Abstract
Dialectical behavior therapy (DBT) is an evidence-based treatment that is considered to be the standard of care in treating individuals with BPD, however there have been few published studies to identify the challenges and solutions for implementing DBT in community-based settings. The current study identified the barriers and solutions within a system-wide roll-out of DBT within a large, urban public health system encompassing both mental health and substance abuse treatment settings. Qualitative interviews were conducted with 19 clinicians receiving DBT training over a period of 13 months. A content analysis revealed three themes that were identified as challenges to the DBT implementation process including program development and recruitment of patients, a lack of administrative support or organizational investment in DBT, and time commitment of DBT. In order to transfer DBT into a public behavioral health system, investment from both clinic- and system-level administrators is required. Strategies to prevent drift, such as incorporating a train-the-trainer model, are discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Psychiatric Association. (1998). Integrating dialectical behavior therapy into acommunity mental health program: The Mental Health Center of Greater Manchester, New Hampshire. Psychiatric Services, 49, 1338–1340.
Ben-Porath, Peterson, & Smee, (2004). Treatment of individuals with borderline personality disorder using dialectical behavior therapy in a community mental health setting: Clinical application and a preliminary investigation. Cognitive and Behavioral Practice, 11, 424–434.
Bloch, R. M., Saeed, S. A., Rivard, J. C., & Rausch, C. (2006). Lessons learned in implementing evidence-based practices: Implications for psychiatric administrators. Psychiatric Quarterly, 77(4), 309–318.
Bohus, M., Dyer, A. S., Priebe, K., Kruger, A., Kleindienst, N., Schmahl, C., et al. (2013). Dialectical behavior therapy for posttraumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: A randomized controlled trial. Psychotherapy and Psychosomatics, 82, 221–233.
Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7–18.
Comtois, K. A., Elwood, L., Holdcraft, L. C., Smith, W. R., & Simpson, T. L. (2007). Effectiveness of dialectical behavior therapy in a community mental health center. Cognitive and Behavioral Practice, 14, 406–414.
DuBose, A., & Ivanoff, A. (2013). DBT teams in training 2008–2011: Implementationfollow-up in 2012. Seattle: Symposium presented at the biennial meeting of the Seattle Implementation Research Collaborative.
Gotham, H. J. (2006). Advancing the implementation of evidence-based practices into clinical practice: How do we get there from here? Professional Psychology Research and Practice, 37(6), 606–613.
Gray, M. J., Elhai, J. D., & Schmidt, L. O. (2007). Trauma professionals’ attitudes toward and utilization of evidence-based practices. Behavior Modification, 31(6), 732–748.
Hawkins, K. A., & Sinha, R. (1998). Can line clinicians master the conceptual complexities of dialectical behavior therapy? An evaluation of a State Department of Mental Health training program. Journal of Psychiatric Research, 32, 379–384.
Kazdin, A. E. (2008). Evidence-based treatments and delivery of psychological services: Shifting our emphases to increase impact. Psychological Services, 5(3), 201–215.
Koerner, K. (2013). What must you know and do to get good outcomes with DBT? Behavior Therapy, http://dx.doi.org/10.1016/j.beth.2013.03.005.
Koons, C. R., Robins, C. J., Tweed, J. L., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., et al. (2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32(2), 371–390.
Landes, S. J., & Linehan, M. M. (2012). Dissemination and implementation of dialectical behavior therapy: An intensive training model. In D. H. Barlow & R. K. McHugh (Eds.), Dissemination and implementation of evidence-based psychological interventions (pp. 187–208). New York: Oxford University Press.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.
Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060–1064.
Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766.
Linehan, M. M., Dimeff, L. A., Reynolds, S. K., Comtois, K. A., Welch, S. S., Heagerty, P., et al. (2002). Dialectical behavior therapy versus comprehensive validation plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67(1), 13–26.
Linehan, M. M., & Heard, H. (1999). Borderline personality disorder: Costs, course and treatment outcomes. The Cost-Effectiveness of Psychotherapy: A Guide for Practitioners, Researchers and Policy-Makers. New York: Oxford Press.
Linehan, M. M., Kantor, J., & Comtois, K. A. (1999). Dialectical Behavior Therapy for Borderline Personality Disorder: Efficacy, specificity, and cost effectiveness. In D. Janowsky (Ed.), Psychotherapy Indications and Outcomes. Washington: American Psychiatric Press.
Lynch, T. R., Morse, J. Q., Mendelson, T., & Robins, C. J. (2003). Dialectical behavior therapy for depressed older adults: A randomized pilot study. American Journal of Geriatric Psychiatry, 11(1), 33–45.
McHugh, R. K., & Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments: A review of current efforts. American Psychologist, 65(2), 73–84.
Pasieczny, N., & Connor, J. (2011). The effectiveness of dialectical behavior therapy in routine public mental health settings: An Australian controlled trial. Behaviour Research and Therapy, 49, 4–10.
Priebe, S., Bhatti, N., Barnicot, K., Bremner, S., Gaglia, A., Katsakou, C., et al. (2012). Effectiveness and cost-effectiveness of dialectical behavior therapy for self-harming patients with personality disorder: A pragmatic randomized controlled trial. Psychotherapy and Psychosomatics, 81, 356–365.
Swales, M. A., Taylor, B., & Hibbs, R. A. (2012). Implementing dialectical behavior therapy: Programme survival in routine healthcare settings. Journal of Mental Health, 21(6), 548–555.
Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69(6), 1061–1065.
Trupin, E. W., Stewart, D. G., Beach, B., & Boesky, L. (2002). Effectiveness of a dialectical behavior therapy program for incarcerated female juvenile offenders. Child and Adolescent Mental Health, 7(3), 121–127.
Turner, R. M. (2000). Naturalistic evaluation of dialectical behavior therapy-oriented treatment for borderline personality disorder. Cognitive and Behavioral Practice, 7(4), 413–419.
Verheul, R., van den Bosch, L. M. C., de Ridder, M. A. J., & van den Brink, W. (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12-Month, randomized clinical trial in The Netherlands. The British Journal of Psychiatry, 185, 135–140.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Carmel, A., Rose, M.L. & Fruzzetti, A.E. Barriers and Solutions to Implementing Dialectical Behavior Therapy in a Public Behavioral Health System. Adm Policy Ment Health 41, 608–614 (2014). https://doi.org/10.1007/s10488-013-0504-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-013-0504-6