SWM-004: Dialectical Behavior Therapy in Clinical Social Work, with Tony DuBose

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Clinical social workers, how do you teach your clients to tolerate emotional pain? The answer is particularly challenging when he or she is suffering from a borderline personality disorder. This episode's guest is Dr. Tony DuBose, a recognized expert in the use of Dialectical Behavior Therapy, or DBT, in the treatment of suicidal and self-injurious behaviors in adolescents. Tony works as the Director of Training at Behavioral Tech, LLC (BTECH), the company founded by psychologist Marsha Linehan, the original creator of the DBT model. In this episode, Communications Director Mary-Lea Cox Awanohara introduces Tony and then hands over the floor to Professor André Ivanoff, who uses DBT with adults and youth in forensic and criminal justice settings.

Background Information & Key Points:

Tony DuBose & André Ivanoff

  • Originally trained in another model of therapy to help suicidal and/or self-injurious adolescents, Tony DuBose sought training in DBT at the Division of Child and Adolescent Psychiatry at the University of Washington at the suggestion of psychiatrist Cindy Smith. After noticing a profound change in one young woman the team was treating, he decided to find out more.
  • What is DBT? The answer to that question requires going into the history of this form of psychotherapy. The developer, Marsha Linehan, was interested in helping suicidal youth. She had originally trained as a behavior therapist, but after noting the futility of going in and telling patients how to fix their problems, went back to the drawing board. Unwilling to settle for a simple acceptance strategy, she decided to develop a treatment that would strike the balance between patients feeling accepted and taking steps to change their behavior.
  • Dialectics means learning how to deal with the opposites in life. It’s both a way of viewing the world and a method of persuasion. In a clinical setting, it means coming to terms with the idea that the world is made up of all sorts of opposites. You have to learn how to juggle the demands of two different, opposing forces in your life.
  • Originally, DBT was developed to help people with borderline personality disorders (BPD), who suffer from extreme emotional distress and whose behavior is out of control.
  • For years, DBT was used primarily with persons with BPD, but now it is “making its way all over the place”: e.g., schools, correctional facilities, college campuses, mental health facilities, the military (to treat PTSD), and even the workplace. BTECH even uses in their office meetings!
  • How hard is it to learn? It’s not a quick, easy learn but it can definitely be learned, Tony insists, adding that, to be an effective practitioner, it helps if you have a background in behavior therapy, client-centered or humanistic psychology, Rogerian methods, and mindfulness practice (principles of Zen).
  • When learning DBT, it's important to find a team—teams keep us motivated and build our skills. Get your team studying Marcia Linehan's Skills Training Manual for Treating Borderline Personality Disorder and its companion, Cognitive-Behavioral Treatment of Borderline Personality Disorder (Diagnosis and Treatment of Mental Disorders), both published in 1993, to master the skills and principles of dialectics.
  • CSSW has the only DBT training program in the country for social work students.
  • Marsha Linehan founded BTECH in the 1990s to take what we know about DBT from university research labs and apply it in clinical settings. BTECH offers intensive training sessions. The initial training process takes at least six months.
  • Fidelity to DBT methods is a big topic of debate. But according to the data, sticking closely to the model produces better outcomes. Currently, there are no standards or certification for DBT recognized by Dr. Linehan, but she and her colleagues are working to establish some.
  • Is DBT a “Cadillac model treatment” that’s not transferable? According to Tony, it looks more expensive because of the need for skills training for providers, as well as added contact between patient and therapist. But if you look at hospital bills for people in just meds management or psychotherapy, DBT is more cost effective over time, he says.
  • "I think it has changed the world in many ways," he asserts. “It actually is about building better lives and living life skillfully… It actually makes a difference in my own life and my work life.”
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