Initiating a DBT Consultation Team: Conceptual and Practical Considerations for Training Clinics

As the evidence base for dialectical behavior therapy (DBT) grows, so too does the need for well-trained DBT clinicians, especially in practice settings that serve populations at high-risk for self-injurious behavior or suicide. Despite the increased availability of resources for learning and applying DBT to such high-risk individuals, comparatively little has been written about initiating DBT training for new therapists in settings where DBT services are being established for the first time. The purpose of this paper is to bridge the gap between existing DBT resources and their high-fidelity application in training clinics by focusing on the consultation team as a key component to training therapists in the model. First, a conceptual overview of DBT and the role of a consultation team to support trainee therapists are presented. Second, elements of the consultation team are reviewed and unique considerations for trainee therapists are highlighted. Finally, the challenges, key strategies for overcoming obstacles, and benefits of initiating DBT training with a consultation team for trainee therapists are discussed via a series of reflections from a new DBT team, which we present as a case example of shared learning on a training team within a university clinic. We address four conceptual and practical domains of the training: the distinction between supervision and consultation, therapist identity development and competency, DBT in clinical training contexts, and embodying a dialectical stance within the university clinic. The implications of these observations for DBT theory and research are discussed. Public Significance Statement The manuscript's focus is on training graduate students to implement high-fidelity dialectical behavior therapy (DBT). We believe this paper will make a significant contribution to the field and help training clinics offer services to underserved populations, as relatively little has been written about setting up DBT training for new therapists in settings where DBT services are just being established.