Reality Check by Juliet Nelson

If Alec Miller challenges you to begin the DBT program certification process together and months pass and you still don’t get going, you might ask yourself, WTF? Why not?

Beware, this is not a tale of overcoming obstacles, rising to the occasion and finally accomplishing that goal.

This is the tale of a new and small DBT practice in Kansas, as yet uncertified…. For those of you who are also waiting and watching or just trying to keep your heads above water, perhaps it will be validating. Why are we not further along?

It’s the usual suspects: competing demands, the onslaught of clinical work and clients with wicked problems, credentialing delays and insurance issues, learning the hard way that we may need an office manager or at least a billing specialist, and throw in a roof leaking into the group room onto an already over-stressed printer.

It’s no wonder the questions from team members arise: Is there any reason to do this? what will program certification get us? Will insurers pay more or consumers even know what it means? What good can come from this? It’s expensive and time consuming and makes you feel insecure. Are we really doing things the way we’re supposed to? How are we tracking outcomes and is it sufficient? Do our client’s get better fast enough? Does our consult team really provide therapy for the therapist? Are we always available 24/7 for crisis and coaching? Is the 4 miss rule really being followed? And, how’s that policy and procedures manual shaping up?

These are the doubts and demands taunting us in the process. Meanwhile, Joan Russo offers a free book on teams to sweeten the deal; and the scholarship possibility is dangled in front of us on the listserv. Having the formal structure of certification had been my plan for motivating us after leaving the community mental health center. We were supposed to be practicing DBT more precisely. Were we willing to sharpen our work and open ourselves up to the feedback?

Without taking action, my DBT desires feel thwarted, the excuses seem lame and Alec’s program has already completed the desk-top review and scheduled their site visit. I have to remind myself the reviewers want programs to come up to standard. And, the more programs that shape up and get certified, the more people will get the actual treatment we’ve all been working so hard to do. I’ve been urging myself along remembering how we fought to go to the first intensive training long ago.

Our program took a leap into the “cloud of unknowing” and came up drunk with ideas and direction from Marsha and her team. You could be curious and ask, so this is what we need? I’m going to use some adaptive denial with the amount of paperwork and process; and borrow some enthusiasm from our first group of practicum students, arrived in June with that new-found DBT fever, just contagious enough to re-infect us all.

They’ve been organizing us, knocking out details from the checklist, creating tracking forms and the policies and procedures manual. I know that we will have to step up and do more to get this off the ground.

Anyone else want to take on the Alec Miller challenge? What are you waiting for? I’m thinking, “WHY NOT? Be the first certified program in Kansas—Just do it!”