What is DBT Consultation and How is it Different?
By Alex Regalado
Those who are trained and use Dialectical Behavior Therapy (DBT) know how integral peer consultation is. Woven into the fabric of its model, DBT recognizes and accepts the unique clinical challenges that arise when working within behavioral health. To ensure therapists’ own sustainability, motivation, and skill, DBT strongly promotes regular collaborative work and case consultation.
Unfortunately, outside of well-established DBT programs, clinicians trained in DBT can often feel isolated, unsupported, and uncertain about their own clinical decision-making. Routinely meeting with individuals who experience complex clinical challenges or “unrelenting crises” can exhaust even the most veteran of clinicians.
The question becomes, if therapists do not have access to a proper DBT consultation treatment team, how can they ensure adherence and accountability while investing in their own longevity and wellbeing?
Dialectics Within Consultation
This is a balance that is not unfamiliar in DBT consultation. In fact, within insular DBT teams, a unique set of agreements are used to attune, strengthen, and challenge aspects of our own professional identities. This is a balance my own DBT team struggled with.
After the start of quarantine and transition into online services, our team experienced difficulties coping with changes in routine. In fact, members began regularly missing consultations. This resulted in our team directly exploring personal urges to miss consultation and our own desire to avoid team meetings. In so doing, we developed a new consultation agreement that would challenge clinicians to treat consultation just as important as any other therapy session.
DBT is no stranger to these types of discussions. Engaging in DBT clinical consultation promotes vulnerability and openness. Its curiosities expand past “learning objectives” or routine case reviews and directly challenge clinicians to look inward. That inward exploration is thus a centralizing process urging providers to engage in their own professional comforts and discomforts.
Challenges Brought to DBT Consultation
In preparation for clinical consultation, participants may review a series of prompts to assist in focusing our discussion. These prompts are generally used in DBT treatment teams and can be used to organize time spent in clinical consultation. Some examples of questions include:
What is my current burnout (rated from 1-5)? Participants who identify a rating of 3 or higher are encouraged to share the cause and if any additional support is needed.
- Are any clients experiencing life-threatening behaviors?
- Are any clients experiencing quality-of-life interfering behaviors?
- Am I (as the therapist) engaging in treatment-interfering behaviors?
- What are some client successes from the previous week?
DBT clinical consultation uses these questions to guide discussion and prompt further exploration. Using a DBT lens, the guiding consultant will clarify, facilitate, and share insight into the question.
The “4-Needs” of DBT Consultation
DBT is a model of structure and within an ever-evolving landscape of clinical complexity, it can become increasingly difficult to know what we are asking for when using these questions. To avoid venting or unfocused discussion, the consultation leader may use a framework to assist participants in identifying their needs. Personally, I appreciate using a “4-Needs” approach when exploring a clinical challenge. These include:
- I need help with assessment.
- I need help with problem-solving.
- I need help building empathy.
- I need feedback and/or validation.
It is not necessary to pick just one. I encourage participants to explore the fluidity of our clinical needs. It is common for a participant to express a need for assistance with problem-solving and after discussion, discover that a need for validation is more relevant. Additionally, DBT clinical consultation acknowledges these challenges may not be resolved in just one check-in. We encourage participants to return to consultation to explore the outcome of feedback or any developing needs.
Recommendations for DBT Consultation
Considering limited access and exclusionary boundaries of DBT consultation treatment teams, it can be exceedingly difficult to find adequate individual or group clinical DBT consultation. DBT-based private practices may offer access to external DBT consultation but most focus their resources and time internally.
If you are interested in further exploring DBT clinical consultation, Firelight Supervision is here to be that support. We would be more than happy to connect and discuss what your current clinical consultation needs are. No one single clinician is an island and we would love to discuss how to further support you and your professional development.
How we can help
For more information about our triadic supervision openings, contact us for a FREE 20-minute phone consultation. Firelight Supervision offers LMHCA triadic supervision from our Washington state approved clinical supervisors. Get started today!
If you’re looking for support and clinical consultation around your clinical work, check out our Clinical Consultation Community, where you can develop professionally within a community of other private practice therapists, just like yourself.
If you are located in Colorado or Washington, we provide clinical supervision for mental health counselors. Our trained and experienced clinical supervisors can provide you with individual supervision or group supervision, based on your clinical areas of interest.
Author Bio
Alex Regalado is a psychotherapist who specializes in Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT), and other skills! He has experience working in community mental health, hospital settings, crisis centers, and private practice. Follow Firelight Supervision on Instagram and Facebook.
