Written by Jessica Oliver, MSW, LCSW (formerly Jessica Tappana), with clinical contributions from Samantha White, MS, LPC. This post is based on my interview with Sam on October 16, 2026.
Maybe the first therapist was fine, but nothing really changed. Maybe the second one taught you a few coping skills and you used them for a while. And maybe the third one, somewhere around month four, started looking a little overwhelmed. Then there was a conversation about how you might be "better served" somewhere else.
That last one leaves a mark. Even when the therapist was kind about it. Even when they were probably right that they weren't the best fit. What you heard was: I'm too much. Even the professionals can't handle me.
So when someone tells you to try DBT, I understand the reaction. Why would this be any different? You've paid for therapy. You've shown up. You've done the worksheets. And you're still here, still struggling, with a growing suspicion that you're the thing that doesn't work.
I asked Sam White, one of our DBT therapists, what she says to people in exactly that spot. I'll share her answer, and mine. And then I'll be specific about what's structurally different this time, because "trust me" isn't a good enough reason to try a fourth therapist.
What do you say to someone who's been burned by therapy before?
Sam's answer was short:
"Honestly, it's pretty simple. We've done the consult or we've gone through the intake and done the treatment plan, and it's just: I got you. This isn't scary for me. We can do this. I have no doubt in that."
I want to be clear about why she can say that. It's not a pep talk. Sam spent much of her career on the DBT team at a community mental health center in Joplin, and led that team for two years, working with people whose situations were about as intense as outpatient care gets. When she says a situation isn't scary for her, she means it in the plainest sense. She's seen it before.
That matters more than it sounds like it should. If your last therapist got overwhelmed, some part of you is going to spend the first few sessions watching the new one for signs of the same thing. Flinching. Pulling back. Getting quieter. The fastest way to settle that part of you is a therapist who isn't flinching because there's nothing here they haven't handled.
My version is a little different. I tell people: I'll hold hope for you for a little while. You're having trouble believing this can work, and that's fair given what you've been through. So for right now, I'll hold that for you. I've seen this treatment work with people in similar spots. I know it can work for you.
I say that because I believe it, and because I've been doing DBT since 2008. But I also say it because asking someone who's been let down three times to walk in hopeful is unreasonable. You don't have to be hopeful. You just have to show up. I'll handle the hope part until you're ready to take it back.
Sam also named something that I think most practices wouldn't say out loud. She said it's hard not to notice that some therapists "have some judgment towards individuals who meet the criteria for DBT." I've seen that too. People with intense emotions and the behaviors that come with them sometimes get treated as difficult rather than as people who need a specific treatment. If you've felt that from a therapist, you weren't imagining it. It's also not what you'll find on a team that chose this work on purpose.
What's actually different this time?
Three things come to mind when I think about what’s different. None of those are simply a nicer therapist…
DBT is a different treatment
If you've been to three therapists, there's a good chance all three were doing roughly the same thing: one hour a week, mostly talking, maybe some skills mixed in. Switching therapists inside that model is like switching brands of the same medication. Sometimes it helps. Often it doesn't, because the model is the problem, not the person.
Comprehensive DBT is a different model. Weekly individual therapy, yes, but structured around a diary card and a chain analysis rather than an open conversation. Plus a weekly two hour skills class, coaching calls in the moment you need a skill, and a team of therapists meeting every week about how to help you. If one of your past therapists mentioned DBT or taught you a skill or two, that was real and it may have helped. It wasn't this. We wrote about that difference in Comprehensive DBT vs. DBT-Informed Therapy. As Sam put it, comprehensive DBT "is not the watered down DBT that we necessarily get other places."
It teaches the things you were “supposed” to figure out on your own
Here's something I've noticed over years of doing this. Most of what DBT teaches are skills everyone is just expected to pick up somewhere in childhood. How to calm your body down when it's at a nine. How to ask for something without blowing up or giving up. How to keep a friendship going. How to sit with yourself without needing to escape.
Some people got those lessons. A lot of people didn't, through no fault of their own. There's a DBT worksheet on how to make and keep friends that I've used with plenty of clients who aren't in DBT at all, because nobody ever taught them and they were quietly ashamed of not knowing. DBT makes those skills explicit. Sam said it this way: by the end of treatment, the goal is to be able to say "I will know how to regulate my emotions. I will know how to interact with others. I can sit with myself and be okay with that."
Honestly, I think we ALL could use some direct teaching on these sorts of skills and I wish it was a required class in all high schools. Think about it-we require US and World History which are fantastic courses, but isn’t how to generally regulate your emotions and make meaningful relationships equally important?
It asks a bigger question about your money and your year
Sam made a point about the investment that I think is exactly right. By the time someone gets to DBT, they usually know the cost of therapy. They've been paying it for years. So she frames the choice honestly:
"Do we want to continue to pay for therapy forever, like you have been in the past? Or do we want to be like, at the end of this year, I will have changed in these ways?"
Comprehensive DBT asks more of you than the therapy you've done before. More hours, more homework, more money for a stretch. We don't hide that. The program page spells out the time and the cost. But the trade is a treatment with specific goals and a plan for checking whether you're getting there, instead of an open ended once a week arrangement that could go on for years without the pattern changing.
I want to be careful here, because I don't want you to hear a promise. Nobody can tell you where you'll be in a year. The ABCT fact sheet on DBT is honest that the research studies ran about a year, that getting dangerous behaviors under control often takes months, and that deeper change can take longer. What I can say is that in DBT, we set the goals out loud, we track progress on the diary card every week, and if it isn't working, we change what we're doing. You'll know whether it's helping. That's different from hoping.
One honest note on fit for DBT
DBT isn't the answer for everyone who's had therapy not work. It was built for people whose emotions run high and fast and who do things in the moment that cost them later. If your pattern is the opposite, more shut down, more rigid, feeling everything underneath and showing almost none of it, standard DBT may not be the right tool. Sam and I are both trained in a related approach for that kind of overcontrol, and we'll tell you if we think it's the better direction. We wrote more about who DBT is and isn't for in Do You Have to Be in Crisis to Do DBT?
The free consultation is where we sort that out together. Nobody is going to agree to a year of treatment in a first conversation, and we wouldn't want you to.
Begin DBT in Columbia or Lee's Summit
If you've been referred out before, or you've started to believe you're the thing that doesn't work, I'd ask you to try one more conversation. Not a commitment. A conversation, with a therapist who has seen what you're carrying and isn't going anywhere.
Our comprehensive DBT program includes weekly individual therapy with a DBT trained clinician, a weekly online skills group, coaching calls between sessions, and a consultation team behind every therapist. You can meet with your individual therapist in person at our Columbia or Lee's Summit office, or online anywhere in Missouri.
Call us at 573-328-2288 (Columbia) or 816-287-1116 (Lee's Summit), or reach out online and our client care team will call you back to set up a free consultation with a DBT therapist.
Whenever you're ready for effective care and lasting change, we're here.
About the Author
Jessica Oliver, MSW, LCSW (formerly Jessica Tappana) is the founder and clinical director of Aspire Counseling. She began learning DBT in 2008 as a BSW intern at Fulton State Hospital, Missouri's maximum security forensic hospital, where the highest acuity clients in the state received the real version of the treatment. DBT was her primary approach for more than a decade, and it's the reason Aspire exists as a practice built around evidence-based care for people other places have struggled to help.
This post is based on Jessica's October 16, 2026 interview with Samantha White, MS, LPC. Sam sees clients at Aspire Counseling in Columbia and online throughout Missouri. She spent much of her career at Ozark Center in Joplin on both the DBT and RO-DBT teams, and served as DBT Team Lead from 2020 to 2022, working with high acuity outpatient clients. She is DBTmo certified, certified in RO-DBT Level 1, and certified in Prolonged Exposure. Sam and Jessica both serve on Aspire's DBT consultation team.
