Jennifer Sayrs, PhD., a DBT – LBC Certified Clinician, is the Executive Director and co-founder of the Evidence Based Treatment Center of Seattle (EBTCS). As part of her role there, she serves as the director of the DBT Center, which is one of the first DBT programs in the nation to be certified by the Linehan Board of Certification. She is the co-author of the new book DBT Teams: Development and Practice, written with the DBT treatment developer, Dr. Marsha Linehan. Dr Sayrs was kind enough to answer three questions for us regarding her recent book, as well as her thoughts on the value of DBT – LBC Certification.
Q. One of your latest publications is the Guildford Practice Series book DBT Teams: Development and Practice, co – authored by Marsha Linehan. As part of my preparing for certification, I often found myself scouring pieces of other texts for insight into how to establish and successfully maintain Consultation Teams. Having an entire text devoted to Consultation Team is exciting! What made you decide to take on this challenge?
A: DBT teams are so important in making sure therapists continue to provide effective DBT even when the going gets tough. DBT clients present with multiple, complicated, long-standing problems that at times can be quite frightening and frustrating. When therapists are faced with fear, frustration, burnout, or any number of other challenges, it is easy to stray from the treatment and respond ineffectively. The team’s job is to watch for these problems and offer support and guidance. I truly don’t think it’s possible to do effective DBT without a “community of therapists” providing DBT.
I have provided many trainings in DBT, both in workshops and in our clinic. In doing so, I realized there were many aspects of team that were not written down anywhere. I have learned so much about what works (and what really doesn’t work!) from my experiences running my own team and being on teams with Marsha Linehan. I approached Marsha and suggested we put all of our experiences and insight in writing, so others can benefit. We agreed that writing a manual for creating and running a DBT team would be an important element in helping therapists improve their skill in DBT as well as their treatment outcomes. We spent many hours talking through which elements of our teams’ structure are necessary, what makes our teams run well, what disrupts their effectiveness, and what “school of hard knocks” lessons we could share with others. The result was this book!
Q: Another of your contributions to the field of DBT researchers and clinicians alike is your serving as guest editor on the Special Series on Behavioral Assessment in DBT Cognitive and Behavioral Practice. The issue highlights the crucial role of ongoing behavioral assessment while both learning and practicing the treatment to fidelity. For a DBT clinician working towards fidelity standards, what advice might you lend on staying awake to drifting from the model?
A: At times, it can be nearly impossible to detect when one has drifted from the model. It is so easy to be influenced by the client and other factors, and therefore make unhelpful or non-strategic decisions in therapy sessions. There are many strategies for managing this, including getting high-quality training, continuing one’s education on an ongoing basis, and staying up to date with developments in the field. Perhaps even more importantly, I would recommend utilizing one’s team. Developing a culture of vulnerability in team, where providers can share their mistakes and trust they will receive help rather than judgment or reprimands, helps to make sure missteps are discussed and the treatment can get back on track. Marsha always asked us, “Do you want to look good or be good?” In other words, are you willing to risk a little embarrassment to talk through mistakes and improve your skill? When doing DBT, the stakes can be high; clients often engage in high-risk behaviors, making it more important to provide the most precise, effective, compassionate treatment possible. This translates into telling all of my teammates every time the treatment I provide is not moving smoothly forward, even when I don’t want to!
Q: In the theme of constantly evolving and shaping ourselves as DBT clinicians, I love the idea of training oneself to attain certification standards. In your work with supervising, training, and consulting with DBT clinicians at all levels of training, what are your thoughts on the potential value of DBT- LBC Certification standards?
A: I deeply believe certification is an essential development in DBT. I have had many, many clients come into our clinic saying they have already received DBT and it didn’t work – only to discover they were taught only a few skills and never received the full treatment. I am not opposed to therapists providing only certain components of DBT when that is all that is needed! But for the clients with severe, long standing emotion dysregulation, and all the very challenging problems that come with such dysregulation, clients often desperately need more than a subset of the skills. And these same clients have no way to evaluate what treatment they are being provided. Certification is a way to communicate to clients that they are receiving a treatment that is supported by evidence and has a strong chance of helping them. Certification also ensures therapists have the training, experience, supervision, and support to treat clients with intense, high-risk problems. As the popularity of DBT has dramatically increased over the years, this method of confirming clients are actually getting DBT has become all the more essential.
Keep on writing, great job!