To Adopt or Adapt

Many providers interested in doing DBT with their clients face a dilemma: To adopt the standard model of DBT or to adapt it. Anyone considering DBT must consider the needs and constraints of their setting, as well as the available research on the treatment. Dimeff and Koerner (2007) present an excellent discussion of the Adopt or Adapt dilemma in DBT in Clinical Practice, as well as tips for navigating the dilemma. Here are just some of the implications they address:

  • Modifications may or may not retain the active ingredients required to get good clinical outcomes
  • A clinician offering an untested modification can’t speak as well to the potential benefits or harm when informing clients about treatment
  • Reimbursement by insurance companies or other funders is commonly linked to documented adherence and program fidelity
  • Best practices when working with a high risk population are to follow acceptable standards of practice

Behavioral Tech encourages mental health providers to first learn standard DBT, then pursue advanced training on how to thoughtfully adapt it for a specific population. This approach maximizes one’s familiarity with the evidence base for standard DBT, then to understand how strategic modifications are made to adapt it to the needs of a population. Clinicians who develop a solid understanding of the principles behind the functions of treatment can adapt the protocols from the corresponding modes of treatment to fit the population or setting. It is important to adapt the protocols only where necessary and keep everything else.

Some providers may want to begin offering one mode or aspect of DBT, such as DBT skills training groups. Providers interested in this path should be familiar with the research comparing modes of treatment (see Linehan et al, 2015), and be committed to learning and applying behavioral modification techniques and DBT strategies. Refer to our Training Catalog to learn more about training options to prepare for offering DBT Skills groups.

For providers interested in learning and implementing the standard model of DBT, including how to later adapt it for adolescents, persons with substance use disorders, or other treatment needs, Behavioral Tech offers Level 3 comprehensive trainings and Level 4 courses on adapting treatment for specific populations.

Not sure how to start or grow your DBT program? We also offer consultation services with one of our DBT experts who can help you explore the needs and constraints you face.