Advanced Dialectical Behavior Therapy (DBT) Mechanisms of Change: The Experience and Understanding of Advanced DBT Therapists

The mechanisms of change in advanced Dialectical Behavior Therapy (DBT) are understudied and not well understood. This qualitative study contributes to the theoretical and clinical knowledge base regarding the mechanisms of change in advanced DBT. This study was guided by a single research question: How do advanced DBT therapists experience and understand advanced DBT mechanisms of change in their practice of advanced DBT? Data pertinent to this research question was collected through 11 semi-structured interviews with advanced DBT therapists practicing in the United States. The researcher used thematic analysis to identify six salient themes regarding mechanisms of change in advanced DBT: (a) therapeutic values, (b) the therapeutic relationship, (c) therapeutic use of self, (d) willingness, (e) acceptance, and (f) validation. This study has four limitations: (a) small sample size, (b) factors affecting qualitative rigor, (c) time and resource constraints, and (d) the potential for coder bias. However, this study is trustworthy and discusses several implications along with recommendations for future research, clinical practice, and social work education. The findings of this study open up dialogue regarding how therapists can creatively use treatment approaches integrating the mechanisms of change in advanced DBT in addition to following manualized protocols.