Limitations of DBT

Although DBT is considered the gold standard for treating self-harming and suicidal individuals with BPD, there are notable limitations. 

For example, DBT is a lengthy and highly intensive therapy with extremely emotionally dysregulated clients in heightened levels of chronic stress and instability, which may place an undue burden on the therapist who is expected to be available 24/7 for emergencies which may cause accelerated burn-out (Ruork et al., 2021). Moreover, DBT’s weekly client commitments and intensity toward changing behaviors and generalizing new skills may present challenges in maintaining a client’s therapeutic compliance long-term (Reddy & Vijay, 2017). Additionally, the length of treatment and associated cost may be unreasonable for many if not covered under managed care, leading to early drop-out (Reddy & Vijay).

 DBT also requires excessively specific training and highly qualified therapists (e.g., Linehan certified providers are generally doctorate level educated professionals) (Reddy and Vijay, 2017). Therapists are required to participate in on-going weekly team collaboration and supervision which may be overwhelming and/or unrealistic for a clinician in private practice or community-based settings (Vaughn, 2018, Kress et al., 2021). This leads to challenges with dissemination and resource usage, especially in non-academic environments (e.g., community and/or resource poor environments) (Reddy & Vijay).

Furthermore, due to the directive, structured, and systematic approach of DBT in which the therapist is teacher, motivating cheerleader, validator, consultant, and role model, there is a real danger that the therapist in the role of expert and trainer may impose his or her values on the client (Reddy & Vijay, 2017; Tan, 2011; Vaughn, 2018 ).

Although, DBT is an excellent skills-based program, especially for difficult-to-treat individuals, the consistent self-focused skill-set limits opportunities for individuals to think outside themselves and practice mentalizing (e.g., conceptualization of what another individual is thinking or feeling), which is a critical skill in maintaining productive relationships (Porr, 2017).