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Letter from the President's Desk - September
Hello everyone! There are so many exciting things going on at the DBT-Linehan Board of Certification. One place I would really like to start, though, is to extend a truly heartfelt thank you to all the behind the scenes volunteers that make our organization work. There are those who are visible, like the Board of Directors and committee chairpersons/members. But, most importantly, there are those who are invisible, behind the scenes, handling confidential materials and doing their jobs with no recognition and therefore little thanks. Our adherence coders are so dedicated and devote hours to each and every applicant’s work to assure that the treatment aspect they are reviewing is following Dr. Linehan’s treatment manuals. Can you imagine reading each and every Case Conceptualization and having to score it from multiple perspectives with consistency, accuracy and fairness each and every time? And to code videos of therapy sessions, not only for what IS there, but also what is missing that makes the session non-adherent? And, our application review team invests a lot of time assuring an applicant is truly ready to pursue the certification process. There are so many dedicated people working to assure our certification process is comprehensive and meaningful. You aren’t merely saying you read a book or attended a workshop or training. If you are participating in DBT-LBC’s certification processes, you are demonstrating your knowledge, skills and abilities to deliver DBT as researched by Dr. Linehan and colleagues. And it is those volunteers behind the scenes that make that privilege of using the designation – DBT-Linehan Board of Certification, Certified DBT Clinician – possible. THANK YOU, dear volunteers.
If you haven’t already noticed there are additions to the website and more to come. The Applicant Handbook has been updated, so you might want to take a look at that. We are working on making the whole Program Certification process clearer with additional guidelines and handouts available. Our Individual Clinician scholarship fund has grown, thanks to the contributions of all our colleagues who want to help others be able to afford the costs of certification. Program Certification scholarships continue to be available and we encourage you to check out the criteria for applying for that. Many programs are eligible, so take a look at the criteria listed.
We have the wonderful ISITDBT conference coming up in November in Washington, DC. I hope to see many of you there. Please say “Hi” and give a thank you to anyone with a Volunteer ribbon on their nametag! We need our volunteers. Have you thought of joining the team? Let us know through Contact Us on the website. We will be in touch.
One final note for now. As of the publication of this newsletter, DBT-LBC has formally applied for Accreditation through the National Commission for Certifying Agencies – NCCA. This is very important to you and we will explain that more once we earn that recognition. For now, I just want to thank the very small committee, led by Dr. Bev Long, for the person hours of dedication it has taken to bring this to fruition. The documentation that this has taken has made our organization even stronger and better equipped to offer you a top quality, high-stakes certification credential. We are committed to the legacy of Dr. Marsha Linehan, who stands out as a Great Scientist, for all the work she has done in the mental health field. Her dedication to the most vulnerable consumers in mental health has been a true gift. We believe getting certified in this treatment is valuable too.
Dr. Joan Russo
Starting Certification? Grab Your Handbook!
Your DBT-Linehan Board of Certification makes available the Clinician Applicant Handbook which you can download at https://dbt-lbc.org/downloads/Applicant_Handbook.pdf. Our goal for this handbook is to explain the process of certification from beginning to end as well as describe the requirements for maintaining the proficiencies and status as a DBT-Linehan Board of Certification, Certified DBT Clinician™. The Handbook was recently updated.
Need a little Inspiration to get Certified?
Consider that DBT's developer, Marsha Linehan, has been profiled in the just released 2018 edition of TIME magazine's Great Scientists. TIME's list of the 100, "geniuses, eccentrics, and visionaries who transformed our world" included Marsha along with such luminaries as Jonas Salk, Marie Curie, Louis Pasteur, Charles Darwin, Margaret Mead, Sigmund Freud, Albert Einstein and Isaac Newton. Marsha has earned several recent major awards for her research and clinical work in Dialectical Behavior Therapy, including the 2015 Scientific Research Award from the National Alliance on Mental Illness, the 2016 Lifetime Achievement Award from the Association for Behavioral & Cognitive Therapies and, in 2017, the prestigious University of Louisville Grawemeyer Award for Psychology. Needless to say, as a DBT-Linehan Board of Certification, Certified Clinician™ you will be in fabulous company!
Another new scholarship for Clinician Certification Too
My name is Nick Salsman and I am a DBT-LBC certified clinician, as well as a volunteer for the DBT-LBC fundraising committee. I choose to volunteer my time to this organization because I believe that the mission of DBT-LBC is critical. This issue of Certification Matters is dedicated to May being Borderline Personality Disorder (BPD) Awareness Month. In honor of BPD Awareness Month, I am proud to announce that DBT-LBC is launching a new scholarship fund for clinicians seeking individual certification.
DBT is the gold standard treatment for BPD. It is a treatment that science has proven to be effective for reducing the suffering of individuals who severely need it. It helps people who may believe that death by suicide is their only choice to alleviate their pain. As a clinician, it is a privilege to be able to work with individuals who are diagnosed with BPD as they journey out of hell and into lives worth living. I have also worked with individuals with BPD who come to me believing that they have been through DBT, when they actually have not had DBT practiced in an adherent fashion. Sometimes these non-adherent treatments have led individuals down a path where they spend more and more time suffering without receiving the help that they need. It takes time to educate these individuals about why the treatment they received was not actually DBT and how participating in adherent treatment is completely different and worth their time.
The mission of DBT-LBC is to ensure that this treatment can be delivered in an adherent manner to those who need it most. The clinicians who complete the LBC certification process have demonstrated through a rigorous process that they have knowledge of and practice adherence to the DBT model that has been scientifically proven time and time again to help those with BPD and others. Having this certification provides assurance to the public that can help guide them to find the treatment that is needed. We need clinicians who are fully equipped to help those who suffer with BPD. The new individual certification scholarship fund will help increase accessibility of certification to all clinicians and thus increase accessibility of treatment from certified clinicians to all clients. DBT-LBC will be awarding scholarships of $270 to those who are dedicated to this mission, particularly those who serve the underserved. The process for applying for these scholarships can now be accessed by http://www.dbt-lbc.org/index.php?page=101172.
Please join me in donating to the Clinician Certification Scholarship Fund. You can do so by clicking this link https://linehaninstitute.org/donate/certification/. This is a new fund that we want to grow continually. Please give what you can and encourage others to do so as well.
(Please note that the funds are initially deposited to the Linehan Institute only because they are a 501c3 charitable organization and can make your donation tax deductible for you. They have generously offered to help DBT-LBC in this way; they then send a deposit of 100% of your donation to DBT-LBC for the scholarship fund.)
New scholarships available for DBT-LBC Program Certification
The DBT-Linehan Board of Certification is pleased to announce the availability of The Michael Chambers Memorial Scholarship Fund (MCMS). This fund was initiated to increase access to certification and to help address financial barriers which could interfere with prospective programs becoming DBT-LBC certified. The scholarship is particularly seeking to fund DBT Programs which are small in size, and/or primarily serving low income, disenfranchised or marginalized individuals. The eligible awardees receive a $2000 scholarship towards the Program Certification fees. Additional information around eligibility criteria and the application process can be found on the Program Certification Information page on the website: link: http://www.dbt-lbc.org/index.php?page=101121. The Scholarship committee is intent on increasing community access to DBT-LBC Certified Programs and further increasing knowledge around the importance of certification, with a goal of awarding five scholarships per year. Efforts are also underway to add to and grow the current level of funding in the MCMS to sustain scholarship availability for years to come.
The desire and demand for DBT has never been higher as this treatment continues to be disseminated world-wide for increasing numbers of client populations and in varied settings. Many DBT clinicians and programs are well trained and are doing excellent work. At the same time, many of us have had the experience of meeting a new client who shares the experience of “already doing DBT- it didn’t help!” While even experts have some occasional clinical outcomes that are less than positive, it has become evident that there are some clinicians and programs that are not delivering adherent, comprehensive DBT as developed by the treatment developer, Dr. Marsha Linehan. The risk is significant as substandard treatment fails to help those in need, increases feelings of hopelessness around treatment in general, increases risk of negative outcomes, and may bias individuals against a treatment which could be life-changing.
To address this growing concern, several years ago the DBT-Linehan Board of Certification (DBT-LBC), with the active participation and endorsement of Dr. Linehan, created a DBT Clinician Certification process to help prospective clients, families, and other professionals identify practitioners who had demonstrated the knowledge and ability to deliver adherent DBT. We are extraordinarily happy to report that the DBT-LBC launched the Program Certification arm of the process in mid-2017.
The goal of Program Certification is to support and encourage a proliferation of DBT programs providing adherent treatment. Importantly, it provides a ‘roadmap’ for programs to follow, highlighting critical elements that should be present in every DBT program – both organizationally to support the clinicians in delivering the treatment as well as clinically to review that all elements of the treatment are present. The review process, done by two trained Site Reviewers, offers feedback to the Program that discriminates between recommendations to the program that must be addressed for the program to be certified and suggestions, which may offer improvements that motivated programs might value implementing but are not required for the program to be certified. The awarding of DBT-LBC Program Certification indicates that the program has the structure and practices consistent with the delivery of a comprehensive implementation of Dialectical Behavior Therapy. It has undergone an extensive review that consists of scoring of responses to a Program Fidelity Scale questionnaire, program document and file review to see the structure of the DBT program, interviews with treatment providers and clients, and on-site observations of the DBT program practices in action. Programs are encouraged to address deficiencies using the recommendations and continue with the site review process to ultimate certification. Thus, Program Certification is another element in the broad set of resources for clinicians and programs implementing DBT.
For a DBT Program to be eligible to apply for certification, the Team Leader must have completed DBT-LBC certification as an individual Clinician. The Team Leader will be the person responsible for completing the application on line. We suggest that every program considering applying first complete the Program Fidelity Scale (PFS) https://dbt-lbc.org/index.php?page=101141. This document will help you preview the expectations and understand the degree to which you currently meet the requirements and whether you are ready to start the program certification process. This is an overall review of your program and gives you confidence that those expectations will be met.
The Program Certification application is only accessed through a Certified Clinician's DBT-LBC online profile. To get a good understanding of what is required in Program Certification and its application, please see the Application Self-Assessment https://dbt-lbc.org/index.php?page=101141.
We encourage DBT Programs to become certified and hope that the availability of scholarship assistance helps interested programs be able to pursue this valuable certification. Please check out the website for more information and feel free to Contact Us via the website with any questions. Thanks for your dedication!
Steps to Review your DBT Program for Certification Consideration:
a. Review and complete PFS Scale link: https://dbt-lbc.org/index.php?page=101141
b. Perform a Self-Assessment link: https://dbt-lbc.org/index.php?page=101141
c. Review or begin application (only DBT-LBC Certified Clinicians will have access to the application because one of the Program Certification requirements is that at least the team leader must be certified)
Alec L. Miller, PsyD
DBT-Linehan Board of Certification, Certified DBT Clinician
Chair, Michael Chambers Memorial Scholarship Fund Committee
Portland DBT Institute Receives Program Certification
Andrew White and Linda Dimeff
When individual certification first became available the Portland DBT Institute jumped at the chance. We had seen firsthand individuals who had continued to suffer after receiving what they thought was DBT, only to find they had not received DBT at all. We felt strongly about DBT programs setting the bar high and having clear criteria for what constitutes DBT. We also found when our clinicians went through the certification process, it had a huge positive impact on the clinic as a whole- people began forming study groups for the exam, sharing case conceptualizations, and increased their recording of sessions to get feedback from peers.
We applied for (and received!) our clinic certification in 2017. This process helped highlight areas of our services where we could tighten up and pushed us to shore those areas up. We have used the certification results to better meet the challenges of delivering high fidelity services to a growing population. Maintaining a high standard of service delivery for over one thousand clients per year and twenty-five full time therapists is a difficult task requiring a great deal of clinic infrastructure.
The on-site review process included feedback to both clinical and management staff which has further helped us to understand the relationship between how a principle or policy is expressed and the way in which it is experienced by individuals in the clinic. Clients interviewed by the review team expressed appreciation for having their voices heard as well as a greater connection to the clinic.
The impact of certification has been far greater than the sum of its parts. Certification has become a point of pride for staff and clients and has an ongoing positive impact. Much more than an administrative task the review process has been designed with the goal of adhering to core DBT principles around increasing staff’s competency and motivation to do the treatment. The completion of the certification process and third-party recognition around our delivery of DBT is an honor and reflects our core values as a clinic.
The Importance of Providing Linehan Board Certified Dialectical Behavior Therapy for Borderline Personality and Substance Use Disorder.
Family Perspective - by Regina Piscitelli
In light of the current opiate crisis in the United States it is more important than ever for families and clients to have access to both DBT-Linehan Board Certified programs and DBT-Linehan Board Certified therapists. About 78% of adults that suffer from BPD also have experienced a substance use disorder (Kienast, Stoffers, Bermpohl, & Lieb, 2014) and there is an increase of up to four times more risk of suicide (Darke, Ross, & Williamson, 2005). Heroin users with BPD have an increase of negative consequences and develop more health related problems. There is also a higher likelihood of heroin overdose (Darke, Ross, &Williamson, 2005). The possibility of an overdose creates an environment where families live in constant fear and uncertainty.
For nearly two decades, Dr. Linda Dimeff, PhD has collaborated with Dr. Marsha Linehan, PhD to develop an adaptation of DBT for BPD individuals who also have substance use disorders (SUD). Comorbidity of BPD and opioid addiction results in a more severe and persistent course of both disorders. People with multi-diagnosis are much more difficult to treat. The DBT-SUD treatment model is based on the standard DBT treatment model but targets specifics related to BPD and substance use disorders. Research has shown that implementing the DBT-SUD treatment model results in less drug use, better global assessment, lower drop out and continued gains. These studies provide evidence that DBT-SUD is effective in treating substance use problems while simultaneously addressing other complex problems.
The importance of including family in the treatment provided for the client gives the family the opportunity to learn some of the basic DBT ideas and skills that clients are learning in the program and explore ways to provide an environment for clients balancing a validation focus with acceptance strategies. Having the family involved promotes a better outcome and motivates the client to stay in treatment.
With the opioid epidemic gripping our nation and people dying from overdose at alarming rates it is important for clients and families to have available DBT-Linehan Board Certified programs and DBT-Linehan Board Certified therapists that are competent in delivering effective evidence based DBT. The potential lethal consequences that could result due to BPD-SUD underlines the need of finding a therapist or program that is Linehan Board Certified and adherent in DBT that can provide a treatment that is evidence based, board reviewed and held to the highest standards.
Darke, S., Ross, J., Williamson, A., & Teesson, M. (2005). The impact of borderline personality disorder on 12-month outcomes for the treatment of heroin dependence. Addiction, 100(8), 1121-1130. Doi:10.1111/j.1360-0443.2005.01123.x
Kienast, T., Stoffers, J., Bermpohl, F., & Lieb, K. (2014). Borderline personality disorder and comorbid addiction: Epidemiology and treatment. Deutsches Arzteblatt International, 111 (16), 280-286.