Brief Intervention Strategies
As designed DBT is not a brief intervention. In standard outpatient DBT, the client makes a commitment to 1 year of treatment consisting of weekly psychoeducational skills training group, weekly sessions with an individual counselor to identify and reduce factors that interfere with the ability to use skills, and telephone contacts with the counselor on an as- needed basis when crises arise, thus facilitating generalization through this in vivo interaction. The counselor in turn agrees to provide 1 year of treatment during which the counselor will participate in weekly consultation group for technical help and emotional support.
Evaluations of a year or less of treatment are important as one must consider issues of cost-effectiveness and practicality in clinical settings where long-term treatments may not be possible. Miller and colleagues (Miller, Rathus, Linehaan, Wetzler, & Leigh, 2007) have adapted DBT for suicidal adolescent outpatients. They shortened the first phase of treatment from 1 year to 16 weeks. Pilot data suggest these adaptations still result in promising treatments. However, the majority of studies conducted on the efficacy of DBT involve a minimum of a year in treatment.
Clients With Serious Mental Health Issues
Counselors treat a variety of disorders in a variety of settings (Seligman, 2004). Dialectical behavior therapy has been modified for use in various settings, including inpatient programs (Barley et al., 1993; Bohus et al., 2000), day treatment programs, and residential programs. Adaptations have been developed for use with different forms of psychopathology, including substance abuse (Dimeff, Rizvi, Brown, & Linehan 2000), eating disorders (Safer, Telch, & Agras, 2001), domestic violence (Fruzetti & Levensky, 2000), bipolar disorder (Van Dijk, 2009), and antisocial personality disorder (McCann, Ball, & Ivanoff, 2000). In addition, DBT has also been applied to various age groups, including adolescent inpatients (Katz et al., 2002), adolescent outpatients (Miller et al., 1997; Rathus & Miller, 2000), and geriatric populations (Lynch, 2000).
Although DBT has been found to be effective in the treatment of BPD and is showing value in treatment of other chronic mental illness diagnoses, there are several clinical concerns. The effectiveness for medication therapy is well documented for mental illnesses that include a physiological component, such as psychosis and mood disorders. Some techniques within DBT require a certain degree of cognitive functioning, potentially limiting its effectiveness with populations that have cognitive impairment. Finally, because the application of the DBT model requires extensive and specific training, the lack of availability of trained clinicians may inhibit expansion of DBT as a treatment model.