4 Questions to Ask Before Choosing a DBT Therapist

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Finding dialectical behavior Therapy (DBT) can change lives. If you are struggling with intense emotions, suicidal thinks, depressionsubstance use disorder, eating disorder or borderline disorder personality disorder (BPD), comprehensive research shows that DBT can be transformative. However, not all therapists advertising DBT services provide fully compliant DBT, which is crucial for people in crisis, especially those who may be suicidal.

What is DBT?

DBT, created by Dr. Marsha Linehan, is an evidence-based therapy designed to help people cope with overwhelming emotions, reduce “unskillful” behaviors, and build a life worth living. It contains three basic elements:

1. Individual Therapy. One-on-one sessions aimed at addressing harmful behaviors, applying DBT skills to real-life situations, and long-term development goals.
2. Skills Training Groups. Group classes during which clients learn and practice DBT skills, including: mindfulness, emotional regulationinterpersonal effectiveness and stress tolerance. These classes provide a supportive environment that allows you to deepen your learning and see skills in action.
3. Phone Coaching. Support as needed 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 compatible therapy. These therapists may incorporate certain DBT concepts or skills into sessions that may be helpful but not sufficient for clients in serious, life-threatening suffering. If you or someone you love is suicidal or at high risk, it is extremely important to find a fully DBT-compliant therapist. Compliance ensures that all elements of treatment are delivered, maximizing its effectiveness. To determine whether your therapist is providing fully compliant DBT, ask them these four questions:

4 questions to ask your therapist

1. What is LOVED? DEAR is a common DBT acronym for interpersonal effectiveness skills. If a therapist cannot explain this on-site, it is unlikely that they will be fully trained in DBT.
2. Do you offer a DBT group or refer clients to one? Skills training groups are a key component of DBT. While some therapists in remote areas may incorporate skills into individual sessions, this is not ideal. Groups allow clients to learn from others, receive positive reinforcement, and understand skills in a richer context.
3. Do you offer coaching over the phone? Telephone coaching is essential in DBT. Helps clients apply skills when emotions run high and decisions seem overwhelming. Therapists who do not offer this service are not ensuring DBT adherence. Although telephone coaching can be demanding on clinicians, it is a necessary part of the treatment structure.
4. Are you part of a DBT consulting team? Dedicated DBT therapists participate on the consultation team to provide support and effective care. This team focuses specifically on DBT principles and provides critical supervision.

If a therapist can answer “yes” to all four questions, it is a great sign that they are practicing fully compliant DBT.

Where do you start your search?

• Ask your insurer. Start by searching for therapists covered by your insurance. If a fully DBT-compliant therapist is not available, ask your provider about a “single-case agreement.” This agreement allows you to use the services of an out-of-network DBT therapist at in-network rates. You will need to ask your therapist for billing “CPT codes” that you can share with your insurer.
• Search the Internet. Type websites Psychology today allow you to search for therapists specializing in DBT. Once you find candidates, ask four questions to confirm their affiliation.
• Check your credentials. Doctors can obtain DBT certification through the Linehan Institute, Dr. Linehan’s organization. This certification process is rigorous and ensures a high standard of care. However, please note that many excellent, fully compliant DBT practitioners are not Linehan certified. Four questions remain key to ensuring they are compliant even if they have not completed Linehan certification.

Just consider skills training

If fully compliant DBT is not available, DBT skills groups can still be very effective, especially for issues such as depression (when suicide is not an issue). Research shows that even self-paced skills training can create significant change. However, if you or a loved one is suicidal, fully following 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 committed DBT therapist may require extra effort, it is worth it for the comprehensive support they provide. With the right doctor, you’ll have access to the life-changing skills and support you need to build a more stable, fulfilling life.

If you or someone you love is considering suicide, seek help immediately. For 24-hour support, call the National Suicide Prevention Lifeline at 988 or contact the Crisis Text Line by texting TALK to 741741. To find a therapist in your area, visit Psychology Today therapy directory.