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Reducing Suicide Attempts: Why Certification and Therapist Adherence Matter in DBT

As we have written elsewhere, we are fully committed to delivering evidence based treatments (EBTs) at TAP. Becoming proficient in EBTs is a multi-step process that generally involves reading and studying, attending trainings by experts, and then getting consultation and supervision as you learn to implement new therapies. Even with all of this, though, the only way to know if a therapist is actually delivering a treatment as it was meant to be delivered (a term we call "adherence") is if their work is evaluated by experts. Very few psychotherapies offer any sort of certification process that would allow consumers to know if their therapist is truly proficient in an EBT. Fortunately, DBT allows for board certification through the DBT-LBC. All of the DBT therapists at TAP are either board certified or are in the process of applying for board certification. In addition, the TAP Clinic has applied for Program Certification status (and we recently got a scholarship to help us in this process!).

Board certification is a long and difficult process, but we think it is a very worthwhile endeavor. Why? Because it is important for clients and families to have some way of knowing that their therapist is doing DBT as it was meant to be delivered. Why on earth would you invest your time, money, and energy into doing something as intensive as DBT if you weren't absolutely sure your therapist knew the treatment backward and forward? After all, you probably wouldn't go to a surgeon who "sort of" knew what they were doing or had only attended a weekend training on a complicated technique they were about to perform.

And now we have even more of a reason to think adherence is of critical importance. At the 2019 Annual Meeting of the International Society for the Improvement and Teaching of DBT (ISITDBT), Dr. Melanie Harned presented data showing that the degree to which a therapist is rated as adherent to DBT makes a critical difference for clients. Specifically, higher therapist adherence predicts fewer future suicide attempts and lower rates of dropout from treatment. That. Is. Huge.

Having an adherent or certified DBT therapist is never a guarantee of a particular outcome in treatment and DBT-therapist adherence is unlikely to be the only variable predicting treatment success markers. Unfortunately, there are no such guarantees in mental health or medicine more broadly. However, we do believe that adherent treatment to a gold-standard DBT model is a vital component to the treatment of individuals with high-risk behaviors such as suicidality or self-injury. We see certification (both individual and clinic) as a way for our own clinicians, our clients, and our referral providers to feel comfortable that we are delivering adherent DBT treatment. As a clinic that believes in evidence-based practice, continuing education, and the highest level of training in our specializations, we believe that DBT certification is one of the very best ways we can support our clients in achieving their life worth living.

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