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Key points
- Many therapists offer "DBT light," but not all provide fully adherent Dialectical Behavior Therapy.
- Skills training alone helps with depression but isn’t enough for suicidal individuals.
- DBT groups are vital for learning skills and gaining peer reinforcement.
Finding a Dialectical Behavior Therapy (DBT) therapist can be life-changing. If you are struggling with intense emotions, suicidal thoughts, depression, substance use disorder, eating disorders, or borderline personality disorder (BPD), comprehensive research shows that DBT can be transformative. However, not all therapists who advertise DBT services provide fully adherent DBT, which is crucial for those in crisis, particularly individuals who may be suicidal.
What Is DBT?
DBT, created by Dr. Marsha Linehan, is an evidence-based therapy designed to help people manage overwhelming emotions, reduce "unskillful" behaviors, and build a life worth living. It incorporates three core elements:
- Individual Therapy. One-on-one sessions to address harmful behaviors, apply DBT skills to real-life situations, and develop long-term goals.
- Skills Training Groups. Group classes in which clients learn and practice DBT skills like mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance. These classes provide a supportive environment to deepen learning and see skills in action.
- Phone Coaching. As-needed support to help clients use DBT skills during emotional crises outside of sessions.
This comprehensive approach supports clients in making lasting changes and managing challenges.
Fully Adherent DBT vs. “DBT Light”
Many therapists list DBT as part of their services but may not offer fully adherent DBT. These therapists may incorporate some DBT concepts or skills into sessions which can be helpful but insufficient for clients in severe, life-threatening distress. If you or someone you love is suicidal or at high risk, it’s critical to find a fully adherent DBT therapist. Adherence ensures that all components of the treatment will be provided, maximizing effectiveness. To determine whether a therapist provides fully adherent DBT, ask them these four questions:
4 Questions to Ask Your Therapist
- What is a DEAR? DEAR is a common DBT acronym for an interpersonal effectiveness skill. If a therapist can’t explain this on the spot, they’re unlikely to be fully trained in DBT.
- Do you offer a DBT group or refer clients to one? Skills training groups are a core component of DBT. While some therapists in remote areas may incorporate skills into individual sessions, this isn’t ideal. Groups allow clients to learn from others, receive positive reinforcement, and understand skills in a richer context.
- Do you offer phone coaching? Phone coaching is essential for DBT. It helps clients apply skills when emotions are high and decisions feel overwhelming. Therapists who don’t offer this service aren’t providing adherent DBT. While phone coaching can be demanding for clinicians, it’s a necessary part of the treatment structure.
- Are you part of a DBT consultation team? Adherent DBT therapists participate in a consultation team to stay supported and ensure they’re delivering effective care. This team specifically focuses on DBT principles and provides critical oversight.
If a therapist can answer “yes” to all four questions, it’s a great sign they’re providing fully adherent DBT.
Where do you start your search?
- Ask Your Insurance Provider. Start by searching for therapists paneled with your insurance. If no fully adherent DBT therapists are available, ask your provider about a “single case agreement.” This agreement allows you to see an out-of-network DBT therapist at in-network rates. You’ll need to ask the therapist for their billing “CPT codes” to share with your insurance.
- Search Online. Websites like Psychology Today allow you to search for therapists specializing in DBT. Once you find some candidates, be sure to ask the four questions to confirm adherence.
- Check Credentials. Clinicians can become certified in DBT by by the Linehan Institute, Dr. Linehan’s organization. This certification process is rigorous, ensuring a high standard of care. Keep in mind, though, that many excellent fully adherent DBT therapists are not Linehan-certified. The four questions remain crucial for making sure they are adherent even if they haven't completed the Linehan certification.
Consider Skills Training Only
If fully adherent DBT isn’t available, DBT skills groups can still be highly effective, especially for issues like depression (when suicide isn't an issue). Research shows that even standalone skills training can create meaningful change. However, if you or a loved one is suicidal, fully adherent DBT remains the gold standard.
Final Thoughts
DBT is a transformative therapy for people struggling with intense emotions, suicidal thoughts, and other mental health challenges. While finding a fully adherent DBT therapist may require extra effort, it’s well worth it for the comprehensive support they provide. With the right clinician, you’ll have access to life-changing skills and the support needed to build a more stable, fulfilling life.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.
