According to Linehan (1993), the consultation-to-the-patient approach is "quite different from, and sometimes diametrically opposite to, the behaviors expected of mental health professionals." Unlike the traditional medical model, "the role of the therapist is to consult with the patient about how to manage other people, rather than to consult with others about how to manage or treat the patient" (Linehan, 1993, p. 411). "The consultation-to-the-patient approach is designed to make sure that if the individual [patient] is not the expert on herself now, she becomes the expert" (Linehan, 1993, p. 422). In other words, DBT providers do not intervene or solve problems for the patient. Because of this approach, our Providers do not speak to family members or other treatment providers without the individual patient being present for or leading the conversation.

Because of the intensive nature of DBT (i.e., individual therapy, skills class, phone coaching, etc.) and consultation-to-the-patient approach, we STRONGLY suggest individuals in this treatment "press pause" with their other therapists. DBT aims to aid individuals in using DBT skills to manage all of their environment which can be difficult when a participant has multiple individual therapists. 

Individuals who participate in Comprehensive DBT may call their individual therapist in order to get help applying and generalizing skills they learn in skills training to their everyday life.

There are three main purposes of phone coaching:

• Replace behaviors that could lead to self-injurious acts or suicidal gestures.

• Get feedback and suggestions while practicing your skills.

• Relationship repair with your therapist.

PHONE COACHING IS NOT:

• A suicide hotline.

• Therapy over the phone (eg. extra individual therapy sessions discussing abstract concerns).

• A way to soothe yourself when you feel bored or lonely, or have no one to talk to.

24-HOUR RULE:

• Your DBT therapist will not allow any phone contact during the 24-hours after you have last engaged in self harm. If you are in need of imminent medical care, go to your nearest emergency department or call 911.

In order to stay balanced in treatment clients in the DBT program, member of our DBT Team agree to the following:

• Dialectical Agreement:  We agree to accept a dialectical philosophy: There is no absolute truth.  When caught between two conflicting opinions, we agree to look for the truth in both positions and to search for a synthesis by asking such questions as, “What is being left out?” 

• Consultation to the Patient Agreement:  We agree that the primary goal of this group is to improve our own skills as DBT therapists, and not serve as a go-between for patients to each other.  We agree to not treat patients or each other as fragile.  We agree to treat other group members with the belief that others can speak on their own behalf. 

• Consistency Agreement:  Because change is a natural life occurrence, we agree to accept diversity and change as they naturally come about.  This means that we do not have to agree with each other’s’ positions about how to respond to specific patients nor do we have to tailor our own behavior to be consistent with everyone else's.  

• Observing & Stretching Limits Agreement:  We agree to observe our own limits.  As therapists and group members, we agree to not judge or criticize other members for having different limits from our own (e.g., too broad, too narrow, “just right”).

• Phenomenological Empathy Agreement:  All things being equal, we agree to search for non-pejorative or phenomenologically empathic interpretations of our patients', our own, and other members’ behavior.  We agree to assume we and our patients are trying our best, and want to improve.  We agree to strive to see the world through our patients' eyes and through one another's eyes.  We agree to practice a non-judgmental stance with our patients and one another.

• Fallibility Agreement:  We agree ahead of time that we are each fallible and make mistakes.  We agree that we have probably either done whatever problematic things we’re being accused of, or some part of it, so that we can let go of assuming a defensive stance to prove our virtue or competence.  Because we are fallible, it is agreed that we will inevitably violate all of these agreements, and when this is done we will rely on each other to point out the polarity and move to a synthesis.

YES! BehavioralTech.org consolidated the following research:

Accumulating evidence indicates that DBT reduces the cost of treatment. For example, the American Psychiatric Association (1998) estimated that DBT decreased costs by 56% – when comparing the treatment year with the year prior to treatment – in a community-based program. In particular, reductions were evident by decreased face-to-face emergency services contact (80%), hospital days (77%), partial hospitalizations (76%), and crises bed days (56%). The decrease in hospital costs (~$26,000 per client) far outweighed the outpatient services cost increase (~$6,500 per client).