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Letter from the President's Desk - May newsletter
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 5th). 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
Thoughts from our Public Member - Chris Kallas
"Using MyDBTSkills 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 readtoday. In it, Brother Christopher, the Prior and head dog trainer, says at one point,“Realityis a relentless instructor.”
Certainly reality affords the opportunity for learning. The pandemic is perhaps the all-timebesteveropportunityforallofustopracticeradicalacceptance.There isnothing we can do about it; it’s here, it’s going to stay here until it goes away (if ever). So weneed to acceptitand then adaptto it.Period.Move on.
The best way to learn, of course, is to have the skills to learn with. Brother Christopherknows this; he teaches dog training, and he has been training dogs for years. (He has alotincommonwithMarsha.)Eachdog-andeachtrainer-hasadifferenttemperament. some approaches will come easily to the pair, and some will require more effort, andmorepractice,oreven a differentapproach.Justlike learning andapplying DBTskills.
When he teaches dog owners how to work with their dogs, he teaches us skills that arevery similar to many of the DBT skills. Starting with the basics, he teaches us to work onourrelationshipwithourdog,justasDBTteachesustouseourrelationshipmindfulness skills. It’s a bit different, since I have much affection for my dog, but I mustbe the “Alpha” in the pack.Much of our work with our dogs depends upon trust, sothere’s a lot of - guess what? - validation!!! How I validate my dog when she has learnedanew skill,orwhen she does somethingIwantherto do,is differentfromhow Ivalidatemy daughter; I don’t give my daughter a treat, or play ball with her. But I might cook herfavorite meal, or spend time with her engaging in an activity that she enjoys: that’s how Ivalidate her. And the result is (we hope) similar: my dog trusts me. I know this becausewhen I walk around the house, even when she is lying in the doorway, she doesn’tmove;sheknowsIwon’tsteponher.(Mydaughterdoesn’talwaysrememberthat.)
When my dog starts to do something that I judge to be dangerous, I will correct her witha quick and emphatic “No!”, or a short tug on her leash. Would that it were so easy withmy child! Both my dog and my daughter sometimes act as if what they want to do ismore important than what I think, notwithstanding my concern about their safety (oranything 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 apropertoneandmanner.Whenshewasyounger,thiswasachallenge.Nowthatsheisan adult, and supports herself, I do the best that I can, knowing that I have very littleleverage, other than the value of our relationship to her. Unlike with my dog, whoseaffection never wains, that value fluctuates for my daughter, depending upon whether Iam aligned with the forces of darkness or the forces of light. So I have learned to do mybest DEAR MAN, and then prepare to radically accept the outcome of my request,whateveritis.Itryto rememberto self-validate,ifI’ve expressed myselfaccurately and with caring. And then I try to let it go and live my life, which I believe is worth living. Imighteven takemydog outfora walk;she loves that.Iwatch hersniffeverything,and play with other dogs, and watch children come up to pet her and enjoy their delightwhenshe unexpectedly licks theircheeks.
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.
DBT Treatment and Telehealth-How are we doing?
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!
Spotlight on DBT-LBC Certification-John Lothes
"What brought me to pursue DBT-LBC Certification"
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.
Thoughts from our Public Member - Chris Kallas
We all say that it’s important to be mentally healthy. After several months of living under this pandemic, we have had a chance to realize how truly important - and difficult to achieve - mental health is. What’s a ‘little thing’ is also more apparent. If everyone is on edge most of the time, we really can’t expect others to act calm and considerate all the time, any more than we can be calm and considerate all the time. Self compassion is necessary even more than before. So we notice who treats us calmly and considerately, perhaps a bit more so than we used to. The mental health providers we know, who treat us and our relatives, are at the top of the calm and considerate list, for the most part. That’s quite a tribute to your training, and your dedication, and we thank you for that.
I have more empathy for those who struggle with mental illness, due to my own struggles recently. Knowing, as I do, that I am luckier than many, I ask myself each day: What’s the lesson for us from this pandemic? The answer will be different for each of us. The challenges are different. Different parts of the country are in different phases of opening up (or closing down?) And the phases can change in a relatively short period of time; no lying back and taking it easy.
I grew up in Manhattan, and have lived here most of my life. Things that I once did without thinking now require planning. For example, sometimes I avoid taking the elevator, rather than getting in with another person, and walk up or down the 6 flights of stairs. I avoid leaving the building through the basement exit; if a neighbor is coming into the building, there is one spot where there isn’t six feet to distance from another person. I have to remember to wear my mask; most of my neighbors are wearing their masks, but not all. Some people wear the mask, then remove it when they are away from others, then forget to put it back on when others approach them. It isn’t like living in a house, where you go to your garage, get into your car, and drive away without meeting anyone else. And this is just the beginning of any trip outside.
We are trying to keep up with doctor visits, which we used to do religiously. Doctors’ offices have largely reopened. But there are still challenges. Not all practices will allow you to show up half an hour early and sit in the waiting room, unless you are visiting a practice that has lots of waiting room space. Some doctors’ offices will give you a ‘Covid quiz’, and take your temperature, before allowing you in. Do they wipe down the examining table where you sit during the visit? Where do you park during the visit? Does it matter if you give your car to a parking attendant, who drives it to a parking spot for you? Do you have to wipe down the steering wheel when you retrieve the car, before you drive it?
Here’s a big question: How do I get anywhere? Do I take a subway, or bus? Or do I walk to where I am going? I used to take the subway most of the time; how do I gauge the amount of time needed to get somewhere when I switch to a bus, or walk? How do I even get there, if I am driving instead of taking public transportation? Where is the nearest parking garage? I haven’t felt this much anxiety since I was waiting for acceptances from college, during my senior year of high school. But I am using my DBT Skills. Radical acceptance is at the top of the list, of course. Distracting is also helpful: I don’t watch as much news as I used to. I am reading more fiction than I used to, and more biographies: Marsha Linehan’s Memoir was wonderfully distracting, as I read about someone else’s problems, but more importantly, how she solved them.
One of the reasons that I believe DBT is so effective is that it incorporates a healthy dose of irreverence, which I often find amusing and helpful. So, in that vein, here is my irreverent approach to our current reality: I’m grateful to COVID-19 because . . .
I can have lunch with lots of garlic in it, and still go to my two o’clock meeting.
I am saving all kinds of money: on new clothes, on haircuts and dye. So far, when I wear a baseball cap, no one can see that my hair is coming in mostly white. Fashion hint: hats may be making a comeback.
I am reading books I have always wanted to and never made the time to.
I am attending online programs I never had access to, because now they are available for free, and don’t require me to travel or stay in a hotel.
I’ve been gardening again. It is fascinating to watch the plants change each day. Lettuce never tasted so good!
I’m cooking using new recipes. By the time I can invite friends over for dinner again, I will have a whole new repertoire of dishes to prepare for them.
My husband is teaching me to play chess.
I am no longer the designated driver; if I want to have wine with dinner, we are already at home.
(Almost) everyone is wearing a mask, so it doesn’t matter what anyone looks like - you can’t see people below the nose. Makeup is optional.
Wouldn’t it be wonderful if we all took some of this time to figure out what we’ve been doing that is ineffective, and how we can change our behavior. What a wonderful upside that would be to this trying experience!
Mary Ihnenfeld, MSW, LCSW - Certified Clinician
Family Counseling Service, Aurora , IL
I completed the 10-day intensive DBT training in 1998. I worked for a community mental health agency that was a referral source for the state hospital. In 1997, the State of Illinois brought out the Linehan Training Group (now Behavioral Tech) to train a group of state hospital employees and community mental health professionals. The agency I worked for was not offered a spot in 1997 and was offered one spot in 1998 and I was lucky enough be to chosen. The State of Illinois was moving towards "training the trainers", and I ultimately became a DBT trainer for the State of Illinois. I have been doing DBT since 1998 and have attended many advanced trainings and continue to attend DBT trainings. When the certification became available, people asked if I would apply. My first response was, "heck no". I did not have the ego strength to have my videotaped sessions observed and reviewed by DBT specialists, I was not sure I was good enough. After some soul searching, I decided my ultimate goal was to be the best DBT therapist I could be and therefore decided to apply. I was scared and felt so validated when I finally received the email that I passed and was Board Certified. For me, it was important to follow through and demonstrate that I have the knowledge, expertise, and credibility as a DBT-Linehan Board of Certification, Certified DBT Therapist. It was important for me to obtain this certification because Dr. Linehan's name is associated with the certification.
Lisa Fitzgibbons, PhD, ABPP - Certified Clinician
My initial interest in DBT was sparked when I completed an internship rotation on inpatient borderline personality disorder unit for women in 1999. The unit did not use DBT; however, I really enjoyed the women on the unit and as a result read Linehan’s groundbreaking text. Who knew I would have to read the book many, many times until I started to understand the concepts and applications?! Nearly fifteen years after my initial interest was sparked, I learned about an opportunity for intensive training for independent practitioners offered by Behavioral Tech. I chatted with my husband about the chance to learn DBT and how this training had always felt a bit out of reach for me because of geography and circumstances. I also highlighted that this seemed like a more productive way to address my mid-life crisis than many other options and although expensive, cost less than a luxury sports car. Several years later, the investment in the intensive training continues to pay dividends in terms of all that I learned, the connections and friends I made, and most importantly, in how it has benefitted my clients.
The ripple effect of DBT interventions in the lives of clients and in their relationships continues to amaze me. Due to the “high-stakes” nature of working with highly suicidal and often impulsive individuals, certification seemed like a “must” for me. It was important to me to not only be able to show that I had completed rigorous training, but that I had demonstrated competence in the application of this complex intervention as well as a commitment to ongoing learning. And, my remarkable team members also valued certification so there was accountability and cheerleading all along the way. Currently, I work in an outpatient behavioral health clinic and I have a colleague who has also sought intensive training, which has fueled my enthusiasm even more. We offer skills training groups for our community and teach graduate students about DBT. I love the sense of community among DBT colleagues, and how this growing group shares expertise and encouragement so providers can effectively help our clients. Certification strikes me as a way for providers to apply DBT principles to their learning of DBT with the use of assessment, self-monitoring, problem-solving, and contingencies. And, if we are going to ask our clients to do these things, why not do them ourselves?
New Fundraising Campaign Begun
If you could help save someone from dying by suicide, would you?
The death of a family member or loved one is someone’s worst nightmare. This tragedy has become increasingly common in recent years.
On the average in the United States, one person dies by suicide every 11 minutes and about half the population knows someone who has died by suicide. The tragedy of teen death by suicide is on the rise. Suicide is among the leading causes of death in the United States and remains on the increase nationwide. The numbers below speak for themselves.
https://afsp.org/suicide-statistics/
There are repercussions to the entire community of such significant, preventable deaths.
Beyond suicide, people with mental illness suffer, along with those who love them. They seem unable to function in a skillful way: to get jobs commensurate with their (sometimes considerable) capacities, to make and keep friends, to enjoy life. They use drugs or alcohol to tamp down their pain. They make decisions that are harmful, to themselves, their families, their fellow workers. They themselves often don't understand their feelings, their needs, their decisions.
There is a solution/a treatment that works to reduce suicide rates for those suffering the most. In order to make the treatment widely available, it will take public awareness and education, proper training of mental health professionals, and assessment of their knowledge and capacity to deliver the treatment in an evidence-based way. It takes insistence on the adherent treatment that works!
Will you help? Donate at http://www.dbt-lbc.org/index.php?page=101173/
DBT is a comprehensive treatment that focuses specifically on reducing the risk of suicide and maladaptive behaviors by teaching people how to cope effectively with suicidal thoughts and urges and to build lives they experience as worth living. Research conducted over the past 30 years has proven that DBT works to save lives and improve the quality of life when it is delivered with adherence to the treatment model. We know that, in order to be effective, a treatment must be provided as it has been researched. This is called ‘being adherent to the treatment model’. Adherent therapy also increases the likelihood of staying in treatment to completion.
Dialectical Behavior Therapy (DBT) is the treatment with the most research showing it is effective in reducing suicidal and self-harming behaviors. We need your support to:
• Publicize this treatment
• Educate the public about the availability and effectiveness of this treatment
• Convince legislators to require demonstrated standards of care to protect the most vulnerable of mental health consumers
• Help to provide scholarships for clinicians and programs so they can afford to go through the certification process
• Help family members who need support in coping with their struggles to help their loved ones
But how do consumers find out whether the treatment being provided is being done with adherence to the model? And how do they know which mental health professionals are capable of delivering high quality DBT? That’s where we come in.
We are the DBT-Linehan Board of Certification (DBT-LBC), a non-profit 501(c)(6) organization. Our overarching aim is to enable the public to clearly identify providers and programs that demonstrate the capacity to offer DBT in a way that is consistent with the evidence-based research through a process they go through called certification. Certified clinicians demonstrate that they have the requisite knowledge and skills to deliver DBT with adherence to the model as defined by the treatment developer, Dr. Marsha Linehan and her colleagues. Certified DBT programs demonstrate that they have all the necessary components and structure in place to deliver DBT with fidelity to the model.
Most DBT clinicians have had the unfortunate experience of meeting with new, desperate clients who tell us that they have already “done DBT” and it did not help. Clinicians often find out in the first few minutes of hearing those statements that the client did not receive ADHERENT, COMPREHENSIVE DBT. Not only is the client often still at high risk of suicide, but now they have also lost faith in a treatment that is likely to work for them if done well. DBT-LBC works to address this problem. Many clinicians can say they provide DBT (or even “DBT-informed treatment”); not all of these clinicians provide adherent DBT. Potential clients and their family members, often in immediately life-threatening situations, have no ability to tell the difference. The DBT-LBC website lists certified clinicians and programs that have the capacity to provide adherent DBT. We also provide education and criteria that helps consumers, both clients and family members, assess those providers who may be well-meaning but not adherent. A searchable database is maintained for consumers to locate certified therapists and programs at http://www.dbt-lbc.org/index.php?page=101163
And you can help us by donating at http://www.dbt-lbc.org/index.php?page=101173/
What do actual clients say?
DBT gives clients real tools. “I’m 16. After trying what I thought was DBT, I finally got into a comprehensive DBT program; it saved my life. I was not judged, blamed or put down for my past choices. I was actually understood and given real tools that worked to help me stop impulsive, life-threatening behaviors.”
DBT helps the difficult to treat. “I’m 42. I was a long-term psychiatric patient since I was a teenager. Prior to beginning DBT at age 32, I spent 75% of the preceding 12 months as an inpatient for suicide attempts and self-harm behaviors. I was about to be committed to a state hospital as I was labeled “untreatable”. I agreed to try DBT by a local expert as a last resort. During my participation in DBT, I had NO inpatient stays. It is now 10 years later, and I still have never made a suicide attempt or been hospitalized for psychiatric reasons. This is a life-changing treatment. It’s a lot of work, but well worth it.”
DBT helps the whole family. “I love my daughter, but it was often hard to understand her. With a 160 IQ in math, she would come home from the grocery store with incorrect change. Then Dr. Linehan’s first book came out. I’m not a psychologist, so it was dense. But when I finished the first chapter, I thought, ‘This doctor understands my daughter. I would do anything to learn more about this DBT, because I know it would help her.’ And, wonder of wonders, it did. Over time, she learned how to handle her emotions. She got a job and weaned herself off Social Security Disability. When that job ended, she got another one! She met a man, fell in love, got married, hosted us and a full panoply of relatives and friends at her home for holiday dinners. She created a life worth living, by using her DBT skills. And we became better parents, better spouses, better friends, and better at all of our relationships, using our DBT skills. We have lives worth living as well.”
What are the negative consequences if adherent treatment is not provided?
More people die unnecessarily! Each death by suicide has a significant negative impact on the entire community that knew the individual. And people suffer needlessly. That’s really the crux of the problem. We would like to do more about that, and we need your help to accomplish that. This is a massive public health problem resulting in significant loss of life. In some ways it is similar to the need for effective testing and vaccines for COVID-19, but in this case, we have a “vaccine” for it but need to make it more widely available.
How can you help?
By making a donation now, you will help more people at high risk access high quality therapy that is likely to save their lives, and ultimately, to help them create meaningful lives. Donate now at http://www.dbt-lbc.org/index.php?page=101173/
Where would my money go to help out?
Total $200,000/year as part of a 5-year campaign
Our Expenses
Overhead expenses for our organization are less than 5 percent. Our ability to operate at such efficiency is in large part due to the large number of committed volunteers who get the work of the organization done. Although the number varies, it averages about 60 volunteers/year. They would be encouraged to continue to do so by seeing your support.
All members of the Board of Directors make donations to the work of the DBT-Linehan Board of Certification
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Special Edition Newsletter. We are all in this together
As we find ourselves in the midst of a global health crisis, we have all had to find our new norm. With that comes many unexpected challenges that we have not had an opportunity to prepare for. So many of us are faced with the challenge of balancing work and home and creating a system where work can ‘turn off’ and home life can ‘turn on’, which can be challenging when your home becomes your workplace. First and foremost, we all have to remember that what we are experiencing now in terms of stress, fear, anxiety, fatigue and frustration is the new normal and we are not alone.
As our anxiety increases, our threat systems become activated and we may be more vulnerable to emotion mind. What a perfect opportunity to ask yourself “how would I coach my client to respond in this situation?” and use this as an opportunity to model to our clients and family what we all know works, DBT skills. As DBT clinicians, it is more important than ever that we recognize our own vulnerabilities and work to reduce them just like we would coach our clients to do. There is a great deal about this situation that we cannot control and cannot change. How would we coach and support our clients if they came to us with a problem that they have no control over and could not change? We would coach them to practice radical acceptance, to completely and totally accept the situation as it is, acknowledging that their feelings about it are what they are. When you find yourself fighting reality, use self-compassion to acknowledge that you are fighting it and then work to turn your mind toward willingness to do just what is needed in that moment.
DBT-LBC wants you all to know that we are here to support you and provide you with resources that you may find helpful during these unprecedented times. I have found the DBT List Serve to be an amazing resource during this time, so we want to thank all of you that have provided support and resources via that platform. Below are some other important practices that you may find helpful, we all could use some reminders to keep moving forward, especially during a time when it may seem like life has been halted.
We are being asked to “stay home” and practice “social distancing” however we are not being asked to practice “emotional distancing” and with all of the amazing technology we have today this ironically can be a time to get more connected to both those close to you and those that you may have lost connection with.
Routine and schedule are key during this time that may feel so unstructured. Despite working from home or being with children who are schooling from home, the daily routine should stay as routine as possible to provide you, your family and your clients structure and most importantly consistency in daily living. It is important to find a space that can be designated for work and/or school so that at the end of the day you can have a clear separation and maintain a work-life balance. We often don’t realize the little things until they are no longer available. For example, it could be helpful to get up in between each virtual session and take a walk (as if you are walking to the waiting room to greet a client). While this may seem like a small thing, it can help provide separation between sessions. Pre COVID-19, we didn’t sit at a desk without moving in between sessions, so why do it now 😊
Finally, we applaud the resilience of Teams and the way that they have pulled together despite the added stress and strain that moving to telehealth has generated. Additional work hours, loss of Team members, loss of the in-person connection with team members and the normal setbacks that all seem enhanced right now. We are equally impressed with the speed that many of you have adapted to finding effective ways to continue seeing and supporting clients who may be poorly equipped to handle this challenging time, while at the same time keeping the community of providers connected. DBT-LBC is here for you in any way we can be and we are continuing to work on your behalf.
Some things to think about:
Other Resources:
Letter from the Old President's Desk (well former, anyway)
I thought I’d share why DBT, DBT-LBC and working as a Board member has made my career as a psychologist a true “life worth living.” I hope it encourages you too.
After I graduated with my Ph.D. in 1985, I started a private practice in Brookfield WI. I didn’t intend to specialize in working with trauma survivors, but we were drawn to each other through shared pain experiences I guess, and I seemed to reach them where others had not been as successful. (Marsha’s identified step in Validation I later came to recognize.). I made a very good living; worked with wonderful clients too. In 1994, when Marsha’s book came out describing DBT, I knew I had found what was missing in all the cognitive, behavioral and exposure work I had been doing. So, I set out to learn and implement it and even was consulted and hired to develop DBT in a local hospital. There I met other dedicated clinicians who also had a passion for delivery of the “real thing” – adherent DBT.
One of those people was Neal Moglowsky. He and I had lunch one day and we started talking about getting Intensively trained and starting our own DBT Program. We dove in, joined forces and entered the world of amazing experts in DBT. Suzanne Witterholt and Alan Fruzzetti were our trainers – and amazing ones they were. Inspiring actually. My clinic, the Center for Behavioral Medicine (CBM), was now primarily a comprehensive DBT program, although I saw other clients too.
Neal, Kim Skerven and I over the years provided DBT to thousands of searching souls. We had the real privilege of offering practicum training to dozens of doctoral and social work students from several colleges and universities. I wish I could let them all know how much they fueled the passion in us to model the commitment it takes to do DBT. I retired from CBM in 2014 after over 30 years in the mental health field.
During the years from 1994 to the present, I also met some pretty fabulous people in our field. I can’t name them all or this would be a never-ending piece. I will say that one highlight was getting awarded the DBT Service award given by Marsha each year at ISITDBT. A sly person assured I was at this meeting, but little did she know that for the first time it was a dual award. Bev Long and I shared this honor that year. I think she was as stunned as I was that two clinicians were honored in this way. I was literally speechless that day – which is pretty uncommon for me.
I was unaware then of all the work behind the scenes of efforts to develop some means of identifying which clinicians were actually doing adherent DBT so the public would know who to trust with their challenging lives. Insurance executives had asked Marsha how to identify who was doing adherent DBT from those who were not. She had a ready answer, “I can tell you who those people are.” I know what you are thinking. “But she doesn’t know me.” And you would be right. How could she know everyone who was committed to adherent DBT? That led those around her to encourage a method for objectively identifying those therapists who could deliver adherent DBT. She agreed; thus, certification development began. I became involved as part of a Task Force in 2011. Marsha, Suzanne, Randy Wolbert, Henry Schmidt, Bev Long, Andre Ivanoff, Alan Fruzzetti, Katie Korslund and I made up this initial group.
Let me just say what an honor it is to have worked with such dedicated and talented people all these years. I wish I could let everyone who has touched my life in this way know what a true blessing they have been.
The DBT-Linehan Board of Certification formally came into existence in 2013. We hired Tim Knettler at that time, and he has guided us along the way with his expert knowledge of how certification organizations work. We started with Katie Korslund as President and I was fortunate to have worked under her tutelage for 6 years before I began to serve as President of DBT-LBC.
Now, in 2020, I have stepped down as President of DBT-LBC to give younger voices a say in the workings of the organization. I will continue to serve on the Board of Directors and in the position of Immediate Past President to offer support as the new President takes the reins. It has truly been one of the proudest opportunities in my career to have been a part of this amazing organization. I am amazed at the colleagues who volunteer their time to contribute to the certification efforts.
The Board members who are serving as of March 2020 – Kim Vay (President), Suzanne Witterholt (Vice President), Henry Schmidt (Secretary), Dan Finnegan (Treasurer), Chris Kallas (Public Member) and the other Members at Large – Katie Korslund, Melanie Harned, Todd Figura, Andre Ivanoff, and of course, Marsha Linehan – our constant inspiration. (Randy Wolbert has just stepped off the Board this year and we thank him for his service all these years.)
I will share this highlight – serving as a Program Certification Reviewer. Of all the people I’ve met in our world of DBT, those who inspire me the most are the dedicated teams who submit themselves and their programs to the scrutiny that is DBT Program Certification. I’ve sat in on Team meetings; met clinicians who are enthusiastic about delivering adherent treatment; interviewed clients who have been the beneficiaries of this treatment; watched talented skills group leaders teach with such passion and creativity the skills that create lives worth living. The words of appreciation they have shared as they have gone through the certification process has made all my efforts truly worth it.
As most of you already know, I am dedicated to Marsha’s legacy. She is one amazing person. If you haven’t already read her memoir, it really is worth it – Building a Life Worth Living. Those experts who continue to research and develop DBT are to be applauded. Those of you who sacrifice to invest in the lives of those who are so challenged, I thank you too. Please work to get certified. It does make a difference in your clinical skills. It is worth it!
I wish I could list every one of you who have made MY life worth living.
Thanks for the privilege of serving.
Joan Russo, Ph.D.
Immediate Past President
DBT – Linehan Board of Certification
Letter from the New President's Desk - April 2020
Hello all:
My name is Kimberly Vay and I am humbled to have been elected as the new President of DBT-LBC and will be working alongside Joan Russo, Immediate Past President. I am so excited to work with the DBT-LBC organization in this new role. Congratulations to Dan Finnegan on his new position as Treasurer. Thanks also to our other Officers – Suzanne Witterholt, Vice President and Henry Schmidt, Secretary.
I am a clinician at Peachtree DBT, located in Atlanta, GA and a Licensed Professional Counselor and Certified Professional Counselor Supervisor. As the first DBT-Linehan Board of Certification, Certified DBT Clinician® in the state of Georgia, I take great pride in delivering DBT with adherence to the treatment model. I hope to get to know many of you personally as I proceed in this role as we are all in this together!
I started with DBT-LBC as a volunteer working with the Program Certification Committee and then was elected as a Board Member-at-Large. I remember the day that I contacted Joan about volunteering to be a Program Site Reviewer, without any knowledge of what I was getting myself into 😊. It was shortly after that when I was assigned my first program to review for program certification. I was lucky enough to be paired up with Randy Wolbert, and it was at that time that I knew DBT-LBC was an organization that I wanted to be a part of, and I haven’t looked back since. Thanks Randy!
I want to send each one of you a heartfelt THANK YOU for your role within the DBT community.
I send my thoughts and prayers to everyone who has been impacted by COVID-19 on a personal level.
Stay Healthy,
Dr. Kimberly Vay
President
DBT-Linehan Board of Certification
Responding to COVID-19 and its impact on the certification process
We understand that there are likely a lot of questions regarding how COVID-19 impacts the certification process so we would like to detail some information below that may answer some of your questions. If you have additional questions, please email us at [email protected].
Individual Clinician Certification:
Application:
There has been no impact or changes to the Initial Application for certification
Knowledge Exam:
We understand that there have been some disruptions to the availability for taking the Knowledge Exam due to some Pearson VUE testing centers temporarily closing. In order to avoid any future delay in the certification process, once the testing centers re-open, we are making the exam windows available year-round. There will still be the requirement of a four-month spacing between a lack of a passing score and being able to re-take the exam. But the availability of having all months open at the testing centers will avoid any further delays than that. Pearson VUE has been very cooperative in granting this expanded access.
(If you have already been provided a registration identification and the center was closed, contact the Pearson VUE to set up a new exam date once they have re-opened. We expect they will get in touch with you when that happens.). If you have any questions and/or concerns regarding these changes please contact us via [email protected]
Video Submission Process
We have had many inquiries regarding the video submission process and how this has been impacted presently. While the recommendations on our website suggest having the camera pointed so that both the practitioner and client can be seen, we understand that in-person therapy sessions are not a viable possibility at this time. Given the need for telehealth sessions, the camera should be on the practitioner so that non-verbal expressions can be seen. We strongly encourage that if you are using this platform that you test the recording before beginning the session to ensure adequate sound quality of both the client and practitioner throughout the session. Other recording options will depend on the capabilities of the specific software packages being used. If your software has the split screen feature that would be optimal for the most effective coding possible.
Please have the clients sign a revised consent to have telehealth sessions recorded. We have been informed that some clients are reluctant to do so. Although that may mean some great sessions are not available for your certification process, we understand their concerns and encourage waiting until in-person sessions are again possible for those clients.
Letter from the President's Desk - March 2020
Wow. It’s hard to believe DBT-LBC has been in operation for over 5 years now. One of our Policies and Procedures states that we will review our certification process every 5 years. We’ve spent about 12 months of intense examination doing so, consulted with other organizations offering certification and also with two organizations that do national and international accreditation of certifying bodies like us. Very enlightening and productive. We have instituted a few changes that we hope you will appreciate and see the value of.
First, we are not raising any fees for the process this year. We have compared our fees with others and we are very reasonable, in fact lower than most. Our volunteers are making it possible for our expenses to remain as low as possible to maintain a lack of fee increases for 5 years!! Thanks to our volunteers for their efforts and contributions, which are many.
Secondly, we are finding that the Exam we have developed has maintained its robustness as far as assessing the relevant knowledge. Our Item Writing group continues to work on an additional bank of questions for subsequent versions of an exam. Pass/fail rates meet the national accreditation standards we are striving to meet.
Third, we are modifying the Work Product requirements a bit. The Case Conceptualization portion of this step is being modified and put into an expanded Session Information Form (SIF), which will no longer be coded for adherence. We want to continue to emphasize the importance of this skill set and will examine a redevelopment of the coding for Case Conceptualization. The SIF is submitted along with the video session tapes; those videos will continue to be coded for adherence. Please see the website for a copy of the revised Session Information Form. We want to continue to encourage conceptualizing your treatment planning from a DBT perspective and those additional questions accomplish that.
The website application process will be updated by the end of March to reflect these changes and those affected have been notified by email and their status will be moved forward accordingly.
Keep up the great work you all do. I’m very proud to be a part of this dedicated community of professionals who make life-changing investments in others who need it most.
Joan
P.S. Please be aware that we do not certify nor endorse any training organizations or trainers. Any statements made that convey that any trainings will prepare you for certification are the opinion of the trainer or training organization themselves. We encourage a buyer beware approach to those offering training.
Thoughts from our Public Member - Chris Kallas
The parent of a child who is ill feels pain. The parent of a child who is mentally ill feels pain, along with a whole host of other emotions: fear, anger, and lots of frustration: at the inability of the doctors to ‘cure’, at the coldness of the insurance company, and at the lack of understanding of most others, to whom we would like to turn to for comfort and support.
Our child was exceptionally bright, and an outstanding artist. As she grew, I was often surprised at her behavior. Who was this person who had a math IQ off the charts, and couldn’t bring home the correct change from the supermarket? Who was this person who ran up astounding credit card bills, with no apparent way to pay them off? Who was this person, who hurt herself in ways I found unimaginable?
She was the same person who painted such amazing portraits, who wrote such heartbreaking poetry, who wrote a laugh-out-loud essay on her college applications (and got in, everywhere she applied). Who loved her cats so much. Who was a fierce defender of wronged friends.
When we would talk to our relatives, and tell them our latest problem, they pulled back in horror. Friends were likewise horrified: “Well, she’s never like that with me; you must be doing something to bring this behavior on.” So much for support.
After we had nearly given up hope, we learned of a new organization: NEABPD, the brainchild of Dr. Perry Hoffman. When I first met Perry, she encouraged me to tell her what we were going through. She listened, intently. She was so validating - a word, and a concept, that I hadn’t really encountered.
Over the next 18 years we worked together: on the NEA BPD Board, on special projects, and as a Family Connections leader. She was consistently thoughtful, effective, and supportive. If our daughter had done something hurtful to us, Perry apologized! Sometimes she saw a ray of hope where we had missed it, so she pointed it out. I always felt better after speaking with her, even if nothing had changed outwardly.
She was so happy with her biological family, and she often shared stories about them. She got how significant family was, and she had the vision to see how much more powerful healing would be if family members understood BPD, and spoke DBT. She made such a difference in our lives, and in hundreds of others. She made a difference in your life too: she recommended me to serve as the Public Member of the DBT-Linehan Board of Certification.
I think her favorite word was “fabulous”. And she certainly was. The world is dimmer without her. I will need to muster all my DBT muscles and practice REALLY Radical Acceptance to come to grips with a new, “Perry-less” world.
Dr. Alex Chapman, PhD, Spotlight on DBT-LBC Certification
Alexander L. Chapman, Ph.D., R.Psych., a DBT_ LBC Certified Clinician, is the President of the DBT Centre of Vancouver, as well as the director of the Personality and Emotion Research Laboratory at Simon Fraser University, where he studies the role of emotion regulation in BPD, self-harm, impulsivity, and other behavioral problems. A DBT Trainer and Consultant for Behavioral Tech, Dr. Chapman has published numerous scientific articles and chapters on these and other topics and has given many scientific presentations on his research. In addition, he regularly facilitates local, national, and international workshops on DBT and the treatment of BPD, as well as provided expert training and supervision to clinicians in Canada, the U.S., and the U.K. Dr Chapman has agreed to speak with us regarding his latest publication Phone Coaching in Dialectical Behavior
Therapy, as well as lend his perspective on DBT – LBC Certification.
Q. One of your latest publications is the Guildford DBT Practice Series book Phone Coaching in Dialectical Behavior Therapy. Having an entire book dedicated to successfully navigating this standalone mode of DBT is long overdue. What made you decide to take on this topic?
Although the idea of phone coaching sometimes strikes fear into the hearts of clinicians, this mode of DBT is a critical way to generalize or transfer what clients are learning to difficult situations in their everyday lives. The vast majority of the time, phone coaching calls are effective, helpful, and at times, maybe even life-saving. Through many years practicing DBT and being a member of DBT consultation teams, I realized that phone coaching is often misunderstood, experienced as burdensome or difficult to fit in, and that therapy interfering behaviours during phone coaching are often the most challenging behaviours to manage. Many of our team discussions have focused on ways to effectively navigate challenges in phone coaching, keep calls brief, helpful and focused on skills, and so forth. Interestingly, very few pages of Marsha Linehan’s original DBT text (Linehan, 1993a) focused on phone coaching. I wanted to combine the wisdom I have gleaned from working with DBT masters earlier in my career (Dr. Clive Robins and Dr. Thomas R. Lynch, Dr. Marsha Linehan, Dr. Katie Korslund, and other clinicians at the BRTC) with my experiences since then and put together a practical guide to this essential component of DBT. My hope was that, using this book as a resource, clinicians would feel enthusiastic about using phone coaching and confident that they had practical strategies on hand to make phone coaching effective and manage common challenges.
Q In the text, you address common phone coaching myths, build a structure for establishing effective intervention, and share strategies for effective collaboration and shaping. As a DBT supervisor and trainer, have you noticed common points of “drift” from phone coaching? Would you be able to note some of those for a therapist working to practice fidelity to DBT?
Yes, there are several ways in which drift occurs with phone coaching.
One common area of drift involves clinicians focusing on topics other than skills during phone coaching calls. Therapists sometimes do the same things during phone coaching calls as they do during individual therapy sessions, turning phone coaching into brief therapy sessions on the phone. Phone coaching is essentially skills coaching on the phone; thus, the focus should be on skills. I usually start my phone coaching calls by asking my clients for a brief summary of the problem they’re dealing with and the skills they’ve already tried. I also remind them that we’re going to focus on skills they can use in the short-term to deal with the situation. Early in therapy, I orient clients to the skills-focused nature of calls, so they are aware that phone coaching is not individual therapy on the phone. I’ve often found that, when clinicians remain focused on skills, other areas of drift tend to… drift away.
A second area of drift is that clinicians sometimes have difficulty keeping calls brief and to the point. They stay on the phone too long. Once in a while, this is fine, but I’ve observed that clinicians sometimes get into a pattern of lengthy calls that raise their risk of burnout. To avoid this problem, I often recommend that clinicians tell clients how much time they have (e.g., “I’ve got about 5-10 minutes, and I’ll let you know when I have to get off the phone.”), and remain aware of how long they’re spending on the phone. Also, it’s okay to end a call, even if the discussion has not wrapped up beautifully or the client doesn’t seem to feel any better. As long as some helpful skills coaching has occurred, it can be considered a potentially effective call.
An additional area of drift that can have dire consequences occurs when therapists are not up to speed on the literature on suicide risk, their conceptualization of their own client’s suicide risk, and the various ways to manage imminent risk. I highly recommend that clinicians conducting phone coaching remain up to speed on the suicide literature, conduct a thorough suicide risk assessment and monitor ongoing risk with their clients, and become familiar with effective protocols for addressing suicide risk during phone coaching (described in one of the chapters in my book).
Q: In the theme of constantly evolving and shaping ourselves as DBT clinicians, the idea of training oneself to attain certification standards can be daunting! In your work with supervising, training, and consulting with DBT clinicians at all levels of training, what are your thoughts on the potential value of DBT- LBC Certification standards?
I think that the DBT-LBC certification standards have been long awaited. DBT has proliferated across the world, extending to various cultures, contexts, client problem areas, and clinicians with various training backgrounds. Clients need to know what kind of treatment they are receiving, and when a clinician is certified, a client knows that clinician has attained at least a foundational level of knowledge or competence. Although the vast majority of clinicians practicing DBT are uncertified, and this is likely to continue to be the case, having delineated certification standards can (a) help clinicians evaluate their own training and background and how it applies to their DBT work, and (b) help clients (if they are made more aware of standards) consider whether their clinician might meet reasonable standards for DBT practice. When I do trainings in DBT, people often ask me what it takes (in terms of training, experience, and key skills, etc.) to become a DBT therapist. Having clear certification standards can help inform a reasonable answer to that question.
Letter from the President's Desk - November
Sometimes I have trouble containing my enthusiasm for this Certification organization and all we accomplish due to our dedicated volunteers, committee chairs and Board of Directors.
We are in our 5th year of the organization’s certification endeavors and we set up our Policy and Procedures to review them every 5 years. We are doing that now. In fact, we hope to have some decisions made that will improve accessibility to certification success, recognize those who go the extra mile to demonstrate their competence and – here’s the big one – make the renewal of your certification meaningful instead of a chore to accomplish at the 10-year mark. We have a group of volunteers who are meeting again this year to provide feedback to DBT-LBC on our ideas. You matter and so do the opinions of those of you affected by the process. Watch the next newsletter and the website for updates.
And Program Certification has been amazing. Sixteen DBT Programs from across the country have dedicated themselves to the hard work, intense scrutiny, well-considered feedback and addressing any concerns to demonstrate they have the organizational structure, the staff, treatment elements and commitment to delivering adherent DBT with fidelity to the treatment model. I know how proud and appreciative Marsha is to all of you for doing that. We have 13 more programs in the process; don’t get left behind. Start your application now. And don’t forget about the scholarship help available for both of the certifications. The website has all the pertinent details about how to get started. www.dbt-lbc.org
I think one of the blessings of being a Program Certification Reviewer is getting to meet so many dedicated staff members on these Teams. As an example of the value and meaningfulness of Program certification, let me share a recent experience. A DBT Program applied after years of providing DBT services. They were enthusiastic. Unfortunately, after just the application review and looking at their documentation for how the program was operating, the Workgroup could see there were some major concerns. Treatment had drifted little by little. Adaptations were made without realizing how far from the original structure of the treatment model they had gotten. Here’s the good news. They were given feedback about this and told they would not meet the requirements to be certified. Instead of backing away, they plunged in full force. They have spent the past 9 months revamping, restructuring, retraining and refocusing their efforts to get fully adherent to the DBT treatment model. The result? They will soon be starting their second review process and we have high hopes they will pass muster this time. They were determined. This is what certification is all about. Helping consumers know when adherent DBT is actually available to them.
I hope to share hugs at the upcoming ISITDBT conference in Atlanta. See you there!
Happy Holidays to all.
Joan
Thoughts from our Public Member - Chris Kallas
I remember taking a music class in seventh grade. We learned to read music, and some of the highlights of the history of music. I enjoyed it thoroughly. But with all the other things I was studying, I didn’t study it again.
Then about 10 years ago I joined my church choir. I am an Orthodox Christian, and I had been attending church for my whole life. But suddenly, the services felt very different, because I was paying attention in a whole new way. When we sang each hymn, I had to learn the words - in Greek, of course. I felt that I was using a whole new part of my brain. I was paying attention to what the priest did, and what the cantor did, and seeing their parts and the choir’s part as intertwined in a new way: antiphonal, to be precise. Antiphony can be defined as: alternate or responsive singing by a choir in two divisions. So there is no way for the choir to just ‘sing’; we must wait for our ‘cue’ from the priest, or the cantor, as he waits for us to cue him.
In the beginning, this approach was exhausting, requiring me to pay attention to what was going on liturgically. I started to notice if the priest’s part was in the same tone (key) as ours. I noticed that tenors sound different from altos (that’s me) and sopranos and basses, and that there are further distinctions in those categories. I started paying attention to the composer’s instructions concerning how to sing the music: it’s speed, it’s acoustics, when we take a breath, when we stop singing. And I learned that our Liturgy has been set to music by many composers, so there are many variations in how the service sounds. I developed significant respect for our choir director, who has to be on top of all the music, and its weekly changes, as well as lead us to form a cohesive unit.
By now, when we sing, I still have to pay attention to what’s on the page. But I can also feel the music take over. My prefrontal cortex doesn’t have to be in charge all of the time; that’s quite a difference from my normal daily functioning. The feelings that the music evokes range from deep sadness to unspeakable joy. Sometimes it’s a little hard to return to the ‘real world’ after the service.
It seems to me that singing in the choir is much like being in a family with a member who has BPD. There are different parts for different members, and often they are all singing at once. Sometimes not everyone knows his or her music, and may not want to admit ignorance, so he blurts out his part anyway. Or he criticizes the composer: “this music shouldn’t be written this way!” Or he criticizes the conductor. That’s where you come in.
A mental health professional is like the conductor. The music is already written; you have to figure out how to help the client sing along with the rest of the choir. Is he a tenor? Can he read music? Does he need confidence to sing out loudly, or confidence to pull it back until it’s time to go “forte”? Is he paying attention to the composer’s cadence and volume instructions? Or does every line end with an “attacca”? How do you help him identify what’s not working? And how do you help him to come up with a plan to make it work?
You have an individual client, and that is the person to whom you owe your loyalties. But remember: the client doesn’t live alone; he or she is part of a family. And everything that you help the client do can benefit the family as well, even if we are not in the treatment room. You help your client in rehearsal; we sing with him all week.
So thank you for helping us to sing our family music so that it sounds more beautiful.
In Memoriam - Dr. Perry Hoffman
We learned the tremendously sad news that Dr. Perry Hoffman, co-creator of Family Connections™ and founder of NEABPD, died peacefully at home on November 3rd. We know that this news may come as a shock to many of you. Perry became ill very suddenly five weeks ago with a rapidly debilitating disease.
At the onset of her illness, Perry’s daughter Rennie commented that Perry said she “had 75 healthy and amazing years personally and professionally and was so grateful for that.” We, in turn, are all deeply grateful for her wonderful positive energy and abiding commitment to helping individuals and families in a variety of ways, but in particular through NEABPD, which she founded in 2002.
May her memory be a blessing.
Spotlight on Certified Clincians - Dr. Jennifer Sayrs
Jennifer Sayrs, PhD., a DBT – LBC Certified Clinician, is the Executive Director and co-founder of the Evidence Based Treatment Center of Seattle (EBTCS). As part of her role there, she serves as the director of the DBT Center, which is one of the first DBT programs in the nation to be certified by the Linehan Board of Certification. She is the co-author of the new book DBT Teams: Development and Practice, written with the DBT treatment developer, Dr. Marsha Linehan. Dr Sayrs was kind enough to answer three questions for us regarding her recent book, as well as her thoughts on the value of DBT – LBC Certification.
Q. One of your latest publications is the Guildford Practice Series book DBT Teams: Development and Practice, co – authored by Marsha Linehan. As part of my preparing for certification, I often found myself scouring pieces of other texts for insight into how to establish and successfully maintain Consultation Teams. Having an entire text devoted to Consultation Team is exciting! What made you decide to take on this challenge?
A: DBT teams are so important in making sure therapists continue to provide effective DBT even when the going gets tough. DBT clients present with multiple, complicated, long-standing problems that at times can be quite frightening and frustrating. When therapists are faced with fear, frustration, burnout, or any number of other challenges, it is easy to stray from the treatment and respond ineffectively. The team’s job is to watch for these problems and offer support and guidance. I truly don’t think it’s possible to do effective DBT without a “community of therapists” providing DBT.
I have provided many trainings in DBT, both in workshops and in our clinic. In doing so, I realized there were many aspects of team that were not written down anywhere. I have learned so much about what works (and what really doesn’t work!) from my experiences running my own team and being on teams with Marsha Linehan. I approached Marsha and suggested we put all of our experiences and insight in writing, so others can benefit. We agreed that writing a manual for creating and running a DBT team would be an important element in helping therapists improve their skill in DBT as well as their treatment outcomes. We spent many hours talking through which elements of our teams’ structure are necessary, what makes our teams run well, what disrupts their effectiveness, and what “school of hard knocks” lessons we could share with others. The result was this book!
Q: Another of your contributions to the field of DBT researchers and clinicians alike is your serving as guest editor on the Special Series on Behavioral Assessment in DBT Cognitive and Behavioral Practice. The issue highlights the crucial role of ongoing behavioral assessment while both learning and practicing the treatment to fidelity. For a DBT clinician working towards fidelity standards, what advice might you lend on staying awake to drifting from the model?
A: At times, it can be nearly impossible to detect when one has drifted from the model. It is so easy to be influenced by the client and other factors, and therefore make unhelpful or non-strategic decisions in therapy sessions. There are many strategies for managing this, including getting high-quality training, continuing one’s education on an ongoing basis, and staying up to date with developments in the field. Perhaps even more importantly, I would recommend utilizing one’s team. Developing a culture of vulnerability in team, where providers can share their mistakes and trust they will receive help rather than judgment or reprimands, helps to make sure missteps are discussed and the treatment can get back on track. Marsha always asked us, “Do you want to look good or be good?” In other words, are you willing to risk a little embarrassment to talk through mistakes and improve your skill? When doing DBT, the stakes can be high; clients often engage in high-risk behaviors, making it more important to provide the most precise, effective, compassionate treatment possible. This translates into telling all of my teammates every time the treatment I provide is not moving smoothly forward, even when I don’t want to!
Q: In the theme of constantly evolving and shaping ourselves as DBT clinicians, I love the idea of training oneself to attain certification standards. In your work with supervising, training, and consulting with DBT clinicians at all levels of training, what are your thoughts on the potential value of DBT- LBC Certification standards?
A: I deeply believe certification is an essential development in DBT. I have had many, many clients come into our clinic saying they have already received DBT and it didn’t work – only to discover they were taught only a few skills and never received the full treatment. I am not opposed to therapists providing only certain components of DBT when that is all that is needed! But for the clients with severe, long standing emotion dysregulation, and all the very challenging problems that come with such dysregulation, clients often desperately need more than a subset of the skills. And these same clients have no way to evaluate what treatment they are being provided. Certification is a way to communicate to clients that they are receiving a treatment that is supported by evidence and has a strong chance of helping them. Certification also ensures therapists have the training, experience, supervision, and support to treat clients with intense, high-risk problems. As the popularity of DBT has dramatically increased over the years, this method of confirming clients are actually getting DBT has become all the more essential.
Fundraising Committee Upcoming Events
The Fundraising Committee aims to keep you connected to the Board and other certified clinicians, and to support DBT-LBC in their mission to support quality DBT treatment across the globe. As always, we are incredibly grateful to all of our donors, who directly impact the dissemination of gold-standard care that truly saves lives.
The DBT-LBC Fundraising Committee is excited for our Autumn events! First up is ISITDBT! Come see us at our table during and after the conference. We will be accepting donations, which will earn a Donor ribbon to wear with pride on your nametag. We will have information about individual and program certification, scholarships, and the importance of your donations. We look forward to seeing you there and learning more about your certification goals and accomplishments!
Next up, we are preparing for Giving Tuesday. Giving Tuesday occurs on December 3, 2019, the first Tuesday after Thanksgiving, and is a global day of giving fueled by social media. The Fundraising Committee will provide links and information via our Facebook page for Giving Tuesday, follow us there to keep up-to-date! Contributing to DBT-LBC during the charitable season helps to fund the behind-the-scenes process of getting clinicians certified and keeps the operation running smoothly. Donations can also be made directly to scholarship funds to support clinicians in obtaining certification who provide services to low-income populations. What better way to use the Contributing skill than to give to the organization that will help your colleagues obtain their DBT goals!
Letter from the President's Desk - September
Hello everyone:
Wow, what challenging weather we have experienced this year. I hope everyone is safe and/or recovered from the heat and storms and everything that went with that.
I thought I would use this time to bring you up to date on what DBT-LBC is doing for you – at least in summary form. First, we congratulated Marsha on her new emeritus status at the University of Washington and her retirement (although she still remains active contributing to DBT around the world). As many of you know, we initiated a fundraising effort with contributions dedicated to sustaining DBT-LBC in the form of a Legacy Fund in Marsha’s honor. Seventy-seven donors contributed over $66,000 and we presented a plaque to Marsha at her retirement party with that information. We will post the video of it on our website, so you can see her joy at receiving this honor. Donations are still being accepted. (see the article below)
We have exciting news on the designation you now use to indicate you are certified by the DBT-Linehan Board of Certification. We filed for and have been granted the following “register” marks by the United States Patent and Trademark Office:
DBT-Linehan Board of Certification, Certified DBT Clinician®
DBT-Linehan Board of Certification, Certified DBT Program®
And the DBT-Linehan Board of Certification logo at the top of the newsletter. You are now required to use this formal designation (in place of the one using ™). Please update your designations wherever they are being used now. We have legal rights of enforcement against infringement, but we need you to be using the correct designation now to maintain that right. Thanks.
We have over 485 clinicians in the certification system – either certified or in process! And, we have wonderful news on the efficiencies now in operation. The delays in getting through the process are being addressed. Video coding wait times are significantly reduced. Thanks to all the volunteer coders who have been trained now and the revised requirements for number of videos needing to be passed. And over a dozen new Case Conceptualization coders are being trained as you are reading this to reduce the backlog in that area. We’ve identified the delays, addressed them and time lags are diminishing.
We have 30 DBT Programs in the certification process also! Half of them are certified and the other half are working on it. Remember, I have an offer of a free Sayrs and Linehan DBT Teams Development and Practice book that was just released by Guilford Press to the first 10 teams who start an application. Three are already accounted for – so the next 7 of you that get an application for Program Certification started get the free book!
Our committees are very active and contributing to the operations and improvement of DBT-LBC. We are working to improve our social media presence – so watch for changes in the Facebook page in the next couple of months. We explore opportunities to enhance the value of certification through communication with insurance providers, state agencies and legislators. New efforts are underway in a number of states. Boy, does that take a lot of time to make progress, but thanks to those hearty clinicians who are tackling this area. And, as always, our volunteers are the heart of our organization. All this happens with two paid (and wonderful) staff and nearly 100 volunteers (who are even more wonderful?)
Thanks to all of you.
Joan
Thoughts from our Public Member - Chris Kallas
Why certification? Newsletter column by Public Member of the DBT LBC Board, Chris Kallas
When someone you love has a mental illness, or even emotional difficulties, you don’t think, “Where can I find someone to help him who has a PhD in clinical psychology, who has at least five years of experience in treating someone with this disorder, who works with clinicians who are similarly and appropriately trained in DBT, and who supervises at a mental health clinic, or who teaches at a major university?”
No, you think: “Where can I find someone to help him?” And then you think: “What kind of help does he need?”
You assume that your state has created requirements for a mental health professional: educational and experiential. So, you don’t need to research that. You call your insurance company, get a list of clinicians who take your insurance, and you start calling them. Or you ask your friends, or people you know in the field. Or you join an online support group dealing with BPD issues, and you ask them for recommendations.
Imagine my surprise when I discovered that people hold themselves out as ‘counselors’ without having a doctorate. Or even a degree in some kind of mental health field. Maybe they wrote a book (based on their own experience). Maybe they have a master’s degree - but it’s from the Julliard School, and that’s not disclosed on their website. Maybe they are a member of the Better Business Bureau. That’s nice, but not likely to help my loved one. Maybe they work as individual practitioners. How can they provide what I now know as ‘DBT’?
We live in New York City. Finding help for my loved one with BPD ought to be easy, no?
If you Google “DBT clinicians in New York City” you get lots of hits.
The first one is an ad for a DBT Online Course at: https://www.udemy.com/dbt-certificate
The Google listing says:
Enroll Today & Get 75% Off
Learn Dialectical Behavior Therapy (DBT) And How To Get Certified!
The pre-requirements for taking this course are:
An interest in counseling or psychology
A basic knowledge of what counseling or psychotherapy involves
An awareness that counseling has different approaches.
Okay, not appropriate if you are looking for a trained therapist today. So, let’s move on.
The next hit, www.dbtsolutions, is for a private practitioner who works, not with those diagnosed with BPD, but with those who want to boost their careers, who want to be “more authentic and effective”, and with university students, ‘emerging adults looking for a boost”. Not suitable for my loved one.
The next hit sounds more promising. The site: https://www.psychologytoday.com/us/therapists/dialectical-dbt/ny/new-york
is a list of those who provide DBT therapy in NY, put out by Psychology Today magazine. It’s not clear if the magazine vets the people on the list in any way. The providers can be sorted by insurance they take, issues they address, languages they speak, and in other ways. So, you can plow through this list, and call people you might want more information on. They have degrees ranging from Art Therapist to PhD. It would be a daunting task to go through them and find one to help. As I browsed through the list, none of them highlight that he or she has been certified.
And so on. The list of people offering “DBT Therapy” is very long. But what each of them means by “DBT Therapy” is not clear. And it’s certainly not obvious who has gone through rigorous training as Dr. Linehan designed the protocol.
Those of us who have gone down the rabbit hole looking for help for our loved ones know that this is the way the search goes. Alas, many of the family members I have worked with in Family Connections have sent their loved ones to some of these people. They think their loved ones are ‘getting DBT’. But it’s not clear to me what they are getting. Can an individual clinician give effective DBT therapy to a patient? The average family has no idea that DBT, as studied, has been developed in a setting where clinicians work together in a group.
From the family’s perspective, how much easier it would be if everyone were certified and had to keep up his or her certification over the years. From the clinician’s perspective, given how complex it can be to work with a client with BPD, how much better it would be to have a list available of those who are practicing adherent DBT, and if our insurance companies paid clinicians more because of their expertise. Those who were not certified could continue to practice; they just wouldn’t treat my loved one, with her complex emotional issues.
I hope to see this result in my lifetime.
Reality Check by Juliet Nelson
If Alec Miller challenges you to begin the DBT program certification process together and months pass and you still don’t get going, you might ask yourself, WTF? Why not? Beware, this is not a tale of overcoming obstacles, rising to the occasion and finally accomplishing that goal. This is the tale of a new and small DBT practice in Kansas, as yet uncertified.... For those of you who are also waiting and watching or just trying to keep your heads above water, perhaps it will be validating. Why are we not further along? It’s the usual suspects: competing demands, the onslaught of clinical work and clients with wicked problems, credentialing delays and insurance issues, learning the hard way that we may need an office manager or at least a billing specialist, and throw in a roof leaking into the group room onto an already over-stressed printer. It’s no wonder the questions from team members arise: Is there any reason to do this? what will program certification get us? Will insurers pay more or consumers even know what it means? What good can come from this? It’s expensive and time consuming and makes you feel insecure. Are we really doing things the way we’re supposed to? How are we tracking outcomes and is it sufficient? Do our client’s get better fast enough? Does our consult team really provide therapy for the therapist? Are we always available 24/7 for crisis and coaching? Is the 4 miss rule really being followed? And, how’s that policy and procedures manual shaping up? These are the doubts and demands taunting us in the process. Meanwhile, Joan Russo offers a free book on teams to sweeten the deal; and the scholarship possibility is dangled in front of us on the listserv. Having the formal structure of certification had been my plan for motivating us after leaving the community mental health center. We were supposed to be practicing DBT more precisely. Were we willing to sharpen our work and open ourselves up to the feedback? Without taking action, my DBT desires feel thwarted, the excuses seem lame and Alec’s program has already completed the desk-top review and scheduled their site visit. I have to remind myself the reviewers want programs to come up to standard. And, the more programs that shape up and get certified, the more people will get the actual treatment we’ve all been working so hard to do. I’ve been urging myself along remembering how we fought to go to the first intensive training long ago. Our program took a leap into the “cloud of unknowing” and came up drunk with ideas and direction from Marsha and her team. You could be curious and ask, so this is what we need? I’m going to use some adaptive denial with the amount of paperwork and process; and borrow some enthusiasm from our first group of practicum students, arrived in June with that new-found DBT fever, just contagious enough to re-infect us all. They’ve been organizing us, knocking out details from the checklist, creating tracking forms and the policies and procedures manual. I know that we will have to step up and do more to get this off the ground. Anyone else want to take on the Alec Miller challenge? What are you waiting for? I’m thinking, “WHY NOT? Be the first certified program in Kansas---Just do it!”
My Path Toward Certification - Courtney Westin, LMFT
Courtney Westin LMFT, first began practicing DBT in 2013, when she moved to California with her husband. Before that, Courtney ran her own practice for four years in Bethesda, Maryland, with a focus on clients with eating disorders. She began practicing DBT for four years working with the DBT Center of Orange County. In 2017, Courtney founded SoCo DBT in Newport Beach, California, named after her focus on providing DBT to the South County OC community.
When she first began practicing in 2007 at a local inpatient program in Maryland, there was little information about DBT provided by her colleagues and supervisors. “I knew there was a skills workbook and thought that was what DBT was, a coping skills program.” But beginning in 2013, Courtney was formally introduced to DBT as we know it, finding it much more complicated and interesting. In particular, she was drawn to DBT by its results. As a clinician, she sometimes questioned whether the efforts “in the room” were having the desired effect to help people. As she began implementing DBT with her clients, she was excited to see the changes they were making and progress they made learning DBT. Clients who had been suffering for years began to stabilize and abstain from behaviors that had been plaguing them. The majority of those who stayed in the DBT program were not just surviving their struggles, but improving their lives.
Courtney obtained her DBT certification in April 2019. The push towards certification began in 2015, when Courtney completed intensive training at Willow Springs facilitated by Dr. Alan Fruzzetti. The process of becoming certified took three more years, and the work product portion of certification process was daunting at times. But her colleagues and clients continued to encourage her, and the most encouragement came from the client whose sessions she ultimately submitted for certification. “The client encouraged me to keep going, told me how far I had come and not to give up.” Ultimately, says Courtney, “Marsha Linehan’s program and teachings were so important to me and my practice, so I knew that I wanted to be able to tell my clients that I was a certified DBT clinician.”
Letter from the President's Desk - May
Hello all,
Our spring issue of Certification Matters coincides with and highlights the retirement of our illustrious leader and treatment developer, Marsha M. Linehan. Her work and findings have been such an inspiration and transformation for so many and her recognition in the special edition of Time magazine, “Great Scientists: The Geniuses and Visionaries Who Transformed Our World” was truly deserved. Marsha was involved in the creation of the DBT-Linehan Board of Certification and continues to value our work and your efforts towards certification. Many of you have contributed to the DBT Donations Where Needed https://linehaninstitute.org/donate/certification/ fund in her honor to sustain our organization. We thank you for that and there is still time to add to our acknowledgement of what her dedication and service have meant to us all.
May is Borderline Personality Disorder (BPD) awareness month and our Public Board member, Christina Kallas, provides us with a timely and heartfelt piece on BPD and the central place of the DBT-Linehan Board of Certification in the continued efforts to address this public health problem. Also highlighted is one of our newly certified DBT therapists and her personal journey to certification. Check out the Latest News on the website also for constant updates.
Sadly, we say goodbye to one of our own, Sarah Stelzner who left us too soon. Please see on our website, http://www.dbt-lbc.org/index.php?page=101126#118 the tribute to her and her wonderful family and her contributions to her profession and to DBT-LBC.
Please know that DBT-LBC is dedicated to providing the most valuable certification credential, accurately assessed and to make it known that it makes a difference to have earned and maintained it. Remember, the updated Applicant Handbook is available for download and provides the answers to your questions about the certification process. http://www.dbt-lbc.org/index.php?page=101149
We’d love to hear from you if you have any ideas to share. Use the Contact Us link on the website. It is checked every business day and we will get back to you. Thanks so much for your investment on behalf of delivering a treatment that truly saves lives.
Very sincerely
Joan
Thoughts from our Public Member - Chris Kallas
May is BPD Awareness Month. Thanks largely to the efforts of NEA BPD, on April 1, 2008, the U.S. House of Representatives passed House Resolution 1005, which recognized the month of May as Borderline Personality Disorder Awareness Month. The vote was 414-0. (Nope, not a typo; even Congress was able to recognize the challenges of this disorder.)
In the past eleven years, some things have not changed. Those with this disorder, and their families, often feel lost, wondering what is wrong, and what to do about it. We still, in this country and around the globe, don’t understand how to recognize mental illness ‘up front’, and how to treat it effectively and early on, so as to minimize its negative consequences. The feeling of isolation that results, of not being ‘normal’, of not fitting in, creates enormous suffering. The need to find effective treatment is a challenge that is daunting, even for those of us who are educated, and who have access to affordable medical care, and who are in areas where treatment is available.
Some things have changed. In 2013, the DBT Linehan Board of Certification was established. Since DBT therapy is the most effective treatment for BPD to date, it made sense to identify those professionals who were practicing it the way Dr. Linehan studied it, so that it was most likely to be most effective. Most states have basic licensing requirements for mental health care providers, but don’t set standards for different types of treatments. So people who practiced in the field decided that they would take on the task of assuring compliance with the DBT paradigm at its best, and the DBT Linehan Certification Board was formed.
Those of us who live in the world of BPD with a loved one sometimes feel that we would do anything to live on a different planet. The stress is never-ending, and often overwhelming. Many years ago I met Dr. Alan Fruzzetti, a mental health practitioner who lives in “BPD World.” He was always smiling, and he always had a suggestion about how to deal with whatever challenge was in front of me. I asked him once, “Why do you do this? Why do you voluntarily work with people who can be so challenging, so angry, so hard to make progress with?” He looked at me as if I had missed the whole point, and said, “But they are so interesting, so intelligent, so creative!”
I have now met so many professionals who treat people with BPD. You are so often extraordinary in this way of Dr. Fruzzetti. You choose to deal with challenges that would overwhelm lesser people. So this May, as far as I am concerned, is also BPD Treaters’ Awareness Month. To those of you on the front lines, who do so much to help our loved ones, I offer a salute, and a heartfelt thank you for all that you do. Please keep up the good work!
May is Borderline Personality Disorder Awareness Month – A Volunteer/Clinician’s Perspective
Nicholas L. Salsman, PhD, ABPP; DBT-Linehan Board of Certification, Certified DBT Clinician™
May is Borderline Personality Disorder (BPD) Awareness Month and DBT-LBC is an organization dedicated to reducing the suffering of individuals with BPD. As a DBT-LBC certified clinician and volunteer, I believe that this organization helps to save the lives of those who are suffering, particularly those with BPD. I choose to volunteer my time to this organization because I believe that the mission of DBT-LBC is critical. First of all, I want to extend my thanks to all of those who join me in donating time and money to this organization. Without your help, we could not fight so well to get state of the art treatment to individuals with BPD. Secondly, I would like to extend an invitation to all who are called to advance this mission to donate. We still have a long way to go to get DBT to all of the people who need it.
DBT is the gold standard treatment for BPD. It is a treatment that science has proven to be effective for reducing the suffering of individuals who severely need it. It helps people who may believe that death by suicide is their only choice to alleviate their pain. As a clinician, it is a privilege to be able to work with individuals who are diagnosed with BPD as they journey out of hell and into lives worth living. I have also worked with individuals with BPD who come to me believing that they have been through DBT, when they actually have not had DBT practiced in an adherent fashion. Sometimes these non-adherent treatments have led individuals down a path where they spend more and more time suffering without receiving the help that they need. It takes time to educate these individuals about why the treatment they received was not actually DBT and how participating in adherent treatment is completely different and worth their time.
The volunteers of DBT-LBC work tirelessly to ensure that DBT can be delivered in an adherent manner to those who need it most. The clinicians and programs who complete the LBC certification process have demonstrated through a rigorous process that they have knowledge of and practice adherence to the DBT model that has been scientifically proven time and time again to help those with BPD and others. We need more clinicians and programs who are fully equipped to help those who suffer with BPD.
Volunteers and donors are the heart and lifeblood of DBT-LBC. To inquire about volunteering, please send an email to [email protected]. In honor of BPD awareness month, please also, join me in making a financial contribution to the DBT-Linehan Board of Certification. You can do so by clicking this link https://linehaninstitute.org/donate/certification/ and scrolling down and clicking on the “Donate” button under the text “Donate to the DBT-LBC: Where Needed Most”. Please give what you can and encourage others to do so as well.
(Please note that the funds are initially deposited to the Linehan Institute because they are a 501c3 charitable organization and can make your donation tax deductible for you. They then send your donation to DBT-LBC, a non-profit 501c6 organization.)
My Path Toward Certification – Emily Vanderpool M.S., LPC
Everyone has their own path that led them to become a DBT-LBC clinician. For me, it all started with autism. I grew up with a brother who was diagnosed with high functioning autism, and I witnessed first-hand the emotional difficulties that individuals with these diagnoses face as they navigate life in a neuro-typical world. Thus, I sought a career in which I could provide support to people with high functioning developmental disabilities who otherwise might fall through the cracks of the system. This led me to receive my master’s degrees in both clinical mental health counseling and applied behavior analysis (ABA).
Meanwhile, I was working as a program therapist at a partial hospitalization for children and adolescents entitled Daybreak Treatment Center. The program’s founder and clinical director, Dr. Garry Del Conte, “Dr.D.”, had just introduced the therapists to DBT and we began meeting weekly for what would become a DBT consultation group. I was sent to the DBT Foundational Training, where my understanding and capacity for the application of DBT grew immensely, and then things really started to click. Not only was DBT working with my clients, but it also utilized the exact principles of behavior change that are inherent in an ABA approach that I learned about in studying interventions for the developmental disabilities populations. I was able to apply my training in ABA to more effectively implement the principles in DBT, and I was also able to enact change from a more dialectical, flexible stance that kept my clients engaged in the treatment.
The client who I used for my case formulation for my DBT-LBC application was a 15 year old, female client who had an extensive history of cutting, suicidality, and thought disturbance. After 7 weeks at the PHP level of care and then several months of outpatient , she was able to maintain zero rates of suicidal or NSSI behaviors and had eliminated thought disturbances across several months. I owe such successful outcomes to DBT. It clearly works. It saves lives, and I believe that it certainly saved my client’s.
Now I can proudly claim to be a member of the DBT-LBC club, and I have so much gratitude for Marsha’s brilliance and courage; an appreciation that is magnified as we collectively honor her retirement this month. I can only hope to “give back” by raising awareness and disseminating this life-saving treatment to other therapists, clients, schools, parents, and even my friends and family. It is a great privilege.
Letter from the President's Desk - March
Hello all,
It is hard to contain my enthusiasm for all the wonderful people who volunteer their time and efforts and all the tasks being accomplished at DBT-LBC.
The Board of Directors met for their first quarterly 2019 meeting and one item on the agenda was our annual Board elections. Dr. Suzanne Witterholt has been re-elected as Vice President and Todd Figura, JD was elected as Treasurer. He steps into the position formerly held by Randy Wolbert, who remains an active and valued Board member. We also voted to add members to the Board, filling the remaining 3 seats allowed by our bylaws. Joining us as At-Large Board Members are Melanie Harned, Ph.D, Dan Finnegan, MSW, and Kimberly Vay, Ed.D. We appreciate their contributions to the field of DBT, their valuing and support of Certification and their willingness to serve on the board. We are thrilled to have them and encourage you to please congratulate and thank them for their service.
Speaking of service, it was uplifting to see all of you at the ISITDBT meeting in Washington DC in November. I think there were about 443 people there. Taking advantage of having many of our over 60 volunteers all in one place, DBT-LBC hosted the first session of DBT-Leadership, Strategies and Future Directions for certification. Over 40 of us met for about 5 hours of small group work and some important projects are now underway. We explored the areas of legislative efforts, research on aspects of certification, communications and fundraising, and Maintenance of Certification. These four work groups are now reviewing what has been developed and proposing any new directions or changes that might be necessary. We will keep you posted.
Many of you participate on the DBT List Serve. As always, I am so appreciative of the many thoughtful and thought-provoking ideas posted there. With the recent national news on the high rates of suicide in our country, Josh Smith began a thread that all of us need to be aware of. I’ve included the link here in case you are not on the List Serve. https://nam03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.jointcommission.org%2Ffirst_data-driven_estimate_of_number_of_suicides_in_us_hospitals%2F&data=02%7C01%7C%7Ce7d60079b8de408d5d6f08d6853ede4d%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636842902399007235&sdata=4UCpyjkV0IxxkNiBm18cwynszXETEB61yUQyaxgW2Po%3D&reserved=0
What has followed this is a discussion about the implications of this article and others. Linda Dimeff shared a relevant article also that I would encourage you to look into. https://eur01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.huffpost.com%2Fentry%2Fa-radical-new-directionf_b_9838932&data=02%7C01%7C%7Cfce7a45ad2a343e85acb08d686ca2933%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636844600763698430&sdata=VHvPbHYuEL8xJnWamxCvhn1R7pnSt5zrAWgUcyOwXyw%3D&reserved=0
How does all this relate to certification? There needs to be spokespersons to advocate for effective treatment of this most vulnerable population. Who better to do that than DBT-LBC Certified Clinicians? As an organization we are working to advocate for the credential and its value to consumers, family members, states, insurance companies and even at the federal level. We are making inroads and slow progress in this area and won’t stop until we have educated, informed and motivated appropriate actions to provide the needed treatment and compensation.
Please know that DBT-LBC is dedicated to providing the most valuable certification credential, accurately assessed and to make it known that it makes a difference to have earned and maintained it. Please check the website regularly as we are updating it and post important news there. The newly updated Applicant Handbook is available for download.http://www.dbt-lbc.org/index.php?page=101149
We’d love to hear from you if you have any ideas to share. Use the Contact Us link on the website. It is checked every business day and we will get back to you. Thanks so much for your investment on behalf of delivering a treatment that truly saves lives.
Very sincerely,
Joan
Many of you know of the existence of the Family Connections program. Run under the auspices of NEA BPD, The National Education Alliance for BPD, Family Connections is a program for family members of people who have BPD. Every year end, my co-facilitator and I gear up for a new Family Connections group starting in January. It is always a moving experience to meet the new group members. These family members have tried everything they can think of to help their loved one with BPD, and often, it just doesn’t seem to have made much of a difference. When they arrive at the first group session, they are often frazzled, exhausted, dispirited, and fearful of the future. Over the course of 12 weeks, many of them start to have a little hope. We teach them about BPD, and they start to realize that the behavior that their loved one engages in is a result of a disorder, not a willful or malicious desire.
We teach them some of the DBT skills, and they suddenly have new tools at their disposal. They come into the group and say things like, “I tried what you suggested - and it worked!” They are surprised, pleased, and - most importantly - empowered in a new, life altering way. They say things like, “You know, I tried using that skill with my boss - and it worked!” So they are able to generalize the skills to other relationships in their world. They learn to be less hard on themselves when the skills don’t work with their loved ones. And they use the skills to ease, or at least tolerate, their own distress.
Many of them start to do things for themselves, things that they have put aside for their care-taking duties: going on dates, and taking vacations. You can see the result: their bodies are slightly more relaxed, and they remember the capacity for laughter, especially at the absurdity that we sometimes experience as humans in relationships of all kinds. Humor is such a powerful tool! In the beginning of my journey down this BPD road, I remember watching Dr. Linehan speak, and thinking to myself that her ability to be irreverent, and to laugh, was key to her ability to address this disorder, which can seem so powerfully destructive. So please, remember the DBT protocols, and do your very best to comply with them. And don’t forget to be irreverent, when needed. I’m always more effective when I follow that part of the protocol.
For more information on the Family Connections program, or to refer your clients to sign up for the group, see the NEA BPD website at: https://www.borderlinepersonalitydisorder.org/family-connections/
Letter from the President's Desk - November
Hello all,
This is the time of year when we consider the many blessing we have in our lives. Often, we get so bogged down with responsibilities, challenges and the demands of our daily lives that we don’t stop often enough to cherish the positives. That’s true here at the DBT-Linehan Board of Certification too. We are running full tilt to get things accomplished and sometimes it just feels overwhelming. Especially with everything that is happening right now. If we were successful in getting this newsletter out before ISITDBT, you will hear and see more about our efforts at that gathering. Please say hi to the many volunteers you will recognize by the ribbons attached to their name tags. And stop by our table in the Poster Session for information and to ask questions.
Scholarships!! We are so appreciative of the funding that allows us to offer scholarship aid of $270 to applicants for Clinician certification and up to $2000 for those applying for Program certification. You can still do an “end of year” tax deductible donation via the Linehan Institute website https://linehaninstitute.org/donate/certification/ directly to DBT-LBC in any of three categories – the two scholarship funds and the “where needed” operations fund. Thanks!
Apply for Program Certification NOW! We have five scholarships available for 2018! If you start your application before the end of the year you could be considered for one of them. And then in January another five are available for 2019! With 10 scholarships available, check out the eligibility requirements http://www.dbt-lbc.org/index.php?page=101170. Talk to any of the professionals who are part of certified programs and hear first-hand what an amazing experience it was for them and their teams. We have had extremely positive responses from every Team we have visited. Yes, it takes effort to accomplish, and, every program reports becoming stronger having gone through the process.
We have welcomed a new member to the Board of Directors. Christina Kallas, J.D., who has joined the Board as our new Public Member. She is replacing Regina Piscatelli. We thank Regina and wish her well and are so happy to have another Public Member who has firsthand experience of the value of DBT for a loved one and the need to be able to identify providers who deliver it with fidelity to the treatment model. Chris has jumped in with both feet and is already contributing in a number of important ways.
Our recruitment efforts to grow the number of adherence coding volunteers has been working. We have new coders added to the team and are tackling a backlog that has challenged those waiting in the queue as well as those of us focused on customer service. If you would like to consider becoming a calibrated video adherence coder, let us know through the Contact Us link on the website. http://www.dbt-lbc.org/index.php?page=101127
A group of colleagues came together for a discussion of DBT Leadership, Strategies and Future directions. We hope ideas generated there help broaden interest in DBT-LBC as well as add value to your certification credential. Stay tuned for updates.
Thank you all for your support, encouragement, contributions and dedication to the mission of DBT-LBC. DBT is a life-saving, life-enriching treatment when done well. We appreciate the work every clinician is doing in learning and delivering adherent DBT.
Happy Holidays to you all. Cherish your loved ones. May 2019 be good to you.
All the best,
Joan
Dr. Joan Russo
President
DBT-Linehan Board of Certification
Clinical trial shows dialectical behavior therapy effectiveness in reducing risk in suicidal adolescents.
Adapted from • Science Update, June 27, 2018
Researchers at the University of Washington, Seattle Children’s Research Institute, and collaborators at the Los Angeles Biomedical Research Institute at Harbor- University of California, Los Angeles (UCLA) Medical Center, and the David Geffen School of Medicine at UCLA have published findings from a year’s long RTC showing that DBT reduce suicide attempts and suicidal behavior in adolescents.
For this study, Elizabeth McCauley, Ph.D., and colleagues enrolled youth ages 12-18 who were at risk for suicide. The adolescents entering the study had attempted suicide at least once, had a history of repeated self-injury, and had trouble with emotional control—for example, unstable, intense, and often negative moods. Youth entering the trial were randomly assigned to either DBT or a comparison treatment, individual and group-supported therapy (IGST).
By the end of the first six months of the trial, suicide attempts and non-suicidal self-injury (NSSI) were significantly less likely in youth receiving DBT than those receiving IGST. Self-harm, which combines both suicide attempts and NSSI, was about a third as likely in DBT recipients compared with those in IGST. Of 65 youth randomly assigned to IGST who completed the end of treatment assessment, 9 had one suicide attempt and 5 had two or more; out of 72 assigned to DBT, 6 had one suicide attempt and 1 had two or more.
Twelve months after the trial began, rates of self-harm had declined in both groups; the rate was still lower in the DBT group, but the difference was not great enough—given the number of participants in the trial—to be statistically significant. Nonetheless, the benefit seen in the first months potentially saved lives; the authors point out that clinical trials of greater size or length may demonstrate a more sustained advantage to DBT and may assess whether altering components of the therapy could increase its effectiveness.
Another finding of the study was that youth receiving DBT attended more treatment sessions and were more likely to complete DBT treatment (attend at least 24 individual sessions) than youth receiving IGST. The greater success in this respect of DBT may have been an element in the difference in treatment effectiveness relative to IGST.
McCauley E et al. Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial. JAMA Psychiatry. 2018 June 20. doi: 10.1001/jamapsychiatry.2018.1109.
Greetings from a new Board Member
I am honored to have been selected to be the new Public Member of the Board.
Like many family members of people with BPD, my husband and I were often highly challenged by the difficulty in understanding our loved one. Then we discovered that there was a new treatment: something called “DBT.” So I went out and bought ‘the book’, and started to read it. At the end of Chapter one, I thought to myself, “This author gets my daughter”, and I continued reading all the way to the end - no mean feat for someone who hadn’t studied psychology since freshman year of college.
We are by no means the only family that feels as if DBT has been key in keeping our family afloat. Our daughter said to us many years ago, “Whatever treatment I get, it has to have a DBT base; that is what will save me.” We believe that she was correct.
We live in NYC, so there are DBT therapists available. The ones we have worked with are wonderful, true life-changers. But the more we spoke with other people who were in similar shoes, the more we realized that good DBT therapists don’t grow on trees, and finding one who is a good fit can be quite an undertaking, even in NYC.
So many of our loved ones have been through therapies of different types, and found those therapies not helpful. There is no way to move forward through BPD with a therapist you don’t trust; you just stay stuck.
So those of you who are therapists, who are seeking to become certified, please know that the people you serve, and their families, value you immensely, even if we don’t always say it to you.
Making sure that DBT therapists are properly trained and supported in an appropriate, team-oriented environment, is - to me - the number two health crisis in the United States today (after we figure out how to pay you what you are worth, or even something close to that.) So making sure that individual DBT therapists and DBT programs are properly practicing could not be more important to me and my family.
I look forward to working with the Board to ensure that our therapists and programs are properly trained and given all the support that they need, much of which is inherent in the DBT protocol itself.
Thank you for all that you do.
Chris
Christina Kallas, J.D.
DBT-Linehan Board of Certification
Public Member
Why did you go through the Clinician Certification process?
When asked, “What made you want to go for DBT-Linehan Board Certification?,” Jacqueline Stratton, MSW, LICSW and now DBT-Linehan Board of Certification, Certified Clinician and Founder of MN DBT Providers Coalition LLC, said, “I thought it would be kinda cool,” and “Why not try something that would enhance my practice and take my skills to the next level?” She had had some time to travel and the opportunity for certification arose. Shortly after she had applied to take the test her mother became ill and her father in law died. Certification was one way for her to cope with these situations. Jacqueline was one of the original test takers in Philadelphia and recalled high anxiety with this step. She found that during the process of certification and deciding to learn how to pass the case formulation step, she became a better practitioner. She was able to think about clients, their life worth living goals, treatment targets and treating these targets with more clarity, precision, and compassion. Recording herself and her sessions was initially quite aversive to her, and while using her own skills to manage this aversion, found a sense of increased accountability to DBT. She was more motivated to be sure that she was following DBT’s principles and protocols and felt she became a more effective DBT Therapist. She also shared that it was exciting to record sessions and recording added to her relationships with clients, including more intimacy. She would like to say a big “Thank you!” to Marsha Linehan, Suzanne Witterholt, and Bev Long.
Letter from the President's Desk - September
Hello everyone! There are so many exciting things going on at the DBT-Linehan Board of Certification. One place I would really like to start, though, is to extend a truly heartfelt thank you to all the behind the scenes volunteers that make our organization work. There are those who are visible, like the Board of Directors and committee chairpersons/members. But, most importantly, there are those who are invisible, behind the scenes, handling confidential materials and doing their jobs with no recognition and therefore little thanks. Our adherence coders are so dedicated and devote hours to each and every applicant’s work to assure that the treatment aspect they are reviewing is following Dr. Linehan’s treatment manuals. Can you imagine reading each and every Case Conceptualization and having to score it from multiple perspectives with consistency, accuracy and fairness each and every time? And to code videos of therapy sessions, not only for what IS there, but also what is missing that makes the session non-adherent? And, our application review team invests a lot of time assuring an applicant is truly ready to pursue the certification process. There are so many dedicated people working to assure our certification process is comprehensive and meaningful. You aren’t merely saying you read a book or attended a workshop or training. If you are participating in DBT-LBC’s certification processes, you are demonstrating your knowledge, skills and abilities to deliver DBT as researched by Dr. Linehan and colleagues. And it is those volunteers behind the scenes that make that privilege of using the designation – DBT-Linehan Board of Certification, Certified DBT Clinician – possible. THANK YOU, dear volunteers.
If you haven’t already noticed there are additions to the website and more to come. The Applicant Handbook has been updated, so you might want to take a look at that. We are working on making the whole Program Certification process clearer with additional guidelines and handouts available. Our Individual Clinician scholarship fund has grown, thanks to the contributions of all our colleagues who want to help others be able to afford the costs of certification. Program Certification scholarships continue to be available and we encourage you to check out the criteria for applying for that. Many programs are eligible, so take a look at the criteria listed.
We have the wonderful ISITDBT conference coming up in November in Washington, DC. I hope to see many of you there. Please say “Hi” and give a thank you to anyone with a Volunteer ribbon on their nametag! We need our volunteers. Have you thought of joining the team? Let us know through Contact Us on the website. We will be in touch.
One final note for now. As of the publication of this newsletter, DBT-LBC has formally applied for Accreditation through the National Commission for Certifying Agencies – NCCA. This is very important to you and we will explain that more once we earn that recognition. For now, I just want to thank the very small committee, led by Dr. Bev Long, for the person hours of dedication it has taken to bring this to fruition. The documentation that this has taken has made our organization even stronger and better equipped to offer you a top quality, high-stakes certification credential. We are committed to the legacy of Dr. Marsha Linehan, who stands out as a Great Scientist, for all the work she has done in the mental health field. Her dedication to the most vulnerable consumers in mental health has been a true gift. We believe getting certified in this treatment is valuable too.
Thanks everyone!
Joan
Dr. Joan Russo
Starting Certification? Grab Your Handbook!
Your DBT-Linehan Board of Certification makes available the Clinician Applicant Handbook which you can download at https://dbt-lbc.org/downloads/Applicant_Handbook.pdf. Our goal for this handbook is to explain the process of certification from beginning to end as well as describe the requirements for maintaining the proficiencies and status as a DBT-Linehan Board of Certification, Certified DBT Clinician™. The Handbook was recently updated.
Need a little Inspiration to get Certified?
Consider that DBT's developer, Marsha Linehan, has been profiled in the just released 2018 edition of TIME magazine's Great Scientists. TIME's list of the 100, "geniuses, eccentrics, and visionaries who transformed our world" included Marsha along with such luminaries as Jonas Salk, Marie Curie, Louis Pasteur, Charles Darwin, Margaret Mead, Sigmund Freud, Albert Einstein and Isaac Newton. Marsha has earned several recent major awards for her research and clinical work in Dialectical Behavior Therapy, including the 2015 Scientific Research Award from the National Alliance on Mental Illness, the 2016 Lifetime Achievement Award from the Association for Behavioral & Cognitive Therapies and, in 2017, the prestigious University of Louisville Grawemeyer Award for Psychology. Needless to say, as a DBT-Linehan Board of Certification, Certified Clinician™ you will be in fabulous company!
Annual Report 2018
BEGINNINGS
Dr. Marsha Linehan, PhD, ABPP, developed Dialectical Behavior Therapy (DBT) over thirty years ago to meet the needs of individuals who were chronically suicidal, repeatedly engaged in self-harm, were difficult to treat, and who had multiple mental health diagnoses, including Borderline Personality Disorder. DBT is an evidence-based treatment that has been subjected to rigorous clinical research trials, both by the treatment developer herself as well as colleagues not affiliated with her university lab, demonstrating repeatedly that it is effective in reducing suicide attempts, reducing self-harm, reducing inpatient hospital days, and reducing costs for treating these individuals while increasing their quality of life.
About 15 years ago, Dr. Linehan received requests from consumers and payers who wanted to know how to identify providers who delivered DBT adherently (according to the model Dr. Linehan developed and researched), so that they were more likely to have positive outcomes. She was convinced by them that she needed to develop a way to certify that clinicians and programs who indicated they offered DBT were capable of delivering it with fidelity to the model.
An initial effort was begun that culminated in the formation of the DBT-Linehan Board of Certification (DBT-LBC™) in February, 2013 as a non-profit 501c6 organization. Bylaws were created and the initial Board of Directors was formed along with a number of committees made up of dedicated volunteers that understood the value and importance of this effort.
DEDICATED PROFESSIONALS AND VOLUNTEERS
The DBT-LBC™ has been blessed with high quality professionals and volunteers that have been the backbone of our success. Many subject matter experts were critical in the development of our current exam and product knowledge assessments. Professionals in certification, psychometrics, business, technology and law were instrumental in the startup and continued development of the organization. In this annual report, we would like to recognize all the volunteers that have participated on the Board of Directors and committees (Fundraising, Scholarship, Program Certification, Item Writing & Test Development, Communications, Legislative, Accreditation Application and Applicant Handbook and Website Development Committees). Without their passion, dedication, work and time commitments, we would not be where we are today. A big THANK YOU to those before and to these current volunteers:
Marsha Linehan, Ph.D., Joan Russo, Ph.D., Suzanne Witterholt, M.D., Randy Wolbert, M.S.W, Henry Schmidt III, Ph.D., Kathryn Korslund, Ph.D., Andre Ivanoff, Ph.D., Regina Piscitelli, Todd Figura, J.D., Beth Lewis, L.M.H.C., Shari Manning, Ph.D., Bev Long, Psy.D., Alex Chapman, Ph.D., Annie McCall, MA, LMHC, Erin Miga, Ph.D., Emily Cooney, Ph.D., Jesse Homan, LPC, Jennifer Sayrs, Ph.D., Suhadee Henriquez, LCSW, Chris Conley, M.S.W., RSW, Nick Salsman, Ph.D., Nancy Gordon, M.S.W, Nikki Winchester, Psy.D., Candace Tomes, Psy.D., April Sobieralski, Psy.D., Melanie Uy, Psy.D., Joseph Morger, Alec Miller, Ph.D., Cindy Mancini, Ph.D., Juliet Nelson, Ph.D., John Bickel, LCSW, Sarah Stelzner, LCSW, Mandy Hyland, LICSW, Janice Kuo, Ph.D., Neal Moglowsky, LPC, Kim Skerven, Psy.D., Sylvia Davidson, Psy.D, Dan Finnegan, LICSW, Kay Segal, Psy.D., Andrew White, Psy.D., Jean Chambers, Barbara Petty, Monte DeBoer, Garry del Conte, Psy.D., and Catherine Johanneck, MSW, LICSW.
VISION, MISSION & CORE VALUES
As we look forward to the future our focus is centered through our vision, mission & core values. Our messaging is quite clear as we continuously strive for improvement in all that we do and represent.
Vision:
Assure high quality DBT mental health services that save lives while reducing overall health costs.
Mission:
Provide a source that clearly identifies providers and programs that reliably offer evidence-based DBT.
Core Values:
" Ethical - scrupulously follows the ethical principles of the mental health field
" Unbiased - Offers certification without bias or discrimination of any kind to all clinicians and/or programs that demonstrate proficiencies that meet DBT-LBC's standards.
" Effective - Develops and maintains a quality certification program; assesses the outcomes and effects of certification on mental health service delivery.
" Life-saving - Monitors research on DBT as any modifications to the evidence-based treatment evolve and updates certification processes to reflect any needed changes.
" Compassionate - Supports the clinicians and programs that treat often rejected consumers.
" Fabulous - the hallmark outcome desired by Dr. Marsha Linehan.
"Effective Compassion" is our tagline and succinctly defines our objective.
Our message is being distributed through our website, our e-newsletter - Certification Matters, our Facebook page, DBT Listservs, professional state DBT groups, state and national DBT advocacy agencies and at national, state and local conferences and meetings.
Certification Emblem Value
New Certification Emblems were created and are now being used by those certified. These emblems represent and recognize those that stand out in their field and are committed to adherent DBT. The value of these emblems is now being recognized by the profession and most importantly the public consumers of this life saving therapy.
CONCLUSIONS, CURRENT STATUS AND NEXT STEPS
DBT-LBC™ will soon be profitable on its own operational basis, but through the dedication of its volunteers and other donors who are committed to our success, DBT-LBC™ has had a positive bottom line for the last few years. A few recent significant donations have provided us with operational funding and allowed us to have a reserve for developing scholarship programs for potential applicants in need.
Since its inception, DBT-LBC™ has slowly grown each year and is becoming recognized throughout the US and around the world as the high-stakes certification standard for DBT clinicians and programs. Despite efforts by some to adapt and modify DBT in ways inconsistent with the research, DBT-LBC™ has maintained the high standards of the treatment and maintains the endorsement of the treatment developer. In the US, the state of Minnesota has recognized DBT-LBC™ as a state-approved certification body for their state's DBT programs, which, if certified, receive higher reimbursement rates for providing DBT to their state's public health consumers. DBT-LBC™ is using Minnesota's program as a legislative "model" for other interested states to adopt. This will have positive effects on the quality of DBT therapy offered along with facilitating the potential for better treatment outcomes, thereby reducing overall mental health services costs. As more states adopt this model through our educational and promotional efforts, more clinicians and programs will see the value and importance and want to become certified.
Obtaining NCCA Accreditation for DBT-LBC™'s Clinician Certification is an important step that shows our commitment to high quality certification standards to benefit the clinician, their programs and most importantly their clients. We will be submitting our NCCA Accreditation Application in August, 2018.
We hope that you will join us in our endeavors and vision to "Assure high quality DBT mental health services that save lives while reducing overall health costs."
Joan Russo, Ph.D. President
DBT-Linehan Board of Certification
Earlier posts
Another new scholarship for Clinician Certification Too
My name is Nick Salsman and I am a DBT-LBC certified clinician, as well as a volunteer for the DBT-LBC fundraising committee. I choose to volunteer my time to this organization because I believe that the mission of DBT-LBC is critical. This issue of Certification Matters is dedicated to May being Borderline Personality Disorder (BPD) Awareness Month. In honor of BPD Awareness Month, I am proud to announce that DBT-LBC is launching a new scholarship fund for clinicians seeking individual certification.
DBT is the gold standard treatment for BPD. It is a treatment that science has proven to be effective for reducing the suffering of individuals who severely need it. It helps people who may believe that death by suicide is their only choice to alleviate their pain. As a clinician, it is a privilege to be able to work with individuals who are diagnosed with BPD as they journey out of hell and into lives worth living. I have also worked with individuals with BPD who come to me believing that they have been through DBT, when they actually have not had DBT practiced in an adherent fashion. Sometimes these non-adherent treatments have led individuals down a path where they spend more and more time suffering without receiving the help that they need. It takes time to educate these individuals about why the treatment they received was not actually DBT and how participating in adherent treatment is completely different and worth their time.
The mission of DBT-LBC is to ensure that this treatment can be delivered in an adherent manner to those who need it most. The clinicians who complete the LBC certification process have demonstrated through a rigorous process that they have knowledge of and practice adherence to the DBT model that has been scientifically proven time and time again to help those with BPD and others. Having this certification provides assurance to the public that can help guide them to find the treatment that is needed. We need clinicians who are fully equipped to help those who suffer with BPD. The new individual certification scholarship fund will help increase accessibility of certification to all clinicians and thus increase accessibility of treatment from certified clinicians to all clients. DBT-LBC will be awarding scholarships of $270 to those who are dedicated to this mission, particularly those who serve the underserved. The process for applying for these scholarships can now be accessed by http://www.dbt-lbc.org/index.php?page=101172.
Please join me in donating to the Clinician Certification Scholarship Fund. You can do so by clicking this link https://linehaninstitute.org/donate/certification/. This is a new fund that we want to grow continually. Please give what you can and encourage others to do so as well.
(Please note that the funds are initially deposited to the Linehan Institute only because they are a 501c3 charitable organization and can make your donation tax deductible for you. They have generously offered to help DBT-LBC in this way; they then send a deposit of 100% of your donation to DBT-LBC for the scholarship fund.)
New scholarships available for DBT-LBC Program Certification
The DBT-Linehan Board of Certification is pleased to announce the availability of The Michael Chambers Memorial Scholarship Fund (MCMS). This fund was initiated to increase access to certification and to help address financial barriers which could interfere with prospective programs becoming DBT-LBC certified. The scholarship is particularly seeking to fund DBT Programs which are small in size, and/or primarily serving low income, disenfranchised or marginalized individuals. The eligible awardees receive a $2000 scholarship towards the Program Certification fees. Additional information around eligibility criteria and the application process can be found on the Program Certification Information page on the website: link: http://www.dbt-lbc.org/index.php?page=101121. The Scholarship committee is intent on increasing community access to DBT-LBC Certified Programs and further increasing knowledge around the importance of certification, with a goal of awarding five scholarships per year. Efforts are also underway to add to and grow the current level of funding in the MCMS to sustain scholarship availability for years to come.
The desire and demand for DBT has never been higher as this treatment continues to be disseminated world-wide for increasing numbers of client populations and in varied settings. Many DBT clinicians and programs are well trained and are doing excellent work. At the same time, many of us have had the experience of meeting a new client who shares the experience of “already doing DBT- it didn’t help!” While even experts have some occasional clinical outcomes that are less than positive, it has become evident that there are some clinicians and programs that are not delivering adherent, comprehensive DBT as developed by the treatment developer, Dr. Marsha Linehan. The risk is significant as substandard treatment fails to help those in need, increases feelings of hopelessness around treatment in general, increases risk of negative outcomes, and may bias individuals against a treatment which could be life-changing.
To address this growing concern, several years ago the DBT-Linehan Board of Certification (DBT-LBC), with the active participation and endorsement of Dr. Linehan, created a DBT Clinician Certification process to help prospective clients, families, and other professionals identify practitioners who had demonstrated the knowledge and ability to deliver adherent DBT. We are extraordinarily happy to report that the DBT-LBC launched the Program Certification arm of the process in mid-2017.
The goal of Program Certification is to support and encourage a proliferation of DBT programs providing adherent treatment. Importantly, it provides a ‘roadmap’ for programs to follow, highlighting critical elements that should be present in every DBT program – both organizationally to support the clinicians in delivering the treatment as well as clinically to review that all elements of the treatment are present. The review process, done by two trained Site Reviewers, offers feedback to the Program that discriminates between recommendations to the program that must be addressed for the program to be certified and suggestions, which may offer improvements that motivated programs might value implementing but are not required for the program to be certified. The awarding of DBT-LBC Program Certification indicates that the program has the structure and practices consistent with the delivery of a comprehensive implementation of Dialectical Behavior Therapy. It has undergone an extensive review that consists of scoring of responses to a Program Fidelity Scale questionnaire, program document and file review to see the structure of the DBT program, interviews with treatment providers and clients, and on-site observations of the DBT program practices in action. Programs are encouraged to address deficiencies using the recommendations and continue with the site review process to ultimate certification. Thus, Program Certification is another element in the broad set of resources for clinicians and programs implementing DBT.
For a DBT Program to be eligible to apply for certification, the Team Leader must have completed DBT-LBC certification as an individual Clinician. The Team Leader will be the person responsible for completing the application on line. We suggest that every program considering applying first complete the Program Fidelity Scale (PFS) https://dbt-lbc.org/index.php?page=101141. This document will help you preview the expectations and understand the degree to which you currently meet the requirements and whether you are ready to start the program certification process. This is an overall review of your program and gives you confidence that those expectations will be met.
The Program Certification application is only accessed through a Certified Clinician's DBT-LBC online profile. To get a good understanding of what is required in Program Certification and its application, please see the Application Self-Assessment https://dbt-lbc.org/index.php?page=101141.
We encourage DBT Programs to become certified and hope that the availability of scholarship assistance helps interested programs be able to pursue this valuable certification. Please check out the website for more information and feel free to Contact Us via the website with any questions. Thanks for your dedication!
Steps to Review your DBT Program for Certification Consideration:
a. Review and complete PFS Scale link: https://dbt-lbc.org/index.php?page=101141
b. Perform a Self-Assessment link: https://dbt-lbc.org/index.php?page=101141
c. Review or begin application (only DBT-LBC Certified Clinicians will have access to the application because one of the Program Certification requirements is that at least the team leader must be certified)
Alec L. Miller, PsyD
DBT-Linehan Board of Certification, Certified DBT Clinician
Chair, Michael Chambers Memorial Scholarship Fund Committee
Portland DBT Institute Receives Program Certification
By
Andrew White and Linda Dimeff
When individual certification first became available the Portland DBT Institute jumped at the chance. We had seen firsthand individuals who had continued to suffer after receiving what they thought was DBT, only to find they had not received DBT at all. We felt strongly about DBT programs setting the bar high and having clear criteria for what constitutes DBT. We also found when our clinicians went through the certification process, it had a huge positive impact on the clinic as a whole- people began forming study groups for the exam, sharing case conceptualizations, and increased their recording of sessions to get feedback from peers.
We applied for (and received!) our clinic certification in 2017. This process helped highlight areas of our services where we could tighten up and pushed us to shore those areas up. We have used the certification results to better meet the challenges of delivering high fidelity services to a growing population. Maintaining a high standard of service delivery for over one thousand clients per year and twenty-five full time therapists is a difficult task requiring a great deal of clinic infrastructure.
The on-site review process included feedback to both clinical and management staff which has further helped us to understand the relationship between how a principle or policy is expressed and the way in which it is experienced by individuals in the clinic. Clients interviewed by the review team expressed appreciation for having their voices heard as well as a greater connection to the clinic.
The impact of certification has been far greater than the sum of its parts. Certification has become a point of pride for staff and clients and has an ongoing positive impact. Much more than an administrative task the review process has been designed with the goal of adhering to core DBT principles around increasing staff’s competency and motivation to do the treatment. The completion of the certification process and third-party recognition around our delivery of DBT is an honor and reflects our core values as a clinic.
The Importance of Providing Linehan Board Certified Dialectical Behavior Therapy for Borderline Personality and Substance Use Disorder.
Family Perspective - by Regina Piscitelli
In light of the current opiate crisis in the United States it is more important than ever for families and clients to have access to both DBT-Linehan Board Certified programs and DBT-Linehan Board Certified therapists. About 78% of adults that suffer from BPD also have experienced a substance use disorder (Kienast, Stoffers, Bermpohl, & Lieb, 2014) and there is an increase of up to four times more risk of suicide (Darke, Ross, & Williamson, 2005). Heroin users with BPD have an increase of negative consequences and develop more health related problems. There is also a higher likelihood of heroin overdose (Darke, Ross, &Williamson, 2005). The possibility of an overdose creates an environment where families live in constant fear and uncertainty.
For nearly two decades, Dr. Linda Dimeff, PhD has collaborated with Dr. Marsha Linehan, PhD to develop an adaptation of DBT for BPD individuals who also have substance use disorders (SUD). Comorbidity of BPD and opioid addiction results in a more severe and persistent course of both disorders. People with multi-diagnosis are much more difficult to treat. The DBT-SUD treatment model is based on the standard DBT treatment model but targets specifics related to BPD and substance use disorders. Research has shown that implementing the DBT-SUD treatment model results in less drug use, better global assessment, lower drop out and continued gains. These studies provide evidence that DBT-SUD is effective in treating substance use problems while simultaneously addressing other complex problems.
The importance of including family in the treatment provided for the client gives the family the opportunity to learn some of the basic DBT ideas and skills that clients are learning in the program and explore ways to provide an environment for clients balancing a validation focus with acceptance strategies. Having the family involved promotes a better outcome and motivates the client to stay in treatment.
With the opioid epidemic gripping our nation and people dying from overdose at alarming rates it is important for clients and families to have available DBT-Linehan Board Certified programs and DBT-Linehan Board Certified therapists that are competent in delivering effective evidence based DBT. The potential lethal consequences that could result due to BPD-SUD underlines the need of finding a therapist or program that is Linehan Board Certified and adherent in DBT that can provide a treatment that is evidence based, board reviewed and held to the highest standards.
References:
Darke, S., Ross, J., Williamson, A., & Teesson, M. (2005). The impact of borderline personality disorder on 12-month outcomes for the treatment of heroin dependence. Addiction, 100(8), 1121-1130. Doi:10.1111/j.1360-0443.2005.01123.x
Kienast, T., Stoffers, J., Bermpohl, F., & Lieb, K. (2014). Borderline personality disorder and comorbid addiction: Epidemiology and treatment. Deutsches Arzteblatt International, 111 (16), 280-286.
http://doi.org/10.3238/arztebl.2014. 0280