A version of this article was also published on Psychology Today.
As a DBT therapist, it wasn't an uncommon experience for new DBT clients to inform me that they hate DBT. During their intake, they'd explain how they'd done DBT before and it didn't work. But, they'd tell me, they're trying one more time because they're still suffering and desperate for help. I'd get so excited when this happened.
While I was not happy that they were still suffering, I was thrilled that they had tried again and had found me. Because almost every time, after a little conversation, we would determine that they actually had *not* been in DBT before. Usually, their previous therapist had taught them DBT skills. But, DBT is way more than the DBT skills.
Just like in those sessions, I'm excited that you're here reading this. Because, if you're even asking the question "How do I know if I'm getting real DBT?", then you're ahead of the game in realizing not all "DBT" is created equal. Below, I'll offer some questions that you can ask yourself and your therapist (or your potential therapist) to know if you're getting "real" DBT, or truly adherent DBT. (If you don't know what I mean by "adherent" DBT, or you just want more background on the below questions, check out my post on adherence.)
7 Questions To Ask
The questions below largely focus on the most obvious features of comprehensive DBT. Comprehensive DBT is the original form of DBT that has been shown in the research to be the most effective treatment for helping with borderline personality disorder, (c)PTSD, and other mental health struggles defined by intense emotional dysregulation and/or impulsive behaviors.
So. What do you ask?
Does your treatment include all three of the following: weekly individual therapy sessions, weekly DBT skills learning sessions (likely in the form of a DBT skills group), and as-needed phone coaching calls with a therapist between sessions? If not, it's not adherent DBT.
Do all of your individual weekly sessions focus on specific behavioral goals and targets that you and your therapist identified together at the start of therapy? If not, it's not adherent DBT.
Do you track these behavioral targets and your emotions daily using a diary card between sessions every week? If not, it's not adherent DBT.
Do you complete homework practicing skills every week? If not, it's not adherent DBT.
Does your therapist attend a weekly consultation team with other DBT therapists? Is this team meeting *entirely* focused on discussing DBT cases and how they can be the best DBT therapist they can be? If not, it's not adherent DBT.
Has your therapist received intensive training in DBT? If not, it's *probably* not adherent DBT. ("Intensive training" may include a semester-long class on DBT, a months-long clinical placement where they practiced DBT, a 1-to-2-weeklong, full-time clinical training session, or some educational equivalent.)
Has your therapist received direct supervision specific to DBT for the duration of treatment for at least one client in comprehensive DBT? If not, it's *probably* not adherent DBT. ("Supervision" is a professional relationship in which your therapist would have attended weekly meetings with another licensed therapist who is an expert in DBT. During these sessions, your therapist would have discussed a current, ongoing DBT client with the supervisor in order to receive feedback about their work and their application of proper DBT techniques. Ideally, the supervisor would have even been listening/watching real footage of your therapist's sessions with this DBT client.)
While there are more features than the above that make a therapy "real DBT," the above questions are the biggest and easiest things to confirm.
If you're thinking: "wait, can I actually ask my (potential) therapist about these things?" YES! Any true DBT therapist would be thrilled if you ask them about whether they're providing adherent DBT to you or not.
One More Thing to Know
It can be tough to find adherent DBT. The frequency of people thinking they’ve been in DBT when they have not is partly what inspired the creation of the Linehan Board of Certification for DBT therapists and programs. DBT-LBC-certified clinicians like me have demonstrated their DBT expertise through written exam and expert-watched recordings of their real DBT sessions with clients. Check out their website for a directory of DBT certified-expert clinicians! (Be aware: there are other trainings that provide "certification" to clinicians in DBT for attending their trainings. While some of these trainings can be great and could be considered "intensive" as described above, only the DBT-LBC certification actually requires clinicians to pass extensive expertise reviews.)
If you attend therapy with an DBT-LBC-certified clinician or program, you can be way more confident that you're getting the real deal. But, DBT-LBC is relatively new. There are a ton of qualified DBT therapists offering adherent, comprehensive DBT who are not LBC-certified. I hope this article and suggested questions help you find "real" DBT!
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