This feature by Vinícius Guimarães Dornelles is Part 1 of 2 in a series about the history of DBT in Brazil. In this first part, he talks about the origins of DBT in Brazil, both informal and formal.
The origin of DBT in Brazil can be broken down into two different aspects, one formal and the other informal. This division aims to distinguish the entry of DBT through texts or introductory presentations (the informal origin) from the beginning of DBT development with the establishment of a specific Standard DBT program and the creation of intensive trainings that disseminated DBT programs throughout the vast country that is Brazil (the formal origin).
INFORMAL ORIGIN
Regarding the “informal origin,” DBT entered Brazil with the translation of the second edition of the book Manual Clínico dos Transtornos Psicológicos (Clinical Manual of Psychological Disorders) in the year 1999. This work, a major reference in evidence-based treatments, presented the first text in Portuguese about Dialectical Behavior Therapy, specifically with Chapter 10 written by none other than Marsha Linehan. The arrival of this text caused great curiosity and frenzy within the Brazilian psychotherapeutic community, as this approach was entirely new to the Brazilian scene. It was an evidence-based model for Borderline Personality Disorder, which until then had limited treatment prospects and was often neglected.
Following this milestone, some very preliminary studies on the approach and a few presentations in academic events focusing on the theoretical foundation and research data of DBT began. However, no specific DBT programs were developed, and there was no significant advancement of DBT in actual clinical practice within the psychotherapy scene in Brazil.
After a few years, in 2010, another significant event occurred for the development of DBT in Brazil. The publisher Artmed, based on the recommendation of psychiatrist Melanie Pereira (one of the leading Brazilian references in Cognitive-Behavioral Therapy), translated the books Cognitive Behavioral Treatment of Borderline Personality Disorder and Skills Training Manual for Treating Borderline Personality Disorder into Portuguese. This was a definitive milestone for the introduction of DBT in Brazil. However, even with the availability of these manuals, the development of DBT programs or teams in Brazil was still not observed. This fact can be partly explained by the lack of substantial research interest in Borderline Personality Disorder and pervasive emotional dysregulation within the research domain of Cognitive-Behavioral Therapy or Behavioral Therapy. The interest in this patient population was predominantly among professionals with a psychoanalytic orientation, which may explain the limited development of DBT after the arrival of the manuals.
Additionally, around the same time, Jeffrey Young’s Schema Therapy was introduced in Brazil, which sparked strong interest among Brazilian cognitive-behavioral therapists. As Young’s model targeted personality disorders, was more familiar to therapists trained in Beckian cognitive therapy, and was simpler and more cost-effective to implement, it naturally took the lead in the development of psychotherapeutic practice for personality disorders in Brazil, widely adopted by cognitive-behavioral professionals.
FORMAL ORIGIN
As stated above, even though the main texts of DBT have already been translated into Portuguese and are fully accessible to Brazilian professionals, the emergence of formal DBT programs, teams, and trainings will occur a few years later. In this sense, there is an intersection between my professional history and DBT as a whole in Brazil. Fortunately, this intersection is continuous, while also expanding to many other groups in our country, not limited to those who work with me or are close to me. This clearly demonstrates the success of the expansion plan for DBT in Brazil, as it becomes a strong movement within psychotherapy as a science and practice in Brazil, not being the “property” of just one specific group, but rather a scientific heritage in service to those who truly need this treatment.
Regarding my professional history, I will be brief. I will do so because it is not the focus of this blog, and I will provide the necessary information to understand why, even in an environment that was not very “conducive” to DBT, as explained in the previous section, DBT will sprout, take root, and become a tree with many fruits in Brazil.
The first point is that I became truly passionate about studying Borderline Personality Disorder very early on in my psychology degree. In the beginning of the third year, in the Psychopathology II course taught by Professor Dóris Helena Della Valentina, I had my first class on the subject and decided then that I would dedicate my life to working and studying BPD. This led me to choose BPD as the focus of my master’s thesis at the end of my psychology undergraduate studies. At that time, I had a greater focus on basic science studies, so my master’s work ended up being a neuropsychological assessment of patients with BPD.
With this passion for studying BPD, three years after completing my master’s degree, I started a group called GEP.PERSONALIDADE (Personality Study and Research Group) in which we initiated a series of studies on personality structure and BPD in general. However, in 2011, in addition to the studies focused on basic science, we began to delve into evidence-based therapeutic approaches for BPD. Thus, as we studied DBT in more depth, I fell in love with it, and we started to focus our studies on it. As a result, in 2012, we conducted a review of research on DBT to present the results at the Latin-American Congress of Cognitive Psychotherapies, promoted by ALAPCO, in the city of Rio de Janeiro.
The point was that, while looking at the conference program, I noticed that there was an Argentine named Pablo Gagliesi who had some presentations on DBT. This caught my attention, and I decided that I should attend the lectures and talk to Pablo Gagliesi. After attending one of Dr. Pablo Gagliesi’s lectures, I approached him to talk. He immediately looked at me and said, “Are you Vinícius? I have many things to give you.” Then, Dr. Pablo handed me two handbooks of the DBT skills manual that was being used at Fundación Foro in Argentina and told me that we needed to assemble a DBT team in Brazil. On the same day, in a café at the Federal University of Rio de Janeiro, I was having coffee with some members of my team, reading some parts of the manuals, and I looked at everyone and said, “We are going to assemble a DBT team.”
Upon returning to Porto Alegre, I got in touch with Dr. Pablo Gagliesi, and we established a cooperation agreement in which he would come to Porto Alegre every six months for two years to provide us with training in evidence-based therapies for Borderline Personality Disorder, focusing on DBT and our development as a DBT team. Thus, in 2013, we formed the first standard DBT team.
Read here for Part 2 of this blog about The History of DBT in Brazil.
Vinícius Guimarães Dornelles – Master in Psychology – Human Cognition, DBT Specialist by Behavioral Tech, First native Portuguese speaking Dialectical Behavioral Therapy (DBT) Trainer, Specialist in Dialectical Behavioral Therapy by Universidad de Lujan/ARG, Specialist in Cognitive-Behavioral Therapy (CBT), Specialist in Evidence-Based Therapies for BPD by Fundación Foro Trainee-in-training at Behavioral Tech, Official reviewer of the translation of the skill manuals by Dr. Marsha Linehan. Read his full bio here.
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