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Training in DBT?

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by little_albert, Jul 12, 2018.

  1. little_albert

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    I am currently on internship and will be attending a VA next year for post-doc. Unfortunately, although I got a decent amount of training in CBT and some exposure to ACT in grad school and internship, I haven't had any exposure to DBT. Although I know the VA I am going to probably does have some DBT stuff going on, due to my post-doc specialty, I don't imagine having sufficient time to be part of a skills group or receive additional supervision outside of my requisite responsibilities and 40 hour work week. I imagine as post-docs we will get some training in DBT during our seminars, etc, but given how extensive DBT seems I wonder whether it will be sufficient to actually use.

    It seems like DBT is a very sought after skill on the job market these days, and I have met a lot of respectable psychologists who are big fans of it and seem to think it works. So, I have been looking into outside agencies who do trainings in it (fellowship i'm on is paying). It doesn't necessarily need to be some fancy/expensive "certification course" (I know this topic has been discussed before), but I'm wondering if anyone on here has done intensive DBT trainings, and how your experience was / whether it was worth it. I know Behavior Tech and PESI do DBT trainings, among others. Would love to hear from anyone who has done them -- both in terms of how the training itself was and your comfort afterwards actually delivering the therapy.
     
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  3. EmotRegulation

    Psychologist Faculty 5+ Year Member

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    Several of my students have done the Behavior Tech trainings online and liked them (I've looked at the materials; they seem good). That said, doing those trainings and then "delivering the therapy" is not really the sequence of events. Full DBT involves group treatment, individual, team meetings and phone consults between sessions, it's a whole package. Is it possible to do some trainings to learn the DBT skills and how to teach them to clients, as well as how to do chain analysis? Sure, totally. But how to do DBT in it's whole glory? That's another story, and you'd need to join a DBT team for that. (Not to mention there is a "style" to full DBT which is hard to teach....not impossible, but hard out of the realm of the full package DBT.)
     
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  4. little_albert

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    Thanks! I don't want to stray from the original topic too much, but your response did prompt another question. I know what you said about doing full DBT is true and have certainly heard that before. But if that is the case, what do you make of so many clinicians saying they are integrative and mix elements of "CBT, DBT, and interpersonal" frameworks (e.g., "my approach or X group is sort of like, DBT light"). Do you think it would be useful to do the Behavior Tech training to be able to integrate elements of DBT into your clinical work, without planning on ever doing full on DBT?
     
  5. smalltownpsych

    Psychologist 2+ Year Member

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    Much of the information that I have learned from Linehan is useful in clinical practice when working with patients with Borderline types of presentations. I say that I know DBT and that it informs my clinical work but that DBT itself is a more structured treatment beyond the scope of typical outpatient once a week therapy. One of the struggles I see with community treatment in many areas is that it is difficult (or expensive) to provide the appropriate level of care that is indicated for a patient. It goes from either brief intensive inpatient to regular outpatient. Most of my patients need options that are in the middle but it is seldom available. This dynamic is one aspect of what gives rise to "DBT-lite" types of conceptualizations.
     
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  6. little_albert

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    Thanks!

    If anyone has done one of the in-person or online courses by PESI or Behavioral Tech, I'd be especially interested to hear about your experiences and whether there was any specific instructors who were recommendable.
     
  7. temppsych123

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    BTech is considered *the* place to go for training, IMHO. PESI trainings are such a crapshoot - I've seen ads for some trainings led by folks who definitely were considered experts in their areas, and others that were just clearly not focused on doing EBT training. There's also the Treatment Implementation Collaborative (TIC, ticllc.org) which, in my experience, has folks leading the training who were fully DBT-trained by Marsha and co, but who aren't part of BTech any longer.

    DBT purists and non-purists will disagree about folks who say they "integrate CBT, DBT, and interpersonal" models, or whatever other combination with DBT, in therapy. DBT is an extremely intensive treatment, both in terms of the requirements on the client (commitment for at least one year of treatment, weekly group + homework + at home diary card completion, weekly individual therapy, phone coaching) and of the therapist (weekly consultation team, being trained to adherence, which requires a LOT of time, energy, and money). Anyone who says they "do DBT" as a single, individual provider in private practice doing individual therapy only is mistaken and/or lying. And, the evidence for DBT in treating BPD, and decreasing suicidality, primarily involves testing of "full model" DBT, so I think it does a disincentive to those clients when they think they are getting "real DBT" from a provider or program but are not, in fact, actually getting all the components. That being said, there are plenty of ways of thinking about psychopathology, and skills that are taught in DBT, that are useful for other clients, and that are helpful to learn even if you aren't going do to full-model DBT, so I think getting training (if possible) is worthwhile. Just don't go to a two-day training and say you do DBT!
     
  8. DynamicDidactic

    DynamicDidactic Ass of Prof
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    As mentioned by @temppsych123, please steer clear of PESI. I'll use much more blunt language, PESI is a money making organization that prioritizes business over science. Feel free to check out the tons of pseudoscience and some straight up quackery that they sponsor. I have never been part of their DBT trainings but I see a lot of marketing gimmicks and tricks that make me very suspicious. Also, their DBT trainers have murky histories of training. Generally speaking, since DBT was developed relatively recently all experts in the field can easily be traced back to where they received their training. Doesn't seem that way for PESI, I can never figure out how/where/by whom these folks were trained. I would say the reputable organizations that provide DBT training start with BTech and include TIC as mentioned by temppsych. I'll also add Portland DBT Insititute and Practice Ground. These organizations are dedicated to training individuals with fidelity to the treatment.

    But as mentioned, practicing DBT requires more than a short training. Even the intensive trainings over a 6 month period is just a starting point.
     
  9. cara susanna

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    I did the intensive training with our DBT team on post doc. It was really great. I'd had DBT exposure beforehand, though, and then my fellowship also involved being supervised on cases.

    And, yeah, full model DBT is awesome but it's hard to implement and, in some places, hard to find. Where I currently work, I just do "DBT-informed" therapy and skills training.
     
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  10. little_albert

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    Do you think the intensive DBT training would be worth it as a first step, if you hadn’t already had DBT exposure beforehand? Also, do you think there is much additive value to doing the intensive inperson training vs. just reading a DBT book? I guess I am trying to figure out if it’s worth it to attend one of these trainings (eg behavioral tech) if one has had little exposure to DBT and only plan to use it as “DBT informed therapy” and/or skills training?
     
  11. cara susanna

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    I think it was really helpful. The thing is that, when you do intensive training, you're training with your team. So it's not really an individual training so much as a team training in order to eventually implement the full model program (or as close to it as you can get). There is an intensive training option for individuals who are hoping to eventually join a team, but I don't know what that's like vs. the team training that I did. If you're only doing skills training, I think you can learn that through other types of workshops or informal training. If you're actually doing individual therapy, even if it's only DBT informed, it may be something to consider. I think that's where the intensive training was the most useful for me. On the other hand, Behavioral Tech has a lot of online courses you can take as well.
     
  12. BuckeyeLove

    BuckeyeLove Forensic Psychologist
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    Most places I've been at, or have been exposed to, say they do DBT, but in reality all they do are talk about the skills in group formats. I live in a pretty decent sized metro area, and I honestly don't know of any practices that are offering the full blown manualized version of DBT (individual, group, phone calls, etc.).
     
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  13. futureapppsy2

    futureapppsy2 Assistant professor
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    Have there been many good studies on the skills training alone as a treatment? Last time I checked, there wasn't, but I'm wondering if things have changed.
     
  14. MamaPhD

    MamaPhD Psychologist, Academic Medical Center
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    It seems like a hidden question in your post is whether you need to have training in DBT to be competitive on the job market. Unless it's important to your career goals (eg, you want to work in a setting where DBT is widely implemented, or with a population for whom DBT is a first-line therapy), then the answer is no. My observation is that much of the DBT-lite/"DBT-informed" therapy out there overlaps a good deal with ACT.

    As an aside, I am always suspicious of people who throw out a big alphabet soup of modalities they've been trained in. This is often a marker of a poorly trained person, or at least a shallow thinker. You don't need to be competent in every therapy, and you may encounter some skepticism if you claim to be versed in more than two or three modalities.
     
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  15. cara susanna

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    Dismantling studies suggest that the skills training is the most effective part of DBT, so there is some evidence behind offering them alone IMO. Obviously it's not ideal, though.
     
  16. little_albert

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    Good points, and I agree regarding clinicians who advertise with a few too many acronyms. Although I am not interested in being a full on DBT therapist, I think part of my interest in learning it stems from frustration I've encountered this year with trying to use traditional CBT techniques and lack of client motivation/interest in completing HW. For example, although things like thought logs might work, how many clients actually complete them as prescribed? I know DBT is grounded in CBT, but I was hoping getting some additional skills training might give me some tools that I could deliver to clients that they might find useful. I've had many clients who are emotionally dysregulated (although not BPD) who I've had difficulty helping, and was hoping some of the skills in DBT might be useful for them. Although again, i'm not sure it's worth shelling out a lot of $ to attend training relative to just reading a skills manual?
     
  17. smalltownpsych

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    I would put forth that many of the skills can be beneficial to just about anyone. I find that for most of our various treatments. I personally use CBT stuff, DBT stuff, effective interpersonal skills such as emphatic listening or strategies for working through conflict that are very much the same as what I would work on with patients. A good example, is how I have coped with any difficulties I might have with anxiety provoking stimuli by gradual exposure. Probably the big difference between myself and many of my patients, is that it tends to be more automatic because of my growing up in a relatively healthy environment without significant neurological problems.
     
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  18. cara susanna

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    Oh, DEFINITELY. I use DBT skills in almost everything I do with almost every patient. However, when you are working with someone who actually has BPD, IMO you really need the full model.
     
  19. smalltownpsych

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    You missed my point, I think. I meant that I use skills from psychology in my own life, although my wife might disagree about the empathic listening part from time to time. :p
     
  20. MamaPhD

    MamaPhD Psychologist, Academic Medical Center
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    Adherence and buy-in can be a challenge with any skills-based intervention. I agree, though, that some skills have more immediate applications and can help engage patients in treatment. Look into the other mindfulness and acceptance-based interventions too.

    While I wouldn't discourage you from learning new skills, I also recommend using your supervision to help you fine tune your delivery of CBT. The kind of problems you describe are very common to new CBT therapists and a lot of people abandon the modality before becoming really skilled at it.
     
  21. DynamicDidactic

    DynamicDidactic Ass of Prof
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    To my knowledge, there has only been a single component analysis or dismantling study. But many have looked at DBT skills alone. Here is a quick overview of the research.
    Dialectical Behavior Therapy Skills Training Is Effective Intervention | Psychiatric Times
    The use of dialectical behavior therapy skills training as stand-alone treatment: a systematic review of the treatment outcome literature. - PubMed - NCBI

    Simple answer: lots of evidence for its efficacy across heterogenous problems (e.g., mood, anxiety, ADHD, disordered eating). So, if you had a mixed group of people just teach them DBT instead of trying to make homogenous therapy groups. HOWEVER, very little evidence for severe problems especially suicidality. As mentioned earlier, perhaps the key is reducing hospitalizations which is more difficult to do without individual DBT. Also, people forget that DBT has 4 modes where skills and individual DBT are just half the treatment.
     
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