This feature by Pablo Gagliesi, MD of DBT Iberoamérica is Part 2 of 3 in a series about DBT in Iberoamérica. Here in part 2, Pablo shares the story of the introduction of DBT to this region.
In part 1 of this blog, I shared a look at the overall landscape of culture and DBT in Iberoamérica. Now, I will share the story of the introduction of DBT to this region.
Since 2009 we kept in touch with Dr. Linehan, who invited us to several Intensives, among them a memorable one in Minneapolis with Suzanne Witterholt and Randy Wolbert. At that time, Guillermo Lencioni, a friend and colleague from Buenos Aires, was our partner on the road. Those trainings were the seed of the foundation of DBT Iberoamérica and DBT Brazil.
I like to tell the anecdote that I left the first Intensive I attended extremely frustrated, confused, believing that I knew nothing. I remember Dr. Witterholt telling me: It’s only the first one, nobody is born knowing. With a beginner’s mind, we returned home to continue studying.
Dr. Linehan summoned us to my first silent retreat led by her and Pat Hawk. In Argentina, we were going through one of many economic crises, and BTECH was sympathetic and cooperative. However, we were already aware of the financial difficulties that dissemination would imply. I had no idea what this silent retreat was all about. My ignorance was such that I packed my suitcase as if for a congress. I am a psychiatrist, so shoes, shirts, suit and tie. The most inappropriate clothes in the world. To embark on a journey of 7000 miles (11200 km) just to be mute? It was a strange proposition, another of Dr. Linehan’s ideas.
From then on, we maintained a kind and loving relationship with the generous Dr. Linehan. We had several meetings in Seattle and later a residency as a visitor professor at BRTC thanks to Dr. Korslund. I accompanied Dr. Linehan in trainings and courses and then continued to attend trainings with Randy Wolbert, Gwen Abney-Cunningham, André Ivanoff, and Tony DuBose within the United States. In 2010, I came up with the idea of setting up a team of trainers for trainings in Spanish and Portuguese and creating two organizations in charge of the trainings.
By then, in the course of seven years we visited 19 countries, attended multiple congresses, accepted invitations to speak even in small groups, always with enormous enthusiasm. We lived in a world where presence was required. It was the only way of dissemination. Soon several study groups were born in Latin America, among them one of the first, already a tradition, in Santiago, Chile, led by Cecilia Brahm. A group that was paired with the dissemination project from the beginning. This, added to a research work proving its use in Spanish carried out in Barcelona by Dr. Joaquim Soler Ribaudi, helped the community expand.
From Seattle, Tony DuBose and André Ivanoff helped us to organize the first DBT Intensive in Ibero-America that took place in Buenos Aires in September 2014 and was attended by colleagues from Argentina, Uruguay, Chile, Peru, Ecuador, Colombia, Brazil, Paraguay and had simultaneous translation in Spanish and Portuguese. We have the best memories of that memorable, incredible meeting. I still can’t get over the astonishment of how we managed to put together such an event. The host was Fundación Foro – my founding team, my home.
The creation of DBT Iberoamérica was spontaneous – we could not have created it in an organized way. A group of extraordinary people joined the project to extend the best available treatment to all the people who need it. We had no sponsor, no university, no professional society to collaborate or serve as a launching pad. Since then, relationships were woven that still exist today and many DBT communities appeared.
And also since then, more than 40 Intensive Trainings have been held in various countries of the region – including Spain – and two training units (DBT Iberoamérica and DBT Brazil) were created in affiliation with BTECH. Dr. DuBose faithfully and lovingly trained future DBT trainers, put more miles on his circumnavigation of the world than Magellan, and some of us followed him on impossible flights, sleeping at colleagues’ houses, eating together at each other’s homes, taking buses, moving in complex terrain. Without Dr. DuBose, who showed unusual skills of adapting to the territory (not knowing the language or the culture and eating strange things at unusual times), we would have gotten nowhere. Moreover, the experience in the territory led to the invention of new ways of training, such as the inclusion of mentors, renewed theoretical discussions from radical contextualism, the pragmatism of some proposals, the simplification and the possibility of creatively reducing the costs of the trainings. What I am saying is that the process with Behavioral Tech Institute was one of mutual collaboration and common learning.
The inclusion of mentors was fundamental to achieve the implementation and give continuity to the project. We all worked ad honorem at that time, paying from our own money for air or land tickets, hotels or meals. Always with Latin music that unified and enlivened the meetings. It is not a mere detail. Finding music that generates identification across all regions has been an important link of the community. I don’t know what Marsha Linehan would think since it was impossible to use music from the training sessions in the United States. I can assure you that our Intensives have a very different sound.
I just know, with all the love in the world, that if I could I would repeat the feat. This is the story I will tell to my nieces if I am lucky enough to grow old. We will laugh for a long time about all the anecdotes we collected with the team of coaches, friends, and colleagues. We will be sad about all the pitfalls, the hopeless interpersonal problems, the losses, the controversial divorces between teams, the short-sighted arguments. I hope that time will make us forget and forgive, or that they will become microscopic with perspective over time. We will be proud every time we see someone on TikTok post about DBT, when a client calls us to tell us something, even if it’s just to ask for help again – after all it is a skill. Because no doubt, this is the story I will have to tell.
Like all families, the DBT family is not without its difficulties, its interpersonal problems, its social emotions that sometimes fracture or unite us. We share one purpose, one value: To bring the best possible treatment to all who need it. A strong sense of fairness runs through the entire training community.
These values are complicated to fulfill in the region, as most therapists were not part of academia or the public health system. Validated treatments end up reaching the middle and upper classes, but do not end up being democratized, accessible, and free. This phenomenon is quite curious. Since the beginning of the dissemination of DBT we have not been able to implement DBT in any public hospital. Only in the last four years some teams have been able to take it to that area. The enormous effort of bringing proposals to different governments has been useless and a bit exasperating.
There are now Intensively-trained groups in Argentina, Uruguay, Paraguay, Chile, Bolivia, Peru, Ecuador, Colombia, Panama, Puerto Rico, Dominican Republic, Costa Rica, Honduras, Nicaragua, Mexico, Spain, Brazil, and Portugal. We can say that the word is out. The first team of trainers was made up of the following colleagues (I want to clarify that some are researchers, but all of them are clinicians): Juan Pablo Boggiano, Paula José Quintero, Vicente del Solar, Jael Camhi, Paolo Pérez Luna, Diana Quant, Nathalia Vargas, Michel Reyes, Ricardo Aguayo, Mariví Navarro Haro, and me. If I were to put little flags to let you know where they are from, you would be surprised at the diversity, but since we are in favor of erasing the dotted lines, I leave you to wonder.
Read here for part 3 of this blog about DBT in Iberoamérica, in which Pablo reveals more about the processes of translating DBT books and some of the more recent developments in the DBT community in this region.
Pablo Gagliesi, MD, graduated from the Catholic University of Cordoba and University of Buenos Aires. He is a specialist in Psychiatry at the National University of Buenos Aires, and graduated in Psychoanalytic, Systemic, and Cognitive-Behavioral psychotherapy. Dr. Gagliesi is DBT-LBC certified and certified in EMDR. He is the first official Trainer for Behavioral Tech in Latin America. Read his full bio here.
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