Dialectical Behavior Therapy Consultation Team: Staying Within the Therapeutic Frame

As a therapist or treatment provider, it is human to experience periods of fatigue, annoyance or irritability. Most have forgotten an appointment or deadline or occasionally been too busy to do routine things like make phone calls or do paperwork. But if you're finding this is happening with any regularity or you're unable to laugh or joke about yourself, it's a sign you need some support.

DBT assumes that effective treatment of people with BPD and other high risk impulse problems must pay as much attention to the therapist's and treatment provider's behavior as it does to the individual's. Treating individuals with high risk behaviors can be extremely stressful and staying within the DBT therapeutic frame can be tremendously difficult.

Consultation teams are designed to provide ongoing training to improve the skill level of treatment providers, to hold them within the therapeutic frame and to address problems that arise in the course of treatment delivery (Linehan, 1993).

DBT is an effective treatment for people with some of the most stressful behaviors-suicide attempts, suicide threats, and hostility. Some behaviors reinforce treatment providers for engaging in ineffective treatment and punish them for effective treatment. The treatment is slow, while risky behaviors demand immediacy. Thus treatment providers make mistakes, take extreme positions, become vulnerable to criticism, and, in general, burn out. The consultation team seeks to support treatment providers and hopefully minimize potential problems in working with individuals with high risk behaviors.

If you're experiencing burnout, the role of a DBT consultation team is to encourage open and full discussion. Team members help you evaluate what is contributing to the problem. It could be anything from specific client behaviors to stresses in your personal life to policies and procedures that are not supporting your work.

In order to return to effective work and balanced emotions, it's important to assess your limits and how you've observed them. You may need to address a client's behavior, build tolerance, attend to problem policies or take care of your own personal stressors.

Regardless of the solution in any individual situation, it is essential that treatment providers address their burnout. Otherwise it is the therapist who may interfere with the progress of treatment.

References:

Linehan M. Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993.