“DBT therapists side with clients.”

DBT clinicians can seem relatively “laid back” or informal when it comes to how they interact with clients. Most likely they do not know about the consult agreements. A couple of them are about limits in relationships. Therapists in DBT programs do not judge other clinicians for their limits, for being too rigid or being to flexible. Therapists set limits for themselves in treatment and not for the client as though they know what is best for the client. The expectation is that the client must adapt to the limits of the therapists, much like any important relationship. Linehan also recommends that clinicians stretch their own limits, since therapists often are trained towards holding too many limits. Newly trained therapists can come across as rigid, distancing themselves from their clients unnecessarily.  This limits the potential of the relationship to help. It is also difficult to expect an emotionally reactive individual to be vulnerable with emotion with someone in what feels like an artificial relationship. A result of patients breaking limits is burnout in the therapeutic relationship. Having too many unnecessary limits increases the risk a client cannot navigate all of them due to a deficit in interpersonal effectiveness.

A favorite therapist assumption for Jo and Ulland capturing both sides of acceptance and change is that clarity, precision and compassion are of the utmost importance. There can be a refreshing directness and irreverence within DBT that helps clients to see things in new ways to promote change. This directness, transparency and genuineness can be off-putting to clinicians who are more comfortable keeping a distance as an authority directing treatment protocols, which is more likely to be found in clinicians using predominantly change-based strategies, such as CBT. It also occurs in clinicians who were trained in modalities that believe it is not acceptable for the clinician to be themselves in the treatment relationship. While DBT clinicians may not reveal much personal information, they are free to do DBT naturally in their own way. Mistakes can be made in DBT, but there is no “right way” to do it.