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Symposia

Dissemination & Implementation Science

Adherence in Dialectical Behavior Therapy: Current Efforts and Critical Need

3 - (SYM 17) Teaching to the Test: DBT Adherence in a Multi-site Study of DBT in College Counseling Centers

Friday, November 21, 2025
5:48 PM - 6:09 PM CST
Location: Celestin A, Level 3
Keywords: Adherence, DBT (Dialectical Behavior Therapy), Competence
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.,  
Abstract Body

There have been significant efforts to implement Dialectical Behavior Therapy (DBT) around the world and across a wide variety of settings and contexts (e.g., Carmel et al., 2014; DuBose et al., 2019; Flynn et al., 2020; Herschell et al., 2014), including college counseling centers (e.g., Chugani & Landes, 2016; Chugani et al., 2020; Pistorello et al., 2012). Data suggest fairly high rates of adoption and sustainability of DBT programs in diverse settings (e.g., Navarro-Haro et al., 2019; Swales et al., 2012). Unfortunately, evidence suggests that even with an above-average amount of training (i.e., 40+ hours of workshop plus ongoing support from DBT expert), therapists in community settings struggled with delivery of adherent DBT (Harned et al. 2021b). This may be especially true in college counseling centers which have to contend with higher severity populations in recent years, high demands for services, university schedules that limit availability and continuity of care, and system-level pressures for briefer treatment.  Since DBT adherence is associated with improved client outcomes, the need for understanding of implementation and training factors associated with therapist adherence is critical including in college counseling centers. In this talk, we will describe two efforts to train DBT-novice therapists (N = 29) to adherence as part of a large-scale multi-site study of suicidal college students (n=227) and methodology for maintaining therapist adherence over time. Results have implications for training DBT-adherent therapists in college counseling centers and broader implementation efforts.