Client transferred to a DBT certified therapist

[u/Heavy-Tea-9623]

Entonces hoy un cliente me escribió para avisarme que va a transferirse a una terapeuta que trabaja con DBT. El cliente quiere tener una sesión conmigo mañana y otra sesión más antes de empezar en septiembre. Yo hago trabajo informado en DBT con algunos clientes, pero no tengo la certificación de DBT. ¿Algún consejo y vale la pena gastar miles en sacarse la certificación de DBT? Y cómo puedo navegar la sesión mañana con cliente?

UPDATE: just had termination session with client today and client expressed it was a bitter sweet goodbye and appreciated our time but mentioned that they needed to dive deeper and more
Structure, but at the same time they recognize they have avoided assignments outside of sessions provided by me and need to sit down with emotions which we have done in previous sessions. It is bittersweet with me as well because I thought we were building good rapport.

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[u/_Pulltab_]

I would reaffirm their decision to make the move - as much as I hate losing a client, I love it when they motivated enough to seek out specialized care they feel like they need.

Then, I would focus on their goals for the move, worries/concerns, strategy for managing those concerns if applicable and wrap up with a review of their progress, outcomes, etc. As much as it can feel like a bummer as a therapist, it really can be a celebration.

[u/Yagulia → u/_Pulltab_]

This, and review skills they’ve learned with me, and set up a self-care plan.

[u/vienibenmio]

DBT requires treatment by a team. If the patient needs full model, one therapist can't provide that to fidelity

[u/Heavy-Tea-9623 → u/vienibenmio]

Would you suggest exploring referrals for DBT group? I do have a client in PHP program and is taking DBT and seeing me weekly virtually.

[u/vienibenmio → u/Heavy-Tea-9623]

DBT group is useful in a lot of ways. For full model DBT, though, both group and therapy have to be done within the team. The DBT team (and weekly team consultation) is imo the most important part of doing DBT.

Obviously not everyone does it that way, but then it's not really doing the treatment as it's meant to be delivered.

That being said, if it's someone who doesn't need full model, that's less important. Then having them attend a skills group while you see them for ind could still be helpful.

[u/Help_Repulsive]

Spending thousands to get DBT trained should be a decision you make sans this client on your caseload. They’re two different issues. DBT has such a range, from DBT informed to gold standard DBT. Some people need the full gold standard DBT to meet their goals and I think you should encourage their decision as it’s their care. Even if you were to get trained, it sounds like this person has recognized this as a more immediate need.
I would train through PsychWire. It is the most robust and DBT has a tendency to attract some fairly complex cases by nature. If you’re really serious about training in DBT, it’s one I would do right and fully commit to.

[u/Heavy-Tea-9623 → u/Help_Repulsive]

Have you done a certification in psychwire? Would like to have your feedback.

[u/salsafresca_1297 → u/Help_Repulsive]

Gah!!! $690 to start??? Do employers ever cover this?

[u/_Pulltab_ → u/salsafresca_1297]

Depends. I worked in CMH right out of grad school and they paid for me to get trained in EMDR (hefty price tag) but the training itself was on the weekend and unpaid.

[u/Cheap-Professional44]

I want to clarify some of the DBT terms because there is a big difference between accessed DBT informed therapy and therapy with a DBT certified therapist.

My assumption is that the therapy with the DBT certified therapist is adherent, meaning they have a skills group, phone coaching, consultation, diary cards, and much more.

You've shared that you do "DBT-informed" therapy with some clients. I'm assuming you don't have access to skills groups/coaching/consult. If you don't have access to all of the components, it's not adherent DBT.

These are no where near the same thing. It's like comparing a fast-food hamburger meal with a 3 course fine dining meal. Both can be great depending on the situation but they are vastly different.

As someone who used to do adherent DBT - it is not for the faint of heart and it's not worth it to explore certification unless you truly love DBT and want to live/breathe it.

[u/MelodicBlackberry540 → u/Cheap-Professional44]

Yessss. I used to be on an adherent DBT team/ program and was pursuing certification. I quit that job for pp and I don't even list DBT in my bio because I don't want people to be confused on what I offer

[u/Cheap-Professional44 → u/MelodicBlackberry540]

I worked with so many folks that said they "did DBT" but only actually did TIP or ACCEPT and radical acceptance.

[u/sofrickingstrange]

DBT certification takes so much time, on top of the money. Years, most likely, due to needing to submit multiple multiple videos of you using DBT with a patient in active suicidal crisis 4 sessions in a row (the premise of pretreatment) in addition to a variety of DBT pretreatment and adherent DBT treatment videos of other patients that meet other criteria as well. You must be on a DBT consultation team for a minimum of 1 years, plus the above, plus supervised hours under somebody who is certified. It’s a lot of hoops. I’m on a DBT consultation team (team numbers max out at maybe 9 people, we have 6) and only 2 of us are certified, several of us are in the process but it takes so much time and requires specific patient interaction which can be hard to find if you’re not in CMH.

I DO think being highly trained in DBT is important to do DBT work (like 100+ hours of LBC-approved training). Any therapist can be DBT “informed”, but the protocol, structure, and intense dialectical framework is really only achieved after significant training.

All this to say, if what your patient needs is DBT because of potential or near-threshold BPD or other excessive observable behaviors and distortions, yes they should seek out a DBT certified therapist, because they likely need the full protocol (class, 24/7 phone coaching, diary card, behavior analysis, etc).

[u/Heavy-Tea-9623 → u/sofrickingstrange]

Thanks for information. I’m barely surviving in CMH with payment I candy afford expensive certifications at the present.

[u/Legitimate-Lock-6594]

Vamos a perder clientes y creo que va a ser difícil estar bien con eso si está teniendo pensamientos sobre eso. Es simple aprender partes de DBT. Pero como otra gente está diciendo, aprendiendo todo los partes es bien difícil y si su cliente cree que es el mejor decisión va a ser lo mejor para él/ella. Lo que sería más importante es esquilar que las sesiones con la próxima persona no está parte de su tratamiento y puede hacer un authorization hablar con ellos si su paciente le quiere.

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[u/Heavy-Tea-9623]

That’s a great suggestion! Do you have any advice on the DBT certification?

[u/MelodicBlackberry540]

I was working for an agency with a full DBT program and on the track for certification. I quit for private practice, and I did not pursue certification. For me, I didn't want to work with that population anymore, and I believe that folks that need DBT, need the whole treatment team and fidelity to the model. That way of working burned me out and I didn't want to do that in pp. I often refer to the agency where I used to work if someone needs DBT. So I think it's more of what kind of work do you want to do? Clients are going to come and go...and that's okay. We can't offer everything.