Comprehensive DBT vs. DBT-Informed Therapy: What's the Difference?
Written by Jessica Oliver, MSW, LCSW, with clinical contributions from Samantha White, MS, LPC
If you've been searching for DBT, you've probably noticed that tons of practices make a brief reference to it on their website.
It shows up on service pages next to CBT and EMDR, in therapist bios, in directory profiles. And most of the time there's no explanation of what the practice actually means by it.
That's a problem, because "we offer DBT" can mean two very different things. One of them is a full treatment program with decades of research behind it. The other is a therapist who knows some of the skills and teaches them in session.
Both can help people. They aren't the same, and the difference matters a lot if you're the person trying to decide where to spend your money and your next six months.
What does it mean when a practice says they offer DBT?
It usually means one of two things. Either the practice runs comprehensive DBT, which is the full four-part program Marsha Linehan developed and researched, or it offers DBT-informed therapy, where a therapist uses DBT skills inside regular individual sessions. Most practices mean the second one, and most don't say so.
Nobody's being sneaky. DBT-informed therapy is real therapy and it absolutely helps people. For many people, DBT informed care in and of itself is enough to make a difference.
But sometimes, it’s really important that you’re getting true comprehenesive DBT. And that’s different. That’s what’s researched for many symptoms that need the intensity of all four components of DBT. Comprehensive DBT is when Dialectical Behavior Therapy is done to fidelity the way Marsha Linehan created it and the way that’s been studied over and over and over again.
What is comprehensive DBT?
Comprehensive DBT has four components that run at the same time: weekly individual therapy, a weekly skills training group, phone coaching between sessions, and a weekly consultation team for the therapists. The research showing DBT works is usually done on all four together, not on any one piece by itself.
Here's what each part does.
Weekly individual therapy. You meet with your DBT therapist every week. You bring a diary card. You look at the week together and work through things in a specific order, starting with anything life threatening. This is where skills stop being classroom material and start applying to your actual life.
A weekly skills training group. Group is where the skills get taught. Mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, usually over a six month cycle. It's a class, not a process group. Nobody's asked to share their trauma history.
Phone coaching. Life doesn't wait for your appointment. Coaching calls exist so you can get help using a skill in the moment, when your emotions are high and you can't think of one. You're not just allowed to call. You're expected to.
A therapist consultation team. Every week, the DBT clinicians meet. In DBT, the team takes responsibility for everyone under its care. Your therapist isn't making decisions alone.
That last one is the part clients almost never hear about, and it's the part I'd want if I were choosing a program. It’s a critical part of the comprehensive treatment. And you’re not in comprehensive DBT if your therapist isn’t consistently showing up and participating in a consultation group every single week.
Is DBT-informed therapy a bad thing?
No. DBT-informed therapy is genuinely useful to many, many people. A skilled therapist can teach you distress tolerance or interpersonal effectiveness skills inside individual sessions and you can absolutely get better. It just isn't the same treatment as comprehensive DBT, and it wasn't studied the same way.
Plenty of people don't need the full program. If you want some concrete tools for handling stress, or you're working on one specific problem, comprehensive DBT would be a much bigger commitment than your situation calls for.
You can also learn a lot on your own. We've written about several of these skills over the years, and they're free to read:
The distinction just needs to be honest. If a practice is offering skills in individual sessions, that's what it should say.
Why does the difference matter?
Because the commitment is different, the cost is different, and what you're likely to get out of it is different.
Comprehensive DBT asks for six months minimum, weekly individual therapy, a weekly two hour group, diary cards, homework, and coaching calls. That's a real ask. It's also the version that was studied, and the version with the strongest evidence behind it for people with severe emotion dysregulation.
Sam White, one of our therapists and a passionate DBT clinician, put the commitment question well:
"A common thing people get wrong about DBT is that it is a big commitment, whether it is from the client, the families, or the therapists themselves. It does take time out of your week to complete the skills and attend therapy. But I think we forget how much it costs not to engage in DBT when it is the recommended practice for certain groups of symptoms. Delaying engaging with DBT could be increasing the amount you spend for therapy overall."
Sam spent much of her early career at Ozark Center in Joplin, where she served on the DBT team and the RO-DBT team. In fact, she was DBT Team Lead from 2020 to 2022. She's DBTmo certified, certified in RO-DBT Level 1, and certified in Prolonged Exposure. In other words, she knows her stuff. And based on my own many years of experience with DBT, I agree with how she’s describing the importance of fully commiting yourself to the process of DBT. In fact, because of the time investment that DBT requires, I like to think of it as more of a full program than just “therapy.”
Why I care about this so much
I want to be upfront that this isn't a neutral topic for me. DBT is the therapy that raised me as a therapist.
In the fall of 2005 I was a BSW student on a competency restoration unit at Fulton State Hospital. Partway through the semester my field instructor left, and I was placed with Janet Heyer, an absolutely incredible clinical social worker who happened to already be part of the DBT program at the hospital. I told Janet I wanted to really help my clients, not just go through the motions with them. So she started teaching me mindfulness.
Then she let me sit in on groups in her program. It was called the New Outlook Program, and it was adherent DBT. I was hooked almost immediately.
With Janet's help, I built and taught a mindfulness skills group on my own ward that semester. I also bought the original DBT manual Marsha Linehan wrote, which anyone who has read it will tell you is dense. But I was a student and I was used to studying things. So, I started studying. And, I marked that copy up badly. I read it at my part time nanny job while the kids napped, highlighting and writing questions in the margins that I'd bring back to the DBT clinicians at the hospital the next week.
The following spring they hired me into New Outlook. I still only had a BSW, but our program coordinator didn't sort people by degree. So I got to do the work. I reviewed diary cards with clients. I ran chain analyses. I led skills groups, mindfulness groups, and chain analysis groups. I left the hospital for a short period of time while I got my Master’s Degree but when I returned with my MSW in hand, it was to the New Outlook Program and comrpehensive DBt that I returned.
That's where I learned that we could hand people real tools and watch them get better. Chain analysis in particular changed how I think about behavior. Instead of asking someone why they did something, which usually sounds like an accusation and rarely gets a useful answer, you walk through the whole sequence together and figure out what they would have needed in that exact moment to do something else.
I've practiced comprehensive DBT in three settings over the years: A state forensic hospital. A school for kids with extreme emotion regulation challenges. And then for years in private practice, where I sat on a consultation team with several really skilled DBT therapists including one of my menotrs, Ronda Oswalt Reitz, PhD.
If you don't know Ronda, she's the person who coordinates DBT services for the Missouri Department of Mental Health. She's responsible for implementing and evaluating DBT programs in public mental health settings across the state, including inpatient hospitals and forensic settings, and she's a national trainer-consultant for Behavioral Tech, the training organization Marsha Linehan founded. She's also one of the mental health professionals who’s had the most profound impact on my career personally.
DBT is the reason we're a trauma practice
I don’t talk about this often, but the only reason I specalize in trauma therapy now, and therefore Aspire Counseling does, is because I was first a DBT therapist.
Ronda told us early in my career that every DBT therapist needs to be able to do quality trauma work. She's right, and she meant it. She helped bring Melanie Harned, PhD, to Missouri to teach us the DBT Prolonged Exposure protocol, which she developed for treating PTSD in DBT clients who are suicidal, self-injuring, or dealing with several diagnoses at once.
So I learned Prolonged Exposure to be a better DBT clinician. From there I learned Cognitive Processing Therapy, and then EMDR.
The more I used these treatments, the more hooked I became. Effective, evidence based trauma therapies were changing lives. So, I started making sure every single clinician we hired was trained in at least one of these methods. And, trauma work became the thing our practice is best known for, and it grew directly out of DBT.
If you've been reading our site and wondering why a trauma and anxiety practice is rebuilding a DBT program, that's the answer. It isn't a new direction. It's where we started.
So why did Aspire stop offering comprehensive DBT?
We used to run it with our therapists participating actively in a fantastic consultation team called DBT Columbia. Then I stepped back from the consultation team for a season. It was one of the hardest professional decisions I have ever made, but there was intensity in my own life that had me feeling I wasn’t able to fully show up for DBT clients right then.
After I stepped back, one by one, the other Aspire Counseling clinicians who'd been on it stepped back too.
The reason was mostly structural, and it was mine to fix. DBT is the hardest work in the practice. Our clinicians were carrying higher risk caseloads, spending an hour and a half a week on consultation team, and taking coaching calls at night, and they weren't paid any differently than they were for a standard session. Consultation team and coaching calls weren't compensated at all. But they are critcal components of comprehensive DBT.
The last several years (about 6) I’ve missed doing DBT. And it’s broken my heart to hear how full other local DBT programs are. I’ve heard of waitlists as long as a year wait.
But I always knew I’d be back to DBT when I had the personal bandwidth to give my DBT clients 100% and had the structure for clinicians to offer it to fidelity without getting burnt out.
What's different this time
Three things.
The therapists get paid for the work. DBT sessions and skills groups are priced higher than our standard counseling rates. I know this makes it more challenging for you as a client to afford this incredible treatment. But it’s needed for this to be sustainable work. That rate covers the consultation team hour and a half and it covers coaching call availability. Both are required parts of your treatment. I'd rather build them into the rate than charge you every time you need help at a hard moment, and I'd rather my clinicians feel well compensated for the hardest work they do. We based our rates off what Minnesota’s legislature has allowed in a law they passed. So, if you lived in Minnesota these are the rates Medicaid/Medicare would reimburse for a well trained, experienced DBT therapist.
We're rebuilding it with help. I’ve consulted with several different experienced DBT-LBC Certified clincians about how to do this right. First, Ronda is leading the orientation for our new consultation team, so we set it up the way it's supposed to be set up. Our clinicians are going back through the full 40 hour DBT training as a fidelity refresher, even the ones who've delivered the model before. We’ll continue to get some support from another group practice owner I know who’s been running a successful DBT program for years. And we're structuring the program against the standards used for DBT program certification.
Four of the six clinicians on our consultation team have delivered DBT before. Not read about it. Delivered it. And in four different settings. This means we have four different viewpoints to help us problem solve anything that comes up. And we have additional clinicians interested in learning from us as well.
Here's Sam again, on what the treatment is actually for:
"The goal in DBT is to get a client or family to a place where they no longer need their therapist."
That's the whole point. Not a longer relationship with us. A life where you don't need one.
What happens if you reach out about DBT today
Call our office or use our contact page and tell us you're interested in DBT. Our Client Care team will match you with one of the clinicians on our DBT consultation team who has delivered DBT before.
From there:
Your care gets discussed by the team right away.
You begin orientation and commitment with your individual therapist. This takes several weeks. You'll go through what the program involves, what we're asking of you, and what you can ask of us. Then you decide, on purpose, whether to commit.
You start DBT-informed individual work in the meantime, so you're not waiting around.
You step into the full program when the next skills group cycle begins. Groups run in cycles, and Client Care can tell you when the next one starts.
This is also where we'd tell you if DBT isn't the right fit. If what you're carrying is mostly stress, or one specific problem, there are approaches that would serve you better and cost you far less. We'd say so, and we'd help you find the right person.
Begin DBT in Columbia or Lee's Summit
If you've tried therapy before and you're still here, that doesn't mean you failed. It often means you got a treatment that wasn't built for what you're carrying.
You can learn more on our DBT page, or reach out and we'll talk it through.
Call us at 816-287-1116 in Lee's Summit or 573-328-2288 in Columbia, or contact us here. We have offices in Columbia and Lee's Summit and see clients throughout Missouri by telehealth. Skills groups and consultation team meet online, so wherever you are in the state, you can be part of the full program.
Whenever you're ready for effective care and lasting change, we're here.
