Top Five Questions to Ask Therapists Before Starting DBT

1.  When does your consultation group meet?

Treatment adherent dialectical behavior therapy groups have specific criteria that a clinic or program must follow.  DBT clinics must have a consultation group for their therapists.  These meetings are designed to support the treatment team.


2.  How are you using coaching?


The integration of technology in counseling has added a new dimension for supporting skill generalization and connection with the treatment team.  Even though confidentiality can be compromised, clients and therapists who use text messages, phone coaching, and emails can guide the client to practice mindfulness skills to regulate, check the facts, reframe the situation, and see the dialectic. 


3.  How are you using assessment to track change over time?


Diary Cards are essential for tracking the change over time for emotions, target behaviors, and DBT skills.  For more information about customized diary cards for clients with specific diagnoses and target behaviors, please contact Sarah C. Turner (me) at scturner@uh.edu. 


I have developed the DBT Diary Card--Texas Edition that includes the emotions, areas for target behaviors, and updated skills from the DBT(R) Skills Training Manual, Second Edition (Marsha Linehan, 2014).


Be sure to ask about developing the life-worth-living-goal, diary cards, chain analyses for working through the problem and target behaviors, and the transition the conversation into solution analyses.


4.  What types of training in dialectical behavior therapy and professional development did you and the staff receive to become DBT therapists?


Different training programs have different approaches for training mental health professions, clinicians, researchers, and staff.  Some are more intensive than others.


5.  Do all clients who come for treatment for a broad range of symptoms and diagnoses receive DBT?


Treatment choice is complicated.  Individuals who are seeking DBT usually carry comorbidities, such as depression and borderline personality disorder.  When looking at evidence-based practice, dialectical behavior therapy is not as effective for certain disorders as other evidence-based treatments. 

Meeting Shari Manning

On a rainy evening in May, I was looking through YouTube videos about borderline personality disorder.  I found Carla Sharp's lecture at Menninger last November.  I was one of the first to sign up for the conference, but caught a cold and couldn't go.  Dr. Sharp's lecture is very research oriented and filled with data, statistical analyses, and references.  Be sure to check the video of her lecture at the link below.

Borderline Personality Disorder in Children and Adolescents by Carla Sharp, Ph.D.

After watching the lecture, a video with Shari Manning at the same conference popped up on my screen.  Excited, I clicked on the video.   

Loving Someone With Borderline Personality Disorder: A Model of Emotional Regulation by Shari Manning Ph.D.

The first words that came to mind were "she is intense," so I was a little nervous when I walked to the front table to introduce myself.  "Hello, Dr. Manning.  My name is Sarah Turner.  I am so glad to be here."

"Not Dr. Manning, Sarah, it's Shari.  So you're the student."  

"Yes.  Thank you for letting me come," I replied, as I looked around the room of the PhDs, MDs, LPCs, LMSWs, and me.  I felt out of place at first, like I wasn't ready for this, but Shari's bell for the call of attention for mindfulness brought "my mind where my feet are." 

As the week continued, I saw Shari's passion for dialectical behavior therapy and the need for further research.  I had so many questions about DBT research, yet I knew that it was time for lunch.  I asked Shari if she would have lunch with me.  She agreed that we would meet on the fourth day of the training, a Sunday in May.  

I had learned the hard way that it is essential to be prepared for meetings, so I started reading about other DBT researchers, including Shireen Rizvi and Linda Dimeff.  I sifted through the literature for the integration of technology in mental health.  I found great journal articles by Shireen Rizvi.  I poured my energy into getting ready for the meeting.  

One of my more helpful ways to cope with anxiety is to prepare for the meeting until it's almost time for bed, and then curl up with a fun book and my journal.  I did enjoy Calvin and Hobbes.

Shari and I were in line for lunch at Menninger.  Shari placed her order and said, "I'm paying for me and the girl behind me.  (Turns to me) You can pay for lunch when you are a professional.  Graduate students never pay for lunch with me."  I was so surprised and honored, a feeling that stays with me when I think of her.

As soon as lunch started, we were knee deep in concepts and applications of DBT research; it was like wading into a teeming river of ideas.  I was so excited to have an intellectual conversation about the skills and ways to teach others about DBT, a therapy we believe can change lives.  We have a common goal: to make DBT more accessible and available to more clinicians and clients.  

The DBT training in Houston is the first of many steps for me.  I will be pursuing mixed methodology studies in the upcoming years.  My current passion is qualitative research.  I will be learning more about quantitative methods soon, as much of the current DBT research is primarily quantitative.  

Shari has been so welcoming of new ideas throughout the training.  I will look forward to reading her book, Loving Someone with Borderline Personality Disorder: How to Keep Out-of-Control Emotions from Destroying Your Relationship

I asked her to sign my copy.  This is the note:

To Sarah- 

Best wishes in your career as a DBT researcher and thank you in advance!

- S. Manning

As we said goodbye next day, she gave me a warm hug and smiled.  Her encouragement has increased my confidence in my ideas and aided me in moving forward in my career as a researcher.

I will look forward to the online section of the training over the summer.