Frequently Asked Questions

 1. What is DBT?

Dialectical Behavior Therapy (DBT) is a gold standard, evidence-based psychotherapy for individuals with borderline personality disorder and self-injurious behaviors that was developed by Dr. Marsha Linehan. DBT has also been found effective in treating a wide range of other disorders and problems. DBT focuses on helping clients to gain control over self-injurious behaviors, participate effectively in therapy, solve problems that negatively impact their quality of life, and increase their use of behavioral skills. In its standard format, DBT is delivered across four treatment modes, including: (1) individual therapy, (2) group skills training, (3) between-session consultation, and (4) therapist consultation team. Click these links for detailed information about DBT and its evidence base.

2. What is DBT therapist adherence?

Adherence refers to the degree to which a therapist uses the required procedures of DBT, and avoids using procedures that are not part of the treatment, in a single session. In short, this means that therapists deliver treatment according to the DBT manual. It is important to note that, because therapists’ adherence can vary across sessions, there is no such thing as an adherent therapist, only an adherent session. In addition, therapist adherence overlaps with but is not the same as therapist competence (i.e., the therapist’s level of skill in delivering DBT). For example, it is possible to deliver a DBT session adherently that may not be highly competent.

3. What is DBT program fidelity?

Program fidelity refers to the extent to which a program is structured to include the necessary elements of DBT. For example, this would include the degree to which a program upholds the structure and functions of the four modes of DBT and stays consistent with DBT principles and assumptions .

4. How can I find a therapist who is able to deliver DBT adherently?

The DBT-Linehan Board of Certification in the United States and the Society for DBT in the United Kingdom and Ireland are currently the only certifying organizations that require therapists to demonstrate the ability to deliver DBT adherently by having an expert review and rate their therapy sessions. In addition, the certification process involves a review of therapists’ employment and training history and a knowledge exam. Therapists who have met these rigorous certification standards can be found in the DBT-LBC Certified Clinician Directory and the Society for DBT Register of Accredited Therapists and Supervisors.

5. How can I find a high fidelity DBT program?

The DBT-Linehan Board of Certification also certifies programs that have been found to have the necessary components and structure to deliver DBT with fidelity to the model. The certification process includes having experts observe, review, and evaluate the practices of the DBT program. Programs that have been found to deliver DBT with high fidelity can be found in the DBT-LBC Certified Program Directory.

6. What training is available for the DBT Adherence Checklist for Individual Therapy (DBT AC-I)?

Free training in how to use the DBT AC-I is available on this website via: (1) reading the DBT AC-I training manual, (2) watching a 2-hour webinar about the DBT AC-I, and (3) using the DBT AC-I to rate mock sessions and compare your scores to those of expert raters. These free trainings are sufficient for anyone interested in using the DBT AC-I for lower-stakes purposes (e.g., quality improvement, training and supervision, team consultation). If you wish to use the DBT AC-I for higher-stakes purposes (e.g., DBT clinical trials research) where it is important to ensure that the scores are both reliable and valid, more formal training will be required. Formal training methods are currently being developed and evaluated. Please contact us with questions.

7. Can I use the DBT AC-I to evaluate DBT skills groups for adherence?

The DBT AC-I was developed specifically to evaluate adherence during DBT individual therapy sessions. The strategies included in the measure are the ones that were found to be most associated with adherence in individual therapy, and may not adequately capture the strategies most critical to adherence in group skills training. In addition, the research on the DBT AC-I has only evaluated its reliability and validity when used to rate individual therapy sessions; thus, its psychometric properties when used to rate DBT skills groups is unknown. At the same time, the strategies included in the DBT AC-I are used in DBT in general, including in DBT skills groups. So, it may be useful to consider if/how you are using these strategies during DBT skills groups. A measure to evaluate adherence during DBT skills groups is currently being developed.

8. How can I get trained in the DBT Adherence Coding Scale (DBT ACS)?

The DBT Adherence Coding Scale (DBT ACS; Linehan & Korslund, 2003) is the gold standard, comprehensive measure of adherence to DBT that was developed by Dr. Marsha Linehan and Dr. Kathryn Korslund. The DBT ACS has excellent psychometric properties and has primarily been used in DBT research and by DBT-LBC for certifying clinicians. The DBT ACS is not publicly available and there is a fee to be trained in and use it. If you are interested in being trained in the DBT ACS, please contact the Behavioral Research and Therapy Clinics at the University of Washington by emailing brtclib@uw.edu.

9. If I’m already trained in the DBT ACS, does that make me a reliable coder for the DBT AC-I?

Individuals who have been formally trained to reliability in the DBT ACS (by Dr. Kathryn Korslund and/or the self-study program at the University of Washington) and are currently calibrated with the gold standard rater can be assumed to be able to code the DBT AC-I reliably as well. This is because the DBT AC-I is made up of a subset of the DBT ACS items and utilizes the same guidelines for coding those items as the original DBT ACS. In addition, in the psychometric study of the DBT AC-I, coders who were trained to reliability on the DBT ACS had excellent inter-rater reliability on the DBT AC-I.