What are DBT Consultation Teams?
The DBT Consultation Team is an essential component of Dialectical Behavior Therapy (DBT) designed to support therapists in providing the best treatment to their clients. The importance of a DBT Consultation Team can be understood through several key functions and benefits it provides to both therapists and, indirectly, to clients.
Benefits of a DBT Consultation Team
The DBT Consultation Team helps ensure that therapists adhere to the comprehensive and evidence-based DBT protocol. Regular meetings allow therapists to discuss cases, strategies, and techniques, thereby maintaining fidelity to the DBT model and ensuring that clients receive treatment that is consistent with proven methods. DBT can be challenging for therapists, particularly when working with clients who have complex and severe disorders. The consultation team provides a forum for therapists to receive support, feedback, and guidance on their cases. This collaborative environment helps therapists to refine their skills, address therapeutic challenges, and apply DBT principles effectively, enhancing their overall effectiveness.
Working with high-risk clients, as is often the case in DBT, can lead to emotional exhaustion and burnout among therapists. The consultation team offers emotional support and a space for processing difficult emotions and experiences. By fostering a supportive community, the team helps mitigate the stress associated with this work, contributing to therapist well-being and longevity in the field.
DBT is a complex and evolving therapeutic approach. The consultation team serves as a platform for ongoing learning through case discussions, sharing of resources, and updates on the latest research and DBT techniques. This environment of continuous professional development helps therapists to stay informed and incorporate new insights into their practice.
The DBT Consultation Team encourages a holistic approach to client care, emphasizing the importance of considering all aspects of a client's life and well-being. Through collaborative discussion, therapists can develop more comprehensive treatment plans that address a wide range of client needs. By discussing cases and strategies within the team, therapists ensure that they are consistently applying DBT principles across clients. This consistency is crucial for the integrity of the treatment and for achieving positive outcomes for clients. The consultation team also builds a sense of community and shared purpose among DBT therapists. This collective identity enhances team cohesion and morale, making the challenging work of DBT more sustainable and rewarding for therapists.
The team encourages dialectical thinking, a core principle of DBT, which involves holding and integrating contradictory perspectives. This approach is vital in navigating complex therapeutic situations and in modeling dialectical thinking for clients. The DBT Consultation Team is vital for maintaining high standards of practice, supporting therapist well-being, and ultimately ensuring that clients receive the best possible care. Through the team, therapists are better equipped to navigate the complexities of DBT, leading to more effective treatment outcomes and enhanced therapist resilience.
DBT Consultation Team Agreements
DBT teams functions under a set of agreements aimed at fostering a supportive and effective environment for therapists. These agreements are designed to help maintain the motivation, competence, and adherence to DBT principles among team members. Here are the DBT Consultation Team Agreements.
1. Dialectical Agreement
We agree to accept a dialectical philosophy. There is no absolute truth, so when polarities arise, the task is to search for the synthesis rather than for the truth. This agreement does not proscribe strong opinions or suggest polarities are undesirable. It points to the direction we agree to take when passionately held polar positions threaten to split the consultation team.
2. Consultation to the Patient Agreement
We agree that we do not serve as intermediaries for patients with other professionals, including other members of our team. We agree that our task as therapists is to consult with our own patients on how to interact with other therapists, not to tell other therapists how to interact with the patients. When a therapist behaves fallibly, we agree to help their patients cope with this therapist's behavior, not necessarily reform the therapist. This doesn't mean the team members do not conduct treatment planning together for their patients, exchange information about the patients (including problems about other members of the treatment team), and discuss problems in treatment.
3. Consistency Agreement
We agree that the job of the therapy team is not to provide a stress-free, perfect environment for patients. We agree that consistency of therapists with one another is not expected; each therapist does not have to teach the same thing, nor do all have to agree on what are proper rules for therapy. Each of us can make our own rules about conditions of therapy with ourselves. We agree that mix-ups are inevitable and are a chance for both patients and therapists to practice almost all of the DBT skills.
4. Observing Limits Agreement
We agree to observe our own personal and professional limits. We agree not to infer that narrow limits reflect therapists' fears of intimacy, self-centeredness, problems with dominance and control, or generally with-holding nature, or that broad limits reflect a need to nurture, problems with boundaries, or projective identification. Patients can learn to figure out the limits.
5. Phenomenological Empathy Agreement
We agree, all other things being equal, to search for non-pejorative or phenomenologically empathic interpretations of our patients', our own, and other members’ behaviors. We agree to assume that the patients are trying their best and want to improve, rather than to sabotage the therapy or "play games" with their therapist. When a therapist is unable to come up with such an interpretation, we agree to assist in doing so, while validating the "blame the victim" mentality of the therapist. We agree to hold one another nonjudgmentally in the DBT frame. We agree not to label therapists who always adopt the empathetic interpretation as naive, unsophisticated, or overly identified with their patients. We also agree not to label therapists who always adopt the hostile, pejorative, "blame the victim" interpretation as aggressive, dominating, or vindictive.
6. Fallibility Agreement
We agree that we are each fallible. Relatively speaking, "therapists are all jerks." There is little need to be defensive, since it is agreed ahead of time that we have probably done whatever problematic things we are accused of. We agree that our task as consultation group members is to apply DBT to one another, in order to help each therapist stay within the DBT protocols. We agree that, as with patients, problem-solving with therapists must be balanced with validation of the inherent wisdom of the therapist's stance. Because we are fallible, we agree 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 search for the synthesis.
