One of the critical elements of a DBT program is the DBT consultation team. Back when Dr. Marsha Linehan was developing DBT, she recognized that clinicians working with clients who have complex mental health concerns and are at high risk for suicide need help and support. Specifically, clinicians need emotional support and social connection to combat demoralization and, deal with stress, and stay motivated to do this important work. Clinicians also need help and feedback from other professionals in order to maintain their skills and effectiveness. In isolation, it’s hard to know whether you’re drifting from effective clinical care; thus, it’s invaluable to have colleagues who are willing to give you (sometimes difficult) feedback. These are the primary goals of a DBT consultation team: to help therapists stay motivated and skillful. Most DBT teams meet weekly to discuss challenges in their work and get help and advice from their fellow clinicians. Whenever I provide training with clinicians who are learning DBT, I often tell them that their DBT program will live or die based on the health of their team.
How does the DBT team keep clinicians motivated and skillful? Well, during our team meetings, we discuss issues and challenges in our work, give each other feedback and suggestions, conduct informal trainings and provide updates about research relevant to our work, and even practice important therapy skills. We also do some of what’s often called “therapy for the therapist.” If a clinician is having particular difficulty with one of their clients, we not only focus on what the clinician can do to provide effective care but also how the clinician is thinking and feeling about the situation. Therapy can be considered a treatment and a relationship between humans. In any relationship, things can sometimes become stressful for both parties. When that happens, we try to help clinicians clarify how they’re feeling and use effective skills to manage their emotions and continue to provide excellent treatment.
My previous blog addressed some of the benefits of social connection. I think that many of these benefits also apply to DBT teams. When you know that other clinicians are accessible, responsive, and engaged, you will be more able to tackle the stressors and challenges of work. Even though we are all working remotely these days, almost every week, I hear about team members reaching out to each other, supporting one another, providing feedback and advice, and even going on physically distant walks together. I believe that a responsive, accessible, and engaged team can significantly enhance the well-being of clinicians, which has a ripple effect on their client.
Another benefit of social connection involves the sharing of labor. Although, on a DBT team, everyone has their own individual clients, our philosophy is that other team members’ clients are also our clients. Even if we are not directly seeing the client, the idea that we are all treating each other’s clients by treating each other can help clinicians feel like the difficult work they are doing and the heavy responsibility they sometimes take on is being shared by others.
Finally, I think another benefit of social connection that DBT teams achieve is the distribution of risk. We sometimes work with clients who are at high risk of suicide or self-harming behaviour. Clinicians who work in isolation with these clients can feel quite overwhelmed and worried about the various risks that could arise, such as risks to the client’s life, the dangers of making the wrong decision, and maybe even risks to the clinician’s career. When you work as a team, however, some of that risk is distributed differently. Even if you’re working with someone who is highly suicidal, you always know you can reach out to other team members, and that you will have your weekly meeting to receive wise advice, suggestions, and support. Team members share risk in some ways by helping others see important blind spots, notice things they might’ve missed, or even just provide reassurance that a clinician is doing everything they could do.
If you have a DBT team, you might consider your team is maximizing the key benefits of social connection, particularly during this very weird world we are currently living in. Try to make sure you carve out time each week to meet as a group, whether it’s virtually or in person. Check whether you are a truly meeting the needs of each team member. Do periodic temperature checks on the stress level of the team, whether more support is needed, and so on. All of these things are more important than ever. ~ Alexander L. Chapman, Ph.D., R.Psych.