First do no harm: Client and staff experiences of negative effects from dialectical behaviour therapy

Area of Science:

• Psychiatry
• Clinical Psychology
• Therapeutic Interventions

Background:

• Dialectical Behaviour Therapy (DBT) is recognized for reducing self-harm and suicidal ideation.
• Evidence suggests potential negative effects of DBT, with discrepancies between client and staff reports.
• Limited research has explored the comparative understanding of these negative effects by both clients and staff.

Purpose of the Study:

• To investigate client and staff experiences of negative effects associated with DBT.
• To compare client and staff understandings of these negative effects.
• To examine how staff manage negative effects arising from DBT.

Main Methods:

• Semi-structured interviews were conducted with eight client participants and seven staff participants.
• Participants had experienced or witnessed negative outcomes from DBT.
• Reflexive thematic analysis was employed to analyze interview transcripts.

Main Results:

• Client themes included 'I'm the problem,' 'DBT can do no wrong,' 'No understanding of trauma,' and 'An unhealthy "blueprint for relationships."'
• Staff themes included 'It's not me, it's the client,' 'DBT or nothing,' 'We don't do 'why' in DBT,' 'We did make some changes,' and 'Organisational "restrictions."'
• Both groups identified pathologisation and re-traumatisation as negative effects.

Conclusions:

• Clients linked negative effects to the therapeutic relationship, whereas staff emphasized organizational restrictions.
• Findings indicate a need for enhanced awareness of potential negative effects in DBT.
• Recommendations include implementing meaningful informed consent procedures and adapting practices to mitigate adverse outcomes.