Why should I consider joining a DBT Consultation Team?
Do you find yourself dreading certain days of the week, and you notice that it’s the days you have clients with traits of borderline personality disorder? Do you find yourself getting angry in a session and then trying to cover it up and pretending you weren’t angry? Maybe you don’t even want to interact with friends or loved ones after work or on the weekends because you’re so drained by one or two of your clients.
Maybe you think to yourself, if I could just transfer this one client then I wouldn’t be feeling so burnt out and overwhelmed.
Clients with BPD are in pain….and the therapists who work with them are often in pain as well
Surveys have estimated the prevalence of borderline personality disorder to be 1.6% in the general population and 20% of the psychiatric inpatient population. With a population of 329.5 million in the US in 2022, that means there are an estimated 5.27 million people who meet criteria for BPD in the United States.
Many therapists, psychologists and doctors do not want to treat borderline personality disorder because they believe it’s too difficult to treat or untreatable. They continue to stigmatize clients. They oversimplify how easy it is for clients to learn how to regulate emotions. They minimize how much damage a single incident of trauma or a childhood filled with little (or big) traumas can add up in a person’s nervous system.
According to the researcher, Dr. Marsha Linehan, one of the largest contributing factors for borderline personality disorder is the combination of a biological predisposition to high emotionality, as well as experiencing an invalidating living environment. Clients with BPD tend to show a biological predilection for emotion dysregulation. Invalidation can come in the forms of trying to live up to perfect standards compared to parents or siblings, a very chaotic household, or a normal household where others do not feel the same intensity of emotion like the person with BPD does.
Therapists struggle to overcome the cultural mindset that there are NO treatments that can help clients with symptoms of borderline personality disorder. Without a weekly DBT Consultation Team for support, it’s an intense effort to stay on task with clients who come in with new crises every week, and even call a few times between sessions. There are so many responsibilities clinicians have each week to run their businesses—it’s difficult to dedicate time to attend weekly DBT Consultation Team meetings instead of those other tasks crying out for attention. Some therapists don’t want to admit that even after years of experience, they still need to be vulnerable enough to ask for help with clients who find and push the therapist’s “buttons”.
A DBT Consultation Team provides a safe, confidential, and supportive place to receive validation for the work that you’re doing with your clients, make sure you’ve conceptualized the client’s problem accurately, and find creative solutions to help with various behaviors.
What is required to participate in your DBT consultation group?
The most helpful thing would be to complete a 5-day Foundational DBT Training course with Behavioral Tech LLC. However, if you’re unable to do that, then at minimum you need to read Marsha Linehan, PhD‘s 1993 text titled Cognitive Behavioral Therapy for Borderline Personality Disorder. You also need to read the two books for the Dialectical Behavior Therapy Skills group. Read the DBT Teaching Manual as well as the spiral bound book with all the DBT Skills Handouts & Worksheets. There are a few other books that will be highly recommended as we work together as a team.
Be prepared to do a mindfulness exercise at the start of each DBT consultation team meeting. Be prepared to occasionally lead that mindfulness activity. Consistently do your own mindfulness practice seven days a week, and if that’s not possible at least three days a week.
Be prepared to be supportive of other clinicians and be willing to be vulnerable with your difficult cases. Do not only come to group to listen and observe others. This will be an active group where you will be expected to be working with clients who have borderline personality disorder. You will also be required to share the progress you are making with your clients.
Why should I join your DBT Consultation Group?
There are many great DBT Consultation Groups out there that you could join. However, many of them require you to be part of their group practice or only be practicing full protocol DBT in your practice. Many of us cannot, but we should still adhere as closely as possible to what DBT Therapy suggests. And, we need good clinical reasoning for when we modify the therapy for clients.
We need support in making those decisions.
I started my training in Dialectical Behavior Therapy back in 2004 in a community mental health agency that practiced full-protocol DBT and I attended a weekly DBT consultation team meeting. During my training, I was required to show video tapes of my work every 6 weeks. I learned to staff clients with a well structured DBT Case Formulation. Clients were required to do DBT diary cards for their weekly individual therapy sessions. Clients were required to attend weekly 2.5 hour DBT skills training groups. I led one of the groups for 2+ years. We had both adult and adolescent programs.
When I was promoted to a Clinical Site Director position in 2008, I joined the DBT Training team and was sent to Fort Collins, CO to complete a 2 week Intensive DBT Training with Behavior Tech LLC. I improved & enhanced my skills of applying DBT with clients & in running skills groups. I learned there how to structure & lead a DBT Consultation Team. I led those meeting for 8 years. We practiced non-judgmental and dialectical stances when staffing cases. We looked for ways to support & validate the therapist in their work--we maintained the assumptions that clients are doing the best they can, they want to improve & they can do better, try harder and be more motivated to change.
When the Linehan Board of Certification was created, I was in the 2nd group of test takers at the University of Washington. I passed this test and started the rest of the process to become certified. However, my agency started the process of merging with another company and I was unable to work with clients in my new position to be able to turn in work the product required to complete certification.
I'm still passionate about the application of DBT with clients. I've just had to modify a few things once I left group practice to have my own solo practice.
Maybe you still have questions about whether joining a DBT Consultation team is right for you…
I don’t have time to attend this team meeting
DBT consultation meetings are helpful to more than only your clients with borderline personality disorder. Over the years I have learned better how to keep clients on track with their commitments and goals, help clients change their behaviors, and learn to be very patient with slow progress. In addition, I have honed my skills in doing behavioral chain analysis with clients. Now it is much easier for me to keep multiple crises organized in my head and on a note page, to keep clients on track with their progress.
I will only attend this meeting when I have problems with a client with BPD
If you only come to DBT Consultation Group meetings when you are stressed out and at your wits end with a client who has borderline personality disorder, then it’s going to be much more difficult for you to learn and apply what you need to with a client that already has you burnt out. When our nervous systems get very stressed out, it impacts our ability to take in information, synthesize it and then remember to try out new things later. When we are stressed out it’s also very difficult to be creative. It is so helpful to maintain regular contact and staff cases often to head off any intense emotional interactions with clients.
I will let the client know that they have BPD and transfer them to another therapist
This could be a fine plan if you haven’t discussed the symptoms and problem behavior that you’re noticing come up over the last few months. The best thing a DBT consultation team can do for you is to learn how to talk to clients about their BPD symptoms and to create a strategic plan for decreasing impulsive behaviors and increasing effective, skillful behaviors. It’s much easier for me to do this with all of my clients because of the time I’ve spent talking, practicing and honing the skills with my DBT team.
How do I sign up for your DBT consultation group?
You can email or call to find out dates and times of our meetings.
You can also call and do a 15-minute consultation to discuss the pros and cons of joining the DBT consultation team