This feature by Shamshy Schlager, PsyD is Part 1 of 2 in a series about practicing DBT in Israel. In this first part, Shamshy shares his initial journey with DBT and his motivations for setting up a practice in Israel.
It is not my intention in this blog to chronicle the development or full state of affairs of DBT in Israel. An attempt to do so by me would be relatively haphazard. Prior to making aliya (i.e. immigrating to Israel), I was not aware of a unified or consolidated framework at that time for practicing or advancing DBT in Israel. I am sharing my personal experience, but realize that there are others who likely have a better understanding of the complexities of the healthcare system, such as Shani Avin, PhD and Helene Sher, MD, official Ambassadors to Behavioral Tech Institute. Therefore, I will briefly posit some hypotheses that may highlight certain natural obstacles that inhibit the ability for clinicians to access high quality training and thereby provide high quality and adherent DBT treatment.
In spite of the fact that comprehensive training and dissemination of DBT may be in relatively short supply, my personal experience has been that — with ambition, focus, and perseverance — creating viable DBT programs is doable. This is especially realistic given the high levels of innovation and entrepreneurship among the Israeli population.
The decision and the process of moving my family to Israel — which at the time included two small children — and my ambition to create a DBT program in Israel involved the merging of my personal and professional aspirations. In addition to the myriad obstacles that one naturally faces when moving to a new country with a family, creating a new practice in Israel presented the dual challenge of implementing the treatment in a different cultural setting and doing so as an immigrant.
Prior to moving, we were inspired by the profound recognition that we, unlike so many generations before us, were born in a time in which we could return to our ancestral homeland. Doing so felt existentially obligatory. My goal was to merge this dream with my aspiration to continue providing a treatment that I also regard as existentially critical and to develop a team of clinicians that feels similarly.
Having been intensively trained by Dr. Jill Rathus, an internationally-recognized DBT expert and long-time BTECH trainer, I was privileged to gain a focused and in-depth training experience within a strong community of clinicians. My training experience was immersive and personal with a high level of individualized attention, instruction, supervision, and support. Developing an outpatient DBT program in Israel was my opportunity to create a similar environment in a new place. I came with a strong desire to find a new community of therapists to treat a new community of clients.
As we slowly adapted and as my caseload grew, I began looking for therapists who would contribute to my ideal team culture, namely, a community of therapists who took their work seriously without taking themselves too seriously. Their training background would ideally include having been previously trained in DBT. However, I was also prepared to accept clinicians with a strong background in behavioral therapy and/or third wave approaches. My goal was to provide a similar treatment, practice, and training environment to the one I had experienced — immersive and personal with a high level of individualized attention, instruction, and support.
My efforts to create a vibrant and adherent DBT practice in Israel forced me to confront certain realities. For example, working in any new cultural environment is one in which the newcomer often lacks the advantages of prior personal connections (Protekzia, in Israeli slang). Other demographic factors provide new challenges as well as opportunities. Israel is a small country of just over 9 million people in which much of the population is intertwined. It is not uncommon for there to be only one-to-two degrees of community and familial separation (especially among the English-speaking communities). This can lead to a greater number of dual relationships that already exist or that may emerge. At the same time, there are increased personal and professional opportunities that develop through word-of-mouth connections — a true dialectic. In fact, even after casting a wide net in search of an applicant, the first clinician I added to my emerging team was referred to me by the younger sister of a childhood friend. In addition, my experience was that there were many clinicians, both psychiatrists and therapists, who had been desperately searching for a program where they could refer their most challenging-to-treat clients.
Read here for part two of this blog, in which Shamshy will share what he encountered as he began to establish a DBT practice in his new cultural setting of Israel!
Shamshy Schlager, PsyD is a licensed clinical psychologist both in Israel and New York and founder and director of Modi’in Behavioral. He specializes in Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), which are the gold-standard, evidence-based approaches for treating a variety of clinical disorders.
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