Residency Programs w/ Strong DBT Training

[DynamicDidactic]

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I was wondering if anyone has info on residency programs that provide training in comprehensive DBT.

I know University of Washington SoM does but who else around the country (or Canada).

 

[Rogue Penguin]

I'm no expert on this subject, but Albert Einstein/Montefiore was very proud of their DBT training and it appeared extensive.

 

[WingedOx]

I know University of Washington SoM does

Seems like this would be an obvious choice for a number of reasons....

 

[splik]

MGH McLean and columbia spring to mind. maybe some other programs in boston. mass mental health has good DBT program.

many places that claim to offer DBT are not really offering true fidelity DBT but DBT-lite.

DBT is not a core requirement for psychiatrists so full training in DBT is elective. There are no places that would provide every single resident with the full DBT training. Even at UW it is an elective and can be done to different degrees of intensity, most people do not do the full training. Also though Marsha Linehan is still kicking around she has absolutely no contact with the psychiatry residents whatsoever as they are on the bad side of the split.

 

[HarryMTieboutMD]

MGH McLean and columbia spring to mind. maybe some other programs in boston. mass mental health has good DBT program.

many places that claim to offer DBT are not really offering true fidelity DBT but DBT-lite.

DBT is not a core requirement for psychiatrists so full training in DBT is elective. There are no places that would provide every single resident with the full DBT training. Even at UW it is an elective and can be done to different degrees of intensity, most people do not do the full training. Also though Marsha Linehan is still kicking around she has absolutely no contact with the psychiatry residents whatsoever as they are on the bad side of the split.

Again in rare agreement with Splik. Real DBT is extra training that takes time and intensive work with supervision. It is rarely done by MDs anyway. If you train at Cornell you can learn Transference Focused Psychotherapy; I'm not sure how much involved Kernberg is in actually teaching, but John Clarkin I think is heavily involved (he gave grand rounds in my dept- was actually pretty interesting).

 

[notdeadyet]

At UCSF you can do elective DBT training and also satisfy your group therapy requirement in PGY-3 year with DBT. There is more supervision potential than interest. UCLA SMI also has supervision in DBT.

I agree with HMTMD and splik though. DBT will not be a required component anywhere. You instead would see which programs have DBT therapists who are interested and available to train psychiatry residents. You would then see the quality and quantity of the therapy portion the training (how many hours of therapy time allocated, how many hours of 1:1 and group supervision, etc.).

Most psychiatrists don't conduct DBT as such. It's great to learn the foundations and I wish more programs did. It is very helpful to learn to use in other psychotherapy modalities and in longitudinal patient care even if it's primarily medication-based. But hard core DBT'ers tend not to be psychiatrists. Telling a panel of patients with acute Borderline pathology that they can call you anytime from 7am-11pm if they feel like cutting or killing themselves gets less and less appealing during residency.

 

[DynamicDidactic]

thanks everyone for the info.

At UCSF you can do elective DBT training and also satisfy your group therapy requirement in PGY-3 year with DBT. There is more supervision potential than interest.
Most psychiatrists don't conduct DBT as such.

I understand that is the case. I wanted to get an idea where residents, if they wanted, could get training in all components of DBT.

 

[DD214_DOC]

Why on earth would you want to do this?

Anyone heard of naltrexone for NSSI? Encountered that yesterday.

 

[notdeadyet]

Anyone heard of naltrexone for NSSI? Encountered that yesterday.

Yeah, there was a study done back in 2008 or 2009 showing the mechanism and used naltrexone as an intervention. I think there have been more studies but I haven't seen much on it.

I'm not very cutting edge with NSSI. Sorry for the obvious pun...

 

[HarryMTieboutMD]

Yeah, there was a study done back in 2008 or 2009 showing the mechanism and used naltrexone as an intervention. I think there have been more studies but I haven't seen much on it.

I'm not very cutting edge with NSSI. Sorry for the obvious pun...

Are you sure? As far as I'm aware the literature on this is limited to case reports and a couple of small, open label pilot studies without control. Jon Grant from Univ Chicago publishes a lot using naltrexone for OCD spectrum/impulse control/process addiction disorders (trichotillomania, skin picking, kleptomania, pathological gambling), but the literature on naltrexone in Borderlines doesn't seem to be great

 

[notdeadyet]

You may very well be talking about the studies I mentioned. They were unimpressive, small n affairs I didn't make much of.

But they were specifically for Non-suicidal self harm. I don't remember the diagnoses, but I want to say it was Axis 2, not OCD or impulse control.

A quick Google search should turn them up. There is always the very real possibility that my memory failed and I'm flat out wrong.

 

[HarryMTieboutMD]

Here is the latest "evidence" on the subject (a very mediocre systematic review published in Canadian J Psych, Impact factor 2.4) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244876/

So yeah, very weak evidence at best. Given how everyone wants to use Naltrexone for everything associated with maladaptive behavior, there probably are completed RCTs that show no benefit over placebo; however I'm not sure why they haven't been published, even in a mediocre journal