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training during residency to increase the likelihood of its in person for 24 hours after the self-harm behavior oc-
use upon graduation (3, 8). curred. Patients could contact other members of the DBT
In order to improve resident psychotherapy training in team during this time period, as described by Linehan in
DBT, psychiatry residents and clinical faculty at the Uni- her model (6).
versity of Utah developed a DBT clinic that began oper- DBT therapists and skills-group leaders met weekly for
ation in January 2009. The purpose of this report is to consultation group.
describe an innovative model that may be used by other
residency programs for the creation and maintenance of a
Implementation
formalized resident-run DBT clinic that incorporates both
The DBT clinic was integrated into the existing resident
academic and clinical teaching and provides needed clin-
psychotherapy clinic. Participation in the DBT clinic was
ical services to high-risk patients with personality disor-
strictly voluntary for residents. The clinic utilized existing
ders.
administrative infrastructure in the resident psychotherapy
clinic. Because existing facilities and administrative re-
Method
sources were utilized, no additional administrative ex-
penses were incurred. No departmental funding was re-
Design
quested or provided. DBT Clinic patients were required to
The University of Utah Resident DBT Clinic was de-
pay the same nominal fee charged to all resident clinic
signed to adhere as closely as possible to the model de-
patients for each individual therapy session. No additional
scribed in Linehans classic text, Cognitive-Behavior
fee was charged for the weekly skills-group meetings.
Therapy of Borderline Personality Disorder (6). Skills-
Senior residents at the University of Utah are required to
training groups were designed around the four skill mod-
carry a minimum number of psychotherapy patients, and
ules described in Linehans Skills Training Manual for
the proposal was worded such that DBT patients would
Treating Borderline Personality Disorder (7). The follow-
count toward the required total caseload in the resident
ing key principles were incorporated into our clinic:
clinic. Also, the clinic required two residents to lead the
Referrals were initially screened by a clinician trained
DBT skills-group for 75 minutes per week. For skills-
in DBT. Acceptable referrals met criteria for BPD.
group leaders, the proposal stipulated that the skills-group
No medications were prescribed in the clinic, as patients
would count as one patient in their required caseload.
received medications from other providers.
Patients who passed the initial screening were expected
to sign a 6-month treatment contract stipulating required Supervision and Training
attendance at both individual therapy sessions and skills- Residents who participated in the DBT clinic were re-
training sessions every week. sponsible for obtaining 1 hour of one-on-one supervision
Patients agreed that all therapists and skills trainers per month from a faculty member for each patient. Also,
involved in the DBT clinic would be actively involved in they were required to attend a weekly combined lecture
their treatment and would have access to their personal series and consultation group supervised by the clinic di-
health information. rector. Furthermore, DBT clinic participants were ex-
Patients agreed that if they missed more than three pected to purchase and read Linehans Cognitive-Behavior
consecutive therapy and/or skills-training groups, DBT Therapy of Borderline Personality Disorder (6) and Skills
would be terminated for the duration of their 6-month Training Manual for Treating Borderline Personality Dis-
contract, after which they could negotiate a new contract if order (7). All of the original participants in the resident
desired. DBT clinic completed a 20-hour online CME course of-
The DBT contract permitted patients to contact their fered by Behavioral Tech, LLC (9). Residents who at-
individual therapists for telephone consultation and skills- tended the 6-month lecture series, completed the online
coaching during and outside of normal clinic hours, with a CME course, completed 6 months of therapy with a pa-
goal of 24-hour telephone coverage. There was no require- tient, and passed a nal written exam administered by the
ment of 24-hour telephone coverage, which differs from clinic director received a letter of certication as a DBT
the original Linehan model (6). therapist. To evaluate the DBT curriculum, residents took
Patients who engaged in self-harming behavior were not a pre-test before beginning the course and a post-test at the
permitted to contact their individual therapist by phone or completion.