skills groups, helping run the PH and IOP programs & DBT-PE. Numerous interns that have also gone on to PhD programs, other sites, etc. I’ve noticed over the years that DBT has not only helped the patients that come through our clinic, but it has changed my life through using the skills myself. One of the biggest compliments I think I’ve ever received from a mentor was when Jane said to me one day, “the reason you do well with DBT is that you live the skills.” As per many of us have probably thought at some point in our DBT journey, “If I would have only known these skills when I was younger!!!”

As any diligent researcher and aspiring academic, I wanted to know if the DBT in PH and IOP we were doing was actually helping. So, after multiple DEAR MANs and Jane’s approval, I started collecting data on out of the PH and then later the IOP program. At this time only 1 person had published anything on DBT in either of these settings (they will show up later in this story). Me, Jane and others that have come through Delta also started attending ABCT and ISITDBT on a regular basis to present our research as well as enhance our DBT by learning from the best. I also found out at this time that I am more of a DBT nerd than I ever thought I would be. I remember a number of times at conferences with some of my fellow Delta clinicians (who’s names I will not mention to protect their nerdom confidentiality) conferences being like “that’s Melanie Harned, or Alan Fruzzetti, or I rode in the elevator with Marsha Linehan!!!”

Fast forward 10 years of doing DBT, collectively as a team we did the 10-day B-Tech intensive in 2014 with Dr. DuBose and Dr. Ritschel (guess who was the first to publish on DBT in IOP!!!). During this training is when DBT certification was first mentioned. I think that year they were rolling out certification for the B-Tech trainers. Since most of my DBT experience was in a PH program I was always a little reluctant and unsure if I was “doing real DBT”. Yes, I had a case load of individual clients that I did DBT with; did diary cards, chain analysis, coaching phone, consultation team, ran weekly DBT groups, read every DBT book I could find, but in the back of my mind I was asking myself, “are you REALLY doing it right?”. So, what better way to answer that question then to consult the experts. In 2017, I attended another DBT training with Dr. Ritschel and at lunch full of self-doubt I was asking her questions about certification. And like any good DBT clinician she suggested opposite action and to apply, while also being very validating. So, I did and completed my certification last fall.

DBT certification not only assures me that I am offering effective DBT, but it allows patients that come through our clinic to know they are getting adherent DBT as well. This has also motivated other clinicians in our office to consider getting certified and a couple of them have already started the process. While it does take a lot of work to achieve this certification, it is one that allows you and your patients to know they are getting DBT the way Dr. Linehan intended it. I have had countless patients come in for intakes and tell me they’ve “done DBT before” only to find out someone handed them some skills handouts and most of the other parts of DBT were missing. I wanted to make sure that what I was doing was in line with Dr. Linehan’s vision.

Congratulations to Dr. Sylvia Davidson for being elected to the DBT-LBC Board of Directors!

At the May Board Meeting of the DBT-Linehan Board of Certification, the board elected 1 new member to serve on the board as At-Large Board Members. Welcome aboard Dr. Davidson!

Hello all, 

Welcome to 2021! I would like to take this opportunity to express to each and every one of you my gratitude and thanks to each of you that remain at the heart of DBT-LBC. I would like to share some updates and acknowledgments with you as we launch into 2021.

First, I want to take a moment to recognize Dr. Joan Russo. As you will read in a later piece honoring Joan, her dedication to DBT and DBT-LBC is something that cannot be measured with a simple “Thank You” or any words for that matter. Joan has been one of the key players in this organization and while she is going to be missed in more ways than we can count, we are so excited for her new journey where she can finally enjoy retirement and travel the world with her beloved husband. We are also thankful for cell phones and zoom video calls that will allow us to continue to stay connected and send her that dreaded text, “Joan, we have a question”. We will not only forever appreciate your work and dedication, but we will do everything to continue this much needed work in a way that will surpass your expectations. Joan, your work and dedication to the field of DBT will be forever appreciated. Thank you! 

In other exciting news, we elected 2 new members to the Board of Directors. We would like to introduce and welcome Dr. Alec Miller and Dr. Alan Fruzzetti. We are so excited to have them both join our board and cannot wait for them to share their wisdom, knowledge, and expertise with us so that we can continue to work to improve. One of my favorite quotes is “Success is a Journey, not a Destination” and we are on a constant journey to continue to keep Marsha’s legacy alive. We welcome all of you on this journey and look forward to what the future holds. 

Despite the challenges that we, along with everyone else, faced during the pandemic and the unprecedented times it provided, we are emerging as we are moving through 2021. As we have mentioned in the past the testing sites were closed for some time which halted the process as applicants could not take the exam. The testing sites have since opened and the process is flowing again. While we resurface from the depths of this pandemic, our nation remains in a mental health crisis and now, more than ever, our clients need to know that they are receiving the treatment as it was intended to be delivered. Remember, we are all fallible! The challenges of life have not skipped over us and going through the process will provide us, as clinicians, a level of support and comfort that we are remaining adherent to the treatment. Many of you took advantage of the discount offered at ISITDBT this year, but if you missed it, I encourage you to take advantage of the scholarships we have available for both clinicians and programs.

Finally, I would be remised to not recognize the nearly 100 volunteers that we have working day in and day out in all areas of the organization. We are actively working to improve and expand our social media presence and legislative efforts to enhance the value of certification through communication with insurance providers, state agencies, and legislators. So, to each and every volunteer, Thank You. Thank You for your time, your energy, and your dedication. Thank you to each and every one of you that have and continue to dedicate your time to supporting DBT-LBC in every capacity no matter how large or small it is all appreciated and greatly needed.  If you are interested or know someone that is interested in volunteering with us, we ask that you please reach out we would love to chat with you! 

In honor of Black History Month, I will leave you with a quote that made me think of Marsha the moment I read it…

 “Every great dream begins with a dreamer. Always remember, you have within you the strength, the patience, and the passion to reach for the stars to change the world.” —Harriet Tubman

The world is in need of dreamers who do. We within DBT-LBC will continue to dream even bigger and do even more and this is what allows us to tackle our nation’s current mental health crisis without hesitation. 

With love to all,

Dr. Kimberly Vay

President, DBT-Linehan Board of Certification®

DBT for Congress

Having lived for many years in a family with a member who has BPD, as I watched our Congress this past year, I kept thinking that teaching Congress members DBT Skills would result in enormous benefits to our country. After the attack on the Capitol a few weeks ago, frightening and sad as it was, I am convinced of this. Think about it:

Begin by setting goals for the Congressional Session:
How can we have a country worth living in? (Hint: not by getting rid of all members of the other party, although if that’s what you believe, we can talk about it.)

Do we still believe that ‘all men are created equal’? Do we mean all ‘people’ are created equal? Who are ‘all people’? What is involved in ‘the pursuit of happiness’? Do we recognize where these words come from?

How can we address lawmaking-interfering behaviors? By initiating new rules in the Senate and the House? What would those rules be? How would we enforce those rules? What would it take to get buy-in for the new rules?

Start with the most benign interpretation:
How would things change if Nancy Pelosi and Mitch McConnell assumed that ‘everyone is doing the best that he can’ and ‘everyone could do better’? (Some members of Congress might need more skills coaching than others.)

It would be particularly helpful for members of Congress to understand the concept of dialectics, and the underlying assumption that reality is not static. As we saw this last Wednesday, life can change on a dime, and ignoring that reality allows us to dig in to positions that may not serve us, and certainly don’t serve our country.

Each session of Congress would begin with a short mindfulness practice. This would be essential because, as Dr. Linehan says in her DBT Skills Training Manual, on page 4, “(l)earning behavioral skills is particularly hard when a person’s immediate environment or larger culture do not support such learning.” Enough said.

Ideally, of course, potential members of Congress would be taught DBT Skills before elections. Then we could assess their adherence to the DBT Protocol of Lawmaking, and only allow them to serve if they demonstrated an ability to adhere to the protocol. Alternatively, we could teach DBT Skills over the course of the first year in Congress, which would give our representatives a chance to really see the benefit of learning some new skills, in real time.

I haven’t decided which skills to start with; it seems to me they are all needed. Radical acceptance is certainly a candidate for first. All this past year it looked to me as if Congress was focused on other things than the fact that US Citizens were suffering from Covid-19, either medically or due to income and other losses. The rest of us had limited options. Members of Congress had more options to reduce suffering in our country, but they appeared unwilling to accept the reality of this pandemic as the context in which action could be taken.

Lessen judgment: Discernment is a good thing; characterizing other people as evil is not helpful, even if it is ego-boosting, and what all of your friends are doing.

Interpersonal Effectiveness would be, ideally, a series of skills that all members of Congress have before they even enter the Chamber. Obtaining objectives while maintaining relationships and self-respect sounds like a prescription for what would benefit our Congress enormously this year, and going forward.