Comprehensive DBT in Columbia, Lee's Summit, and Across Missouri

Both are required in our program, and that's true of comprehensive DBT generally. The skills group is where you learn the skills. Individual therapy is where you figure out how to apply them to your actual life, your actual relationships, and the specific behaviors you're trying to change. One without the other leaves a real gap.

Think of group as the class and individual therapy as the tutoring. Sitting in the class without anyone helping you apply it rarely goes well. Working with a tutor on material you were never taught doesn't either.

There's a structural reason as well. In comprehensive DBT, your individual therapist and your group leaders sit on the same consultation team and coordinate your care every week. That coordination is part of the treatment, not a nice extra.

We're willing to talk about unusual situations, though. If you live somewhere we don't have an office and you're already working with a fully trained DBT therapist who simply can't offer you a group, reach out and let's talk it through.

It depends on where you are right now, and you don't have to choose between them at Aspire Counseling. DBT comes first when emotions and behaviors feel out of control, because trauma work is hard to do well when the ground underneath you isn't steady yet. Once you have skills and some stability, we have clinicians trained in CPT, EMDR, Prolonged Exposure, and ERP who can help you address the trauma more directly.

This is one of the most common places DBT goes sideways. People learn distress tolerance, get better at surviving crises, and then cycle for years without ever treating the thing underneath. Surviving is a real accomplishment. It also isn't the finish line.

Phone coaching is a required part of comprehensive DBT. It exists so you can use your skills in the moment you actually need them, not just in the room where you learned them. At Aspire Counseling, coaching calls are available to DBT clients 24 hours a day, with limits your therapist will talk through with you directly at the start of treatment.

Here's why it matters. It's not that hard to practice distress tolerance sitting in a skills group on a Tuesday. It's much harder at 9pm when your best friend just said something that landed wrong, your whole nervous system is off, and you want to say something extreme even though some part of you knows you might regret it tomorrow. That's the moment coaching calls are for.

You call, you get a few minutes of help figuring out which skill fits, and you use it. That's it. It's usually short.

And your therapist is a human being. In your first few sessions the two of you will talk about what coaching typically looks like and what their natural limits are. If they're at a movie with their family when you call, they may finish the movie before calling back, so the two of you will have already made a plan for how you'll get through until then. Knowing that ahead of time is part of the point.

There are a couple of firm limits, and we'd rather explain the reasoning than hand you a rule. The main one is that coaching calls aren't available for 24 hours after a suicide attempt or an act of self harm.

That isn't a punishment, and it has nothing to do with thinking you're being manipulative. Here's the real thinking. For a lot of people, crisis is what has historically gotten them help. Reaching out after something already happened is what worked, because that's what their life taught them. We don't want a warm, caring phone call to be one more thing that shows up right after self harm, because then we'd be strengthening the exact pattern you came here to change.

What we want is for you to get that same care beforehand, while you're trying, when a skill can still change what happens next. So we make ourselves available at the hard moment, not just after it.

To be very clear about one thing: this pause applies to skills coaching, not to your safety. If you're in immediate danger or need medical attention, you should get it. Every DBT client at Aspire Counseling builds a written crisis plan with their therapist early on, so you'll already know exactly who to call and what to do. Nobody is left without a plan.

A DBT consultation team is a weekly meeting where every clinician in the program brings their own cases for support and accountability. At Aspire Counseling, our team meets for 90 to 120 minutes every single week. Attendance is taken seriously, and every clinician is expected to actually discuss their clients, not just sit in.

Linehan described the consultation team as therapy for the therapists, and that's close to accurate. DBT is demanding work. Without real support, therapists drift, burn out, or quietly start avoiding the hardest parts.

I think it’s helpful for you to know that on a DBT team, it's an expectation that your therapist actively participates in team and sicusses all of their cases. If a clinician is struggling with something related tow orking to you, they bring it to the team and do the work on their end. You may not know each time they discuss you in team (although sometimes you may). You'll just experience a therapist who shows up for you, week after week, and means it.

A diary card is a daily tracking sheet where you record emotions, urges, target behaviors, and which skills you used. Yes, we ask you to fill it out daily, and yes, it's one of the harder habits to build. It's also one of the most useful tools in the treatment, and it's what structures your individual sessions.

Tracking a behavior is one of the most reliable ways to start changing it. Simply noticing, on paper, how often something happens tends to shift it before you've done anything else.

The diary card also solves a real problem with therapy. Without it, we sit down and I ask how your week went, and you tell me about whatever was most recent or most dramatic. The quiet Wednesday where you almost did something and then used a skill instead disappears. That Wednesday is often the most important thing that happened all week.

There's solid research behind this, and not just in DBT. A meta-analysis of 138 studies including nearly 20,000 people found that monitoring your progress toward a goal genuinely improves whether you reach it, and the effect was stronger when people physically recorded what they were tracking. That's the general principle: if you want to change a behavior, tracking it helps.

In DBT specifically, a study of 44 people using daily diary cards, published in Frontiers in Psychiatry, found that suicidal thinking was lower on days when people used skills and found them effective compared to days they used no skills at all. Day to day skill use matters. The diary card is how we see it.

We want to be transparent in saying that we are not yet certified. Aspire Counseling's DBT program is actively working to adhere to the program standards set by the DBT Linehan Board of Certification, but we are not currently a certified program and we're not going to describe ourselves as one. Certification is a multi year process, and it's a goal we're deliberately working toward.

The DBT Linehan Board of Certification is the organization Dr. Linehan helped establish to verify that clinicians and programs are delivering DBT the way it was researched. You can read about their standards at dbt-lbc.org.

What we did was build the program to those standards from day one. All four modes. A consultation team that meets weekly. Structured training for every clinician before they take a DBT case. We'd rather do the work first and earn the credential later than put a word on our website we can't back up.

Plan on about a year for the primary course of treatment once you've started skills group. The skills curriculum itself runs roughly six months and most clients go through it twice, which is by design. You catch things the second time that you weren't ready for the first time.

Before group starts, you'll do a short orientation and commitment process with your individual therapist. That's where you decide together what you're working toward and whether this is the right treatment for you right now.

A year is a real commitment and we don't want to soften that. We also want to say plainly that the people who complete it usually describe the year as the one that changed the direction of their life.

Because comprehensive DBT asks substantially more of the therapist than a standard weekly session does, and charging more is what makes it possible to offer the real thing. Our DBT clinicians complete extensive training before they ever take a DBT client, sit on a 90 to 120 minute consultation team every week, prepare and co lead a two hour skills group, and stay available for coaching calls between sessions.

Most of that work happens where you never see it.

I want to be honest about the math, because I think you deserve the real answer. Our therapists are passionate about this work. But a DBT client takes several hours a week of their time beyond the session itself. If we paid the same rate we pay for a standard therapy hour, taking a DBT client would mean giving up other clients and earning less for more work. Over time, that's how DBT programs quietly become DBT informed programs, and then disappear.

So we priced it in a way that's sustainable. That's what lets us offer all four modes, keep our clinicians well trained and well supported, and stay in this for the long run instead of burning out in two years. It's the difference between a program that says DBT and a program that delivers it.

Start by reaching out to our client care team by phone or through the contact form on this page. They'll schedule a short call to learn a little about what's going on and match you with one of our DBT clinicians. From there you'll have a free consultation with that clinician, where you can ask questions and both of you can decide whether this is the right fit.

Nobody is going to push you into a year long program on a first phone call. The consultation exists so you can find out what you'd actually be signing up for.

If it turns out DBT isn't what you need, we'll say so and help you think through what might fit better. We'd rather do that than enroll someone in the wrong treatment.