I’ve done quite a few intake sessions with individuals coming to our agency, seeking out our skills training group, which is fantastic & we LOVE having anyone come to seek us out for services. One thing I have run into while completing these intakes, is that some people coming in for group, have no individual therapist at all, have an individual therapist that is not trained in DBT, yet may have some basic knowledge of DBT skills, OR an individual therapist that has little to no DBT knowledge. While in our DBT skills training group, it is required that a person meets with their individual therapist at least on a every other week basis. The rationale behind this is that it will assist you in implementing the skills, and/or processing difficulties in using them effectively. The DBT skills training group at Cincinnati Center for DBT is an adherent skills training group, meaning it is upheld to the standards set in place by the creator, Marsha Linehan. Being an evidenced based therapy approach, this is pivotal to reach the expected outcomes that you would prefer from DBT therapy. At CCDBT, we want to see you make significant progress toward your life worth living goals!
In this blog, I’m going to give you a few of the pros and cons, of having a therapist with CCDBT while engaging in our group vs the pros and cons of not having a therapist at CCDBT while in our group. If you are someone that does not have a therapist at all, I would suggest engaging with one of our therapists for ease of access and abilities to set you on the right track from the start. Some therapists may recommend you engage in our comprehensive DBT program, which is a commitment of 6 months-1 year minimum of treatment. Not everyone is in need or does it make sense to do comprehensive, so there is also an option to have one of our therapists work with you through just the group engagement, 6 months worth of treatment (24 weeks, you can stay longer if you wish!), and you could take an informed DBT approach. Both approaches have shown effectiveness!
In the Pros & Cons Chart below (from the DBT Skills Training Manual), I have listed the pros and cons of having a CCDBT therapist vs an outside therapist. I have expounded on these points following the chart further.
Pros of Having a CCDBT Therapist While In Our Groups:
- Ease of collaboration between group therapist & your individual: Therapists at CCDBT hear about group clients during team consultation meetings and are in frequent contact, creating an easier avenue for us to communicate concerns about a client not understanding a skill, missing group, and/or successes in the group.
- Adherent DBT therapy: Therapists at CCDBT are supervised by a Linehan Board Certified Clinician, Nikki Winchester, and are actively working toward LBC certification, training and learning with new education, new DBT insights, and using the skills a client would be learning, within their work and daily life.
- Therapists have weekly consultation meetings to stay updated about client cases: At CCDBT, we have weekly consultation meetings to discuss client cases, receive feedback and approaches to assist our clients in reaching their goals.
- Therapists receive consistent trainings to stay on top of the most effective DBT approaches and perspectives: Therapists at CCDBT are required to keep up with trainings for their licenses, to obtain LBC certification, and attend ISITDBT annually.
- Further understanding of how to implement skills tailored to your specific needs: Because therapists at CCDBT are adherently trained in DBT and practice the skills consistently themselves, they are able to assist you in adapting the skills you are learning in group, and possibly offer you additional skills before you learn them in group to assist you in making progress toward your goals.
- 6 months – 1 year commitment minimum*: This could be a pro or a con (hence the *), I am listing this as a pro due to 6 months-1 year commitment assists in having a therapist willing to commit to you for this amount of time to work with you on your life worth living goals.
- Therapists at CCDBT embracing the DBT assumptions: DBT assumptions are extremely important to creating a validating environment for clients and to maintain the principles (balancing acceptance and change) of DBT. An example of a few of the assumptions are: 1) All people are doing the best they can; 2) People want to improve and be happy; 3) Figuring out and changing the causes of behavior work better than judging and blaming. Therapists at CCDBT commit to embracing these assumptions to assist in creating a safe space for clients.
- Therapists willing to embrace change and also acceptance: Therapists at CCDBT are working toward assisting you in changing things in your life that cause misery and suffering, and they also realize that at times, we may need to accept situations. This can be a difficult balance and DBT therapists, in general, are oriented to working towards balancing these more effectively to assist with modeling and teaching the clients how to do so as well.
- Therapists committed to creating validating environments: CCDBT therapists teach and believe in the Biosocial theory, which references how invalidating environments can cause difficulties with emotional regulation and impulsivity. By creating validating environments, clinicians are able to assist clients in learning strategies to manage these behaviors and emotional reactions, as well as identify how to create/locate validating environments in their everyday lives.
- It works/is effective: Adherent DBT offers a structured approach that has been shown to improve emotional regulation and impulsive behaviors, as well as various other mental health issues.
- You can return to your previous therapist after your 6 months commitment if that makes sense for you: I’ve had a few clients finish up group with me and express their desire to continue with their other therapist, which is COMPLETELY OKAY! We offer specific skills and skillset and once you feel you have obtained what you needed, and it makes sense for you, it is more than okay to return to your previous therapist.
Cons of Having a Therapist at CCDBT while in our Group:
- You would have to change therapists for at least 6 months – 1 year*: This can be challenging if you have built rapport and a sense of safety with your therapist.
- It’s hard work: If engaged in comprehensive, you would be expected to complete diary cards, homework for group, homework for individual, and practice skills outside of sessions.
- Cost can be intimidating/may be a lot for some: Since we are out of network with most insurances, it may be intimidating to commit to weekly group sessions, and individual therapy, financially for some individuals. It’s important to look at your benefits if you will be seeking reimbursement. We’ve had clients who receive significant reimbursement and some who have no benefits. You can always use a HSA or FSA card for services. Please feel free to use this tool to check your out-of-network benefits: Insurance Benefits Checker. I encourage you to call your insurance and use our Tips for Using Out-of-Network Benefits sheet to confirm that these numbers are accurate.
- Making a 6 month – 1 year commitment for 2 hours weekly of group and at minimum 1 – 60 minute bi-weekly appointments, can be difficult: This does require a lot of your time AND so does changing behaviors.
- You would have to build trust with a new therapist and learn their style: Learning a new person comes with challenges and it may not seem like an instant “click,” when attempting to find a new therapist. If you’ve never had a behavior therapist or a DBT trained therapist before, their style may differ vastly from what you’ve experienced in the past. Additionally, each therapist has their own unique insights and style, this could also be a new learning curve for you.
Pros of Not Having a CCDBT Therapist while in our Group:
- You don’t have to build trust with a new provider/”start over”: You already have a flow and therapeutic relationship with your current therapist and depending upon how long you’ve been working together, it may feel like one of the best supports you have: It totally makes sense you would want to maintain this relationship.
- You already have an established schedule, rapport, and expected cost budget you’re used to: No new routines to get into, revisiting things your new therapist would have to know but you’ve already told this provider, and the cost is something you’ve regularly been doing already.
- You don’t have to change what you’re doing individually: Change can be scary, by staying with your current provider, you don’t have to worry about feeling scared or concerned about a new provider doing things you are not accustomed to.
Cons of Not Having a CCDBT Therapist while in our Group:
- They may not be an adherently trained DBT therapist, so they may not know how to teach you the skill accurately or how to implement it: While a few of the DBT skills are relatively similar to CBT interventions and other styles of therapy, knowing the process of adherent DBT takes a lot of training and education, DBT is a niche modality of therapy, it can be difficult, without this type of training and education, to know exactly how it was intended to be implemented and how to explain it to clients accurately.
- Harder to collaborate with group clinicians: While therapists at CCDBT do their best to collaborate with outside therapists, unfortunately, schedules and coordinating times to talk with other therapists can be a challenge. Additionally, if a client does not complete a release of information, we would not have the client’s permission to speak with this provider.
- The therapist may understand one of the skills, yet not know how to incorporate it, contextually with other skills in the ways DBT was intended: While a therapist may understand one skill from DBT, they may not know how to assist you in using multiple skills together or identify how to use multiple skills in conjunction with specific issues you are having, as explained by the DBT model. This could result in a misunderstanding of the skills or using skills in ways they are not intended.
- The therapist may not know of DBT assumptions: While we would hope that every therapist out there is nonjudgmental, accepting, and challenging, this may not always be the case. You may run into noticing judgments your therapist makes and ways that the group leaders’ approaches differ from your individual therapists’.
- The therapist may not have access to a DBT consultation team or a consultation team at all: Each agency works differently. Some therapists meet directly with their clinical supervisor and also their team, some places meet just with their supervisor, and some meet with just their team. While your therapist may be well educated, consultation is important to get different perspectives and alternative approaches from other clinicians. Not having access to a DBT consultation team could limit the therapist’s abilities to offer various perspectives, collaborate with others to help with a client’s case, and limit the ability to learn more about DBT strategies and skills.
While I am sure there are various other pros and cons for each side of this debate, hopefully, you can notice (whether in the chart or the list I provided), there tend to be a lot more pros to seeing a therapist here vs pros to seeing an outside therapist, just as there are less cons to seeing one here than there are to seeing an outside therapist. The bolded items above are to emphasize long term effects/outcomes. We want a good life, not just a good day/season/year/month, etc. By highlighting the long term effects/outcomes, we can prioritize our goals and make a more effective decision for ourselves related to choosing a CCDBT therapist or continuing with our previously established individual therapist. I can speak to seeing the changes when a client has transitioned from an individual therapist to a CCDBT therapist, and it has been transformative! I would encourage you to come to your own conclusions, while still giving some weight to the more clinical aspects I’ve detailed here. I hope this helps you figure out the best choice for you and further consider Cincinnati Center for DBT for your individual therapy!
About the Author
Alyssa Eichhorn (she/her), M.A., LPCC-S, is a Licensed Professional Clinical Counselor who specializes in dialectical behavior therapy. Alyssa works with all ages in a radically genuine and nonjudgmental setting to help individuals identify more effective and balanced behaviors to create a life worth living. Alyssa provides a directive and warm approach with her clients to facilitate solutions, growth, and change where they want it. Click here to learn more about Alyssa and her therapeutic approach.
Sources:
Linehan, M. M. (2015). DBT® skills training manual (2nd ed.). Guilford Press.