therapists are paid the same by insurance companies for treating high risk, high demand clients as therapists who treat less severe clients who have minimal or no contact between sessions, DBT certification was created with two aims: 1) to ensure that clients are actually receiving DBT when they are in a DBT program or with a DBT therapist; and 2) to create a credential that will inspire third party payors/legislatures to offer enhanced reimbursement rates to clinicians who can demonstrate that they are providing the treatment with fidelity.
At this point, November 2015, the only certification that is live is certification as a DBT Individual Therapist. Within the next 6 month, the DBT-LBC will go live with DBT Skills Trainer certification and DBT Program Certification. DBT Program certification will require a specified number of certified individual therapists and skills trainers. In addition, program certification will involve examination of the structure of the program, service delivery patterns and documentation as well as training and supervision plans. Not all DBT teams will go for program certification. Larger teams, agencies and systems will benefit from program certification.
DBT Individual Therapist Certification ::
There are several steps to DBT individual therapist certification. They are completed in order. After passing each step, the clinician is invited to complete the next step and given instructions on how to submit the information needed for the step. Applicants who fail one part of the process will be given one additional attempt. If s/he fails the second time, the applicant will be required to wait 1 year and start the process over at the beginning. The requirements for certification are as follows:
Step 1: Apply for certification. The applicant is asked to submit information on education, clinical experience, DBT experience and his/her license to practice in a mental health field. As part of the application process, clinicians will be asked to attest that they have led or co-led skills training groups, are currently on a DBT consultation team and have attended mindfulness training and have a mindfulness practice. To demonstrate their experience, applicants write 3 brief case histories of clients who have completed Stage 1 DBT. Finally, applicants will be asked to submit a letter of recommendation from someone who can attest to their character and DBT abilities.
Step 2 :: Take the exam. It is around 100 multiple choice questions about DBT. Sample questions can be found on the DBT-LBC website. Tests are taken at Pearson Vu Testing Centers and there is a fee that is paid to the testing center, usually around $150. If the exam is failed, the applicant may re-take the exam one time.
Step 3 :: Case Conceptualization. After passing the exam, applicants will receive an invitation to enter the Work Product Demonstration (WPD) stage of certification. In the final step of the WPD, applicants will be asked to submit session recordings of a DBT client. The case conceptualization is the formal formulation of that DBT client. The format is available on the DBT-LBC website and includes categories such as biosocial theory, life worth living goals, behaviorally defined problems, stage, targets (primary and secondary), controlling variables for two target behaviors and outcome measures. The cases are scored by coders. If the applicant fails the first submission, s/he is given a second opportunity.
Step 4 :: Session Adherence. After passing the case conceptualization, applicants will be invited to submit 3 consecutive individual therapy sessions with the client from their case conceptualization. These sessions are scored using the Dialectical Behavior Therapy Adherence Coding Scale by Linehan and Korslund. Sessions are given a score between 0.0 and 5.0. Any session scoring a 4.0 will be deemed “adherent.” If the applicant receives two out of three adherent scores, s/he will be certified. If the applicant fails the first submission of 3 sessions, s/he is given a second opportunity.
TIC supports and has played a role in the development of certification of DBT individual therapists, skills trainers and programs through the Linehan Board of Certification, www.dbt-lbc.org. TIC trainers have been involved in creation of the certification exam, the work sample and are part of assessing clinicians’ work products for certification.
DBT certification has evolved as the demand for DBT programs has increased. As with any “product” as the demand has climbed, there has been an increase in clinicians and institutions providing DBT services. Although many of them conduct DBT with fidelity, some of them provide treatment that is far enough away from the model as to not be helpful for clients and in some cases to be harmful or iatrogenic. In addition, DBT therapists provide around the clock services (telephone consultation) and live with the risk for highly suicidal and dysregulated clients. In the current reimbursement climate,