Factors that impact the implementation and sustainability of dialectical behaviour therapy programs: a qualitative study of clinician perspectives

Abstract

Dialectical behaviour therapy (DBT) is a psychological treatment developed for individuals experiencing significant mental health issues along with high-risk behaviours (e.g., suicidal behaviours, self-harm, substance use, aggression, impulsivity). Despite substantial evidence supporting its use, many DBT programs have problems with sustainability, which leaves individuals with severe mental health issues without the treatment they need. The goals of the current study were to: a) identify factors that impact the functioning of DBT programs in Thunder Bay, Ontario; b) identify factors that are particularly relevant for youth DBT programs; c) make recommendations to foster the facilitators of success and address the barriers that hinder the functioning of DBT programs. Clinicians (N=31) trained in DBT completed a semistructured interview exploring their experiences providing DBT and thoughts on the factors that facilitate or hinder the functioning of the DBT programs. The interviews were transcribed verbatim and then organized into themes using inductive thematic analysis. Three major themes emerged as barriers to the functioning of DBT programs: systemic challenges, conflicts within the consultation teams, and clinician burnout. Factors influencing the success of DBT programs included: systemic support, clinician commitment and “buy in,” and team cohesion. Unique factors specific to providing DBT with youth (i.e., level of commitment, simplifying the language, and parental investment) were also identified. The findings provide novel information on barriers that impact the functioning of DBT programs from clinicians’ perspectives within a Canadian publically funded mental health system. These findings have clear clinical utility and can be used to generate solutions to clinicians’ perceived barriers and to foster perceived facilitators.