Using DBT in Outpatient Settings

It’s not one size fits all.

It can be hard to decide how to use DBT in an outpatient setting. Often as therapists we think we should be using a treatment modality to fidelity or not be using it at all. What if there was a different way? Perhaps - a more dialectical approach!

As a trained DBT therapist, I have used DBT in therapy both directly with clients and as a consultant to therapists for years. Most importantly, I have done so in different therapeutic settings. Residential, intensive outpatient, and outpatient settings are all valid settings for using behavioral interventions to help our clients change.

In its onset, DBT was meant to help clients who were struggling primarily with suicidal ideation and behaviors, and was meant to be used in an outpatient setting with once a week therapy, once a week group therapy, and once a week DBT consultation group for the therapists. What if any of these factors are not possible given very understandable constraints on the therapists’ or clients’ part?

Here’s what I have learned: DBT is a modality just like any other and it functions well when the therapist is engaged and supported. Too often, therapists are focused on fidelity and adherence over providing services that our clients desperately need. What if you can only see your client every other week, but you have a consultation team available to you every week? What if the client can join a DBT group but you cannot find and/or afford to attend a consultation team? It may be an unpopular opinion, but my belief is that as long as we are practicing ethically and within our scope of practice, and being clear and transparent with our clients about what services we are offering (never saying we offer comprehensive DBT if we are not following the model to adherence, for example!), then we can practice evidence based models with some flexibility when it is needed.

Tell us what has worked for you in this or similar types of clinical situations - we’d love to hear from you!