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Evaluation ViewAttendees 4

Dissemination & Implementation Science
Session Type:: Symposia

Symposium 17 - Adherence in Dialectical Behavior Therapy: Current Efforts and Critical Need

Friday, November 21, 2025
5:00 PM - 6:30 PM CST
Location: Celestin A, Level 3
CE: 1.5

Keywords: Adherence, DBT (Dialectical Behavior Therapy), Competence
Level of Familiarity: Basic to Moderate
Recommended Readings: Rizvi, S. L., Bitran, A. M., Oshin, L. A., Yin, Q., & Ruork, A. K. (2024). The state of the science: Dialectical behavior therapy. Behavior Therapy. 55(6), 1233-1248. https://doi.org/10.1016/j.beth.2024.02.006,   Harned, M. S., Schmidt, S. C., Korslund, K. E., & Gaglia, A. (2023). Therapist adherence to Dialectical Behavior Therapy in routine practice: Common challenges and recommendations for improvement. Journal of Contemporary Psychotherapy. https://doi.org/10.1007/s10879-023-09601-x,   Koerner, K. (2013). What must you know and do to get good outcomes with DBT?. Behavior Therapy, 44(4), 568-579.,   Harned, M. S., Schmidt, S. C., Korslund, K. E., & Gallop, R. J. (2023). Development and evaluation of a pragmatic measure of adherence to Dialectical Behavior Therapy: The DBT Adherence Checklist for Individual Therapy. Administration and Policy in Mental Health and Mental Health Services Research, 50, 734-749.,  

Dialectical Behavior Therapy (DBT) is used for a variety of problems and in a wide variety of settings. Like many other cognitive-behavioral treatments, DBT is effective when delivered in real-world contexts, but also appears to lose some of its potency and outcomes tend to be more variable (Walton & Comtois, 2019). One potential explanation for this drop in consistency and potency is therapist adherence. Adherence is defined broadly as the therapist consistently and correctly implementing the strategies included in the treatment without deviation to treatment-inconsistent strategies (Perepletchikova et al., 2007). DBT is a complex, principle driven intervention, which requires therapists learn many acceptance, change, and dialectical strategies. Moreover, to be adherent the therapist must also understand how and when to apply this large number of strategies. This complexity can make DBT a challenging treatment for therapists to learn to deliver adherently. Evidence suggests that adherence is associated with improvements in client outcomes, including reduced suicide attempts, treatment dropout, fewer subsequent hospitalizations (Harned et al., 2022), as well as lower rates of positive drug screens (Linehan et al., 1999). Unfortunately, data also indicates that adherence in real-world contexts is mixed at best, with some studies suggesting that therapists can deliver treatment adherently (Stiglmayr et al. 2014; Priebe et al., 2012). But stronger evidence suggesting that therapists tend to deliver DBT at slightly to moderately below average rates (Harned et al., 2021a; Harned et al. 2021b; Harned et al. 2024). Similarly, the complexity of DBT makes it difficult to measure adherence in clinical effectiveness trials. Research is needed to understand how training contributes to adherence, best practices for measuring adherence across different settings and populations, maintaining adherence in these settings overtime.
This symposium will present on 4/5 different evaluations of therapist adherence to DBT, along with a discussion of the decisions made to increase the likelihood of therapist adherence, followed by a broader discussion about future directions for studies of therapist adherence in DBT.
First, Dr. Lynn McFarr will present on the LA County Roll Out of DBT, including findings evaluating therapist skill acquisition, competency in DBT, and how measuring competency can assist systems in identifying qualified providers. Next, Dr. Melanie Harned will present results of the evaluation of DBT adherence scores from seven cohorts of therapists (n = 64) in a nationwide year-long DBT Training Program within the Veteran’s Affairs system. Third, Dr. Allison Ruork will present on the training and subsequent adherence data of college counseling center therapists (n =29) participating in a multi-site study of suicide among college students. Finally, Dr. Janice Kuo will discuss client characteristics that impact therapist adherence from a study evaluating DBT in the treatment of suicidal individuals (n = 240). The symposium will then conclude with a discussion led by Dr. Shireen Rizvi, and audience Q&A.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Describe scientific rationale for collecting DBT adherence data.
  2. Identify different measures and methods for assessing therapist adherence and competency.
  3. Describe approaches to training therapists and factors to consider in training novel adherent therapists across settings.
  4. Compare adherence data across various populations and settings.
  5. Describe potential challenges that may arise when training adherent therapists and maintaining adherence over time.
  6. Discuss relevant implications and recommendations for future implementation efforts.

Presentations:

  • 5:06 PM - 5:27 PM CST
    (SYM 17) Measuring Competency in Dialectical Behavior Therapy: The DBT California Competency Scales (DBTCCS)

    Speaker: Lynn McFarr, Ph.D. – CBT California

    Co-author: Kate Comtois, PhD, MPH – University of Washington School of Medicine

    Co-author: Alex King, PhD – CBT California

  • 5:27 PM - 5:48 PM CST
    (SYM 17) Evaluation of Therapist Adherence to Dialectical Behavior Therapy in the U.S. Department of Veterans Affairs' Suicide Prevention 2.0 Clinical Telehealth Initiative Training Program

    Speaker: Melanie Harned, ABPP, Ph.D. (she/her/hers) – VA Puget Sound Health Care System & University of Washington

    Co-author: Ciara Oliver, BS – Central Arkansas Veterans Healthcare System

    Co-author: Meredith Sears, PhD – Rocky Mountain MIRECC for Suicide Prevention, Rocky Mountain Regional VAMC

    Co-author: Catherine Flores, LCSW – Department of Veterans Affairs

    Co-author: Laura Meyers, ABPP, Ph.D. – Orlando VA Healthcare System

    Co-author: Trevor Coyle, PhD – Department Of Veterans Affairs

    Co-author: April (Dawn) Orr-Sherrill, LCSW – Department Of Veterans Affairs

    Co-author: Jeffery Pitcock, MPH – Central Arkansas Veterans Healthcare System

    Co-author: Jessica Walker, PhD – Department of Veterans Affairs

    Co-author: Sara J. Landes, Ph.D. (she/her/hers) – US Department of Veterans Affairs

  • 5:48 PM - 6:09 PM CST
    (SYM 17) Teaching to the Test: DBT Adherence in a Multi-site Study of DBT in College Counseling Centers

    Speaker: Allison K. Ruork, Ph.D. (she/her/hers) – Evidence-Based Practice Institute

    Co-author: Linda Oshin, Ph.D. – Rutgers University

    Co-author: Hannah R. Krall, B.S. – Rutgers University

    Co-author: Jacqueline Pistorello, Ph.D. – University of Nevada, Reno Counseling Services

    Co-author: John R. Seeley, Ph.D. – University of Oregon

    Co-author: Scott N. Compton, Ph.D. – Lurie Children's Hospital of Chicago

    Co-author: Shireen Rizvi, ABPP, Ph.D. – Montefiore Medical Center

  • 6:09 PM - 6:30 PM CST
    (SYM 17) How Can We Enhance DBT Adherence?: Examining the Impact of Client Factors

    Speaker: Janice Kuo, Ph.D. (she/her/hers) – PAU-Stanford PsyD Consortium, Palo Alto University

    Co-author: Alexander Chapman, PhD – Department of Psychology, Simon Fraser University

    Co-author: Shelley McMain, Ph.D. – cAMH