• Alicia Paz

What It's Really Like to Be a DBT Therapist

When other counselors find out my specialty is Dialectical Behavioral Therapy (DBT) and Borderline Personality Disorder (BPD) I am often looked at with disbelief. The stigma is there and I have been told there is something wrong with me to want to work with "the hardest group of people there is in mental health." I sometimes find myself having to explain that "borderlines" are not bad people and that the stigma isn't true. I have done DBT groups for 6 years online and 1 year in person at an outpatient clinic, as well as phone coaching, group consult and individuals. Not all the clients I have served have been diagnosed with BPD. BPD often isn't covered by insurance as a diagnosis and clinicians are hesitant to diagnosis it. The following is what it is like, both good and bad about running DBT groups. I understand each group is different and forms its own culture. The following is my opinion from my experience in an outpatient setting. Note the use of the word 'some.'

  1. Some DBT clients will (fairly) hold counselors accountable. The group was 2 hours long with a 10-15 minute break, the one time we (the co-facilitators) were late we were asked to apologize by multiple members of the group as when a client was late they were not allowed in. I appreciated the reminder and was never late again.

  2. Some DBT clients are initially combative regarding "changing their ways." I was always open about this in the first group session. DBT can be hard to get into at first. Being told that what you have been doing is ineffective and that you're here to become more effective is uncomfortable. Some clients get upset, over-personalize, and feel judged by this. I have had one person hold up his fis