It seemed to me to be really rubbish that it was so difficult to find a DBT treatment provider, and that it fell to me to do it, at a time when I was most vulnerable and least able to cope with even ‘simple’ tasks like getting out of bed in the morning. I promised myself that I’d at least collect the information I did find together in one place, so that other people in the same position wouldn’t have to go through such an arduous research process. (When my psychiatrist later met my DBT therapist, she said “Excellent! I’ve been looking for a good DBT therapist… now you’ve found her for me!” Hmph, she can’t have looked very hard…)
Be warned: the range of choices is rather underwhelming!
Newham DBT Team, East London NHS Trust http://www.eastlondon.nhs.uk/our_services/dept_newham_dialectical_behaviour_therapy_team_dbt_newham.asp
Oscar Hill Service, Camden & Islington NHS Trust
http://www.candi.nhs.uk/our_services/services/oscar_hill_service.asp
South West London & St George’s NHS Trust
http://www.swlstg-tr.nhs.uk/services/dialectical_behaviour_service.asp
Cygnet Hospital, Ealing ~ “New Dawn’, a private inpatient programme (most patients are sectioned and NHS-funded)
http://www.cygnethealth.co.uk/psychiatric/hospitals/ealing/bpd.html
The Tuke Centre, York ~ a private outpatient programme
http://www.thetukecentre.org.uk/dbt.php
Maple Psychology, London ~ a private practice with DBT trained therapists (HPC registered)
http://www.maplepsychology.com/
Sloane Court Clinic, London ~ a private practice with a DBT trained therapist (HPC registered)
http://www.sloanecourtclinic.com/index.php
Hampshire Psychology, Hampshire ~ a private practice with a DBT trained therapist
http://hampshirepsychology.co.uk/index.html
Essex Behavioural Therapy ~ a DBT trained therapist offering individual DBT, couples DBT, and group skills training (BACP registered)
http://www.essex-behavioural-therapy.co.uk/default.asp
Fenella Lemonsky is not a DBT provider but an Expert by Experience and was fantastically helpful to me when I was trying to find treatment. Fenella is also an advocate of Mentalization Based Treatment (MBT) so can give information on that too.
http://www.organiclemon.org/index.html
Accessing NHS DBT treatment:
DBT is a tertiary service in the NHS, so it will be used when primary (GP) and secondary (community mental health teams) care have been tried and the difficulties remain.
DBT is accessed via a diagnosis of borderline personality disorder, so even if your reason for seeking treatment is self-harm or suicide ideation, acquiring this diagnosis may be a necessary evil.
DBT provision is a postcode lottery; if I had not had private health insurance, I would have moved to a borough which fell within an NHS Trust offering DBT, but I recognise that this was relatively straightforward for me (renting in London and childless) and may be impossible for others.
If you have to fight your local Trust for access to DBT, it’s worth being armed with the NICE guidelines for treating and managing BPD; these guidelines specify best practice based on the available evidence. Section 1.3.4.5 says “For women with borderline personality disorder for whom reducing recurrent self-harm is a priority, consider a comprehensive dialectical behaviour therapy programme.”
Accessing DBT on health insurance:
The game here is quite different. Many insurers exclude treatment of Axis II disorders (i.e. personality disorders vs affective conditions such as depression and anxiety) so here a diagnosis of Borderline Personality Disorder is likely to actually work against you. If you already have a diagnosis, it may be best to get the professional requesting treatment authorization to focus on the symptoms (self-harm, suicide attempts, depression) rather than the label. Insurers will also often try to refuse payment on quite spurious grounds- my esteemed insurance company wrote to my psychiatrist saying that they didn’t cover ‘analytical’ treatments… the psychiatrist and I wrote a polite letter back saying that DBT was a behavioural treatment, not an analytical one, and the clue was in its name (dialectical behaviour therapy), and they paid up.
Even with the most comprehensive policies, insurers also limit how many sessions they will pay for. DBT is an intensive treatment comprising one individual session and one skills training session weekly. DBT generally involves a minimum of a year’s contract, but it is likely to take longer than this to cement the new skills learnt. There is then ‘Stage 2′ work (treating the underlying difficulties such as PTSD) to consider. Once you have reached your session limit, your insurer is likely to withdraw coverage for any treatment of any psychiatric condition (not just the one for which you sought DBT) and neither your own insurance company nor any other will cover you for psychiatric conditions until you have been well for a period of 2-3 years or more. In short, you are very likely to max out your coverage before you finish the treatment and will then be uninsurable. This is what happened to me. Before starting DBT I had been using my insurance for acute hospitalization during suicidal crises, which I could not have paid for, but I decided that since DBT would reduce the need for hospitalization, it was worth using up my coverage on. I was also really fortunate to have the security of a reasonable sum of money I received in settlement for previous disastrous treatment, so I knew I wouldn’t have to stop treatment when my insurer pulled my coverage. However, even if you are wholly dependent on your insurer, I would urge you to still consider DBT, tailored around however many sessions you are covered for.
To learn more about what DBT is and how it can help you, go to the About DBT page. If you have successfully accessed DBT either on the NHS or via health insurance (or indeed if you’ve tried and had difficulties) do please leave a comment so that I can make this information more useful.
I will periodically run new searches and update this page accordingly, but since I’m no longer actively looking for treatment, I may not notice new providers straight away. If you know of any treatment providers whom you think should be added, do please leave a comment.
Obvious disclaimer: Thus far I have managed to hang on to the therapist I originally chose(!), so I’ve not personally tested each of these providers, and their inclusion here is not a personal endorsement. This is quite a handy link about what to look for in a therapist: http://bpd.about.com/od/findingatherapist/a/TherapCriteria.htm In addition, it’s really important that the therapist has access to a DBT consultation group (or at least DBT-specific supervision) and that the therapist/service can offer telephone consultation. Make sure you inform yourself about the components of DBT, so that you can be clear whether you are being offered therapy that is adherent to the model. I came across several who said they had some DBT training but weren’t actually offering DBT, or could offer ‘DBT-informed’ treatment.
It is also important to ensure that any therapist you choose is registered with their profession’s regulating body (usually the Health Professions Council or British Associattion for Counselling and Psychotherapy), which ensures that the therapist meet minimum standards of competency and engages in continuing professional development. The regulating bodies are also an important last resort should you need to bring a complaint against the therapist.
Other effective treatments for DBT:
If you can’t access DBT, don’t despair. There are other effective evidence-based treatments for BPD. These include:
Mentalization-Based Therapy
Schema Therapy
16 comments
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October 16, 2010 at 1:08 pm
dedicationtorecovery
Hey, I’ve struggled to research the logistics of finding DBT in this country, many sufferers I know don’t live in a catchment area or know how to make a case for having it. Would it be possible if, in some point at the future, when anyone asked me for this information, I could link to this page, either on my blog (giving you the credit) or on a mental health forum I am on, where this issue comes up a lot?
I understand if that’s not possible, but I really respect that you published what you know. It’s so useful to me.
October 19, 2010 at 3:50 pm
improvingthemoment
Hi dedicationtorecovery
Yes, of course, please do pass this information on to anyone it might help. I’m not remotely worried about credit or anything, I just want to help people access DBT as I know how frustrating it can be. Only caveat is that I’ve essentially made up this information based on my own experiences, so it’s not all gospel truth. I’m always glad to get new and better information, and to update this page. Thanks also for the info about the Bradford DBT programme- I’ll try to add it.
October 16, 2010 at 1:09 pm
dedicationtorecovery
Also, I am in Bradford, Yorkshire, and out local hospital, Lynfield Mount, has a NHS DBT program.
June 13, 2011 at 11:20 pm
improvingthemoment
Hi dedicationtorecovery
I’ve been unable to find a link for this so haven’t yet added it. Can you point me in the right direction?
April 1, 2011 at 12:07 pm
Anon
Hi
thanks very much for these resources. Are you aware of any organisation that organises DBT training weekends or similar, particularly for couples?
many thanks
May 5, 2011 at 6:58 pm
improvingthemoment
I’m afraid that everything I know about is on this page. If you find anything, do let me know so I can add it. I hope you find what you’re looking for…
June 6, 2011 at 6:41 am
RecoveryBeginsHere
As DBT seemed to me to be so inaccessible and expensive, and having led DBT courses for more than three years at a private hospital, I decided at the end of last year to offer individual skills training in my ‘catchment area’ – anywhere east of central London, into Kent, Essex, Suffolk and Hertfordshire. I also run group DBT courses (16 weeks), and the next one starts in September, 2011.
June 6, 2011 at 3:00 pm
improvingthemoment
Thanks Amanda, I’ve added your details. You seem to be unique in being able to also offer group skills training in private practice. And couples therapy based on DBT principles. I did have a commenter in April asking about couples DBT, so I will email them with their info as they’re unlikely to check back here.
June 14, 2011 at 7:07 pm
amandawatson.pro
That’s very kind of you. Kind also of you to add the details, and I’ve reciprocated with a link back tothis page here, as it’s a very good summary of what’s out there. I am very passionate about working with this client group, and quite ‘fundamentalist’ when it comes to DBT as a model. I think a lot of DBT trained therapists can be daunted and put off by the level of problems and the complex nature of chronic emotional disorders.
June 8, 2011 at 6:23 pm
caroline simpson
Hi, I am a psychology graduate with 5 years mental health support experience and some experience of working and training in BPD. I am hoping to find out about training to become a registered DBT therapist as I feel passionately that it should be more widely available for more individuals. I read the previous comments about the course in DBT and would love to find out about access to this.
Many thanks.
June 9, 2011 at 1:59 pm
improvingthemoment
Hi Caroline
Great that you’re interested in DBT- I agree it should be far more widely available! The information on this page is mainly for clients trying to access DBT, but I’m happy to help as far as I can. DBT training in the UK is provided by British Isles DBT training (http://dbt.uk.net/), though I’m not sure whether they have the monopoly on this. DBT tends to be a specialism though and you have to already be a therapist. There are several routes to becoming a therapist. You could do a professional doctorate in Clinical or Counselling Psychology. Clinical Psychologist and Counselling Psychologist are protected titles and you must have done the doctorate to use them. The clinical course is funded whereas the counselling one is self-funded. These courses are typically highly competitive and may require several years experience as an assistant psychologist before admission to the programme (see http://www.clinpsy.org.uk/forum/) for more info on these routes. You could also become a counsellor or therapist (which are not protected titles); routes and the extent of training for these are far more varied. See the BACP or UKCP websites for more info on this. There are alternatives to becoming a qualified therapist; you could work as a psychology assistant or support worker on an inpatient DBT programme, for example, where you would assist with running skills groups and skills coaching. I know that several of the programmes listed on this page (e.g. the Cygnet Ealing programme) have staff in these roles.
Hope this is helpful. Good luck!
June 13, 2011 at 8:35 am
Bronte
Hi, I have just found this site whilst looking in desperation for some clarity on why I am being treated almost s a non person by local psych therapies team. My situation is too complicate and boring to go into here but having had mental health issues most of my ilfe (I am now 43)I have recently had a new diagnosis of BPD but only after I found info about it myself and mentioned it to my very good GP who re refered me to psych therapies. I was seen by the psychiatrist (who is supposedly well thought of) who agreed I have BPD and recommended DBT would help. Since that, (about 3 months or more ago) my GP and I have been fighting to find out what happens next with very frustrating results. The local mental health team nurse said I could have DBT at the clinic where I was initially assesed for CBT some 18 months or more ago. When I contacted the clinic they knew nothing about me. My GP contacted them and we were eventually told I had been given incorrect info and that DBT was not available at that clinic but at another which is too far for me to access. I have since been trying to find out more (along with my GPs help) and have just received a letter saying I do not qualify for secondary therapy but ‘can have group therapy’. I have made it very clear from day one that I cannot cope with groups of any kind and each nurse, therapist, psychologist, and psychiatrist I have spoken to has been made aware of this so ‘they’ are obviously not listening. My life has got worse since I started CBT so my therapist and I agreed to suspend it until I was in a more stable position. Since then I have things have got worse rather than better so when DBT was mentioned I seized at what seemed the first real hope of help, probably in my life. Now that has turned out to be ‘pie in the sky’ and for whatever reason I seem to have been ‘discarded’ by the Psych therapy team and I have been made to feel like a hypochondriac and not worthy even of their acknowledgement of my existence eihtout a huge battle. My CBT counsellor and mental health nurse know I have had real problems over the years having consistent help and wanted this to be the time it worked for me. Instead I feel worse than ever as my last hope has been snatched away. I now have no hope at all and am putting my long term suicide plans into action. Surely this is wrong!
June 13, 2011 at 11:18 pm
improvingthemoment
Bronte, I’m so sorry that you’ve been messed around so badly by people who should be offering you care. It sounds like a very stressful and confusing situation. I do feel for you.
I’m not an expert by any means in accessing treatment on the NHS, but a few ideas come to mind:
1. Can you fight the NHS Trust? This would probably involve going through a systematic complaints system, beginning with PALS (Patient Advice and Liaison Service). This could take considerable time. You would need to be clear about whether your priority was to complain about the confusion and false promises, or to access DBT. If you wanted to access DBT you would need to wave the recommendation from the psychiatrist, and the NICE guidelines. It’s not clear from your post whether there *is* DBT provision in your area but you’re not yet at a high enough tier to access it (i.e. you have to go through group therapy and this has to be unsuccessful to be allowed to progress to DBT) or whether there simply isn’t any provision, and group therapy is all they have to offer; in this case you would be fighting them to fund you to have DBT under another NHS Trust. I do think it would be a good idea to get written documentation from the psychiatrist to say that group therapy is contraindicated for you. Or you could ‘comply’, go to the wretched group therapy, and see if they’ll give you DBT after that? I suggest you contact Fenella Lemonsky (link on this page) as she will be much more knowledgeable than I am about how NHS provision works.
2. Can you use your own resources to do DBT? This blog has links to workbooks, websites, skills groups and forums. Apart from the books, these are all free. If your supportive GP agrees, you could even suggest that you have a weekly appointment and look at one skill together, and you then go off and work on the skill for the week. It requires motivation, which is hard to find when you’re at your lowest ebb, but there are thousands of people online teaching themselves the skills and supporting each other.
3. DBT is not the only hope for people with BPD. Does your NHS Trust offer schema therapy or transference focused therapy? Both of these also have good evidence of effectiveness…
I’m sorry you feel so let down. I know what it’s like to feel hopeless and desperate. I hope so much that you can find a way to go forward. Do let me know how you get on.
Very best wishes
November 4, 2011 at 4:10 pm
Lindsay
Hi, I have a 17 year old daughter who has been diagnosed with ‘emerging’ bpd and we are struggling to get treatment for her. As there is nothing locally I requested that camhs refer my daughter to an adolescent DBT programme at Maudsley Hospital. I was told that this would not be possible because of funding. It is extremely difficult to find help for under 18s with bpd sypmtoms which I can’t understand as surely the sooner you intervene, the better. The reluctance to diagnose bpd in teenagers seems to be very unhelpful and I wonder what they expect us to do for a year until she is able to access DBT through adult services!? If you have the symptoms to the point that you cannot function and have to pull out of school and spend months in hospital then surely that is enough to warrant treatment. According to the DSM IV you can diagnose BPD in teenagers if the symptoms have been persistent for at least a year. I contacted a private clinic and was quoted £660 PER DAY! Who can afford that?! I can’t believe that the decision to fund nhs treatment lies with a commissioner who is far removed from the situation and from my conversation with her badly or uninformed. She said that they were treating personality disorders locally with EMDR and that the crisis unit that my daughter is in is the best place for her to be treated. It is a mixed unit that doesn’t offer DBT, schema or mentalization therapy. The mind boggles. Very scary though because at the end of the day she holds the purse strings. I haven’t given up though and will continue to fight for treatment. In the meantime my daughter has to limp along, doing her best to cope and is expected to apply what she learned in about 10 cbt sessions she had between May and August this year. If recommended treatment for adults is a minimum of 12-18 months of psychotherapy then how do they imagine a self harming, suicidal 17 year old with high risk impulsive behaviour is going to turn life around on 10 cbt sessions. Something needs to change.
November 5, 2011 at 9:37 am
improvingthemoment
Lindsay, I’m so sorry your daughter is in such a bad position. It must be very difficult for your whole family.
I wonder whether it is worth taking on the commissioner. To argue that ‘personality disorders’ (for there are many!) can be treated using EMDR is quite extraordinary. EMDR is a treatment for trauma. Its link with BPD is indirect at best- having had a quick look at the evidence base in the literature, Brown and Shapiro in the journal Clinical Case Studies (2006, volume 5, pages 203-420) argue that ‘Given the significance of childhood abuse and trauma, eye movement desensitization and reprocessing (EMDR), a recognized trauma therapy, may be a reasonable treatment option for BPD’. EMDR is therefore only indicated for your daughter if she has a history of childhood abuse and trauma.
In the field where I work, we use a ‘response to intervention model’. Which basically means, the client gets whatever treatment is provided, and only if they do improve, do we then go to the next level. So another line of argument is to consider whether you daughter has shown any improvement following her 10 CBT sessions, or during her time in the crisis unit. What do the professionals treating her say? It may be that she should take up the offer of EMDR, so that it can be established that this isn’t effective for her. The downside of this is that we are effectively ‘waiting’ for clients to ‘fail’. losing time and hope in the process, and putting clients through treatments which are likely to be ineffective. But showing that the existing provision has not helped your daughter may work?
I too looked at self-funded treatment in a clinic programme, and could not possibly have afforded. When you ask who can, well- one private clinic told me that all their patients were NHS patients, sectioned under the mental health act. So it would seem the NHS is the only ‘client’ who can afford private clinic treatment! There are private therapists listed on this page who offer individual therapy and skills training, which is what I did. One, for example, offers a 16 week DBT skills group (2.5 hours a week) for £900, and weekly individual therapy plus skills coaching for £60. I don’t know whether this is more within your means (and I wholeheartedly agree that you shouldn’t have to pay!) but it might be a better option?
Happy to help further if I can. Your daughter is fortunate to have a supportive family member fighting her corner. Best wishes to you and her.
November 5, 2011 at 10:20 pm
Lindsay
Hi again. I have decided to approach the commissioner again with recommendations from camhs, Hope Services and Aquarius Unit who all feel DBT is the treatment needed. This last time, my daughter was taken to the unit under section 2 of the MHA having run down the tracks of our local train station. Her behaviour seems to be getting more impulsive and dangerous with time and I really thought that something would happen about treatment. If I weren’t so concerned about her safety I would accept weekly therapy but I think she needs more intensive therapy focussed on reducing dangerous behaviour and self harm and keeping her out of hospital. I really think that the commissioner needs to have a clearer picture of my daughters difficulties so that she can see that none of the services involved are able to offer suitable treatment. I contacted a very reputable hospital that offers a PD service and was told that they are looking for patients which isn’t surprising if commissioners aren’t authorising treatment. Even if you had the money, they don’t take private referrals so it has to go through the nhs. We definitely won’t get inpatient treatment so we are going to seek it outside of the UK but I am hoping to get outpatient treatment for when we get back.