Why Adherence Matters

September is National Suicide Prevention Awareness Month, so what better time to review the impact Dialectical Behavior Therapy has on reducing suicidal thoughts and urges?  DBT was initially developed for suicidal clients and has rigorous research data supporting Dialectical Behaviour Therapy (DBT) as an effective evidence-based treatment.  We also know that adherent DBT programs yield the most significant patient outcomes. 

What is less well known, based on the research, is whether therapist adherence influences patient outcomes. 

In 2022, Harned and Colleagues published research on this very topic, looking at the temporal relationship between therapist adherence to DBT and patient outcomes. The study also reviewed if there were any moderators of those relationships. 

What did they find?

Higher therapist adherence significantly predicted:

 - Fewer subsequent suicide attempts - Lower risk of dropout (strongest impact to those with co-occurring opioid dependence) - Fewer subsequent hospitalisations (among community therapists) and for patients that were not exclusively suicidal/self-injuring

The study also found if patients have more frequent non-suicidal self-injury (NSSI) and had worse global functioning this predicted higher subsequent therapist adherence was also found when patients had more frequent non-suicidal self-injury (NSSI) as well as worse global functioning. This was moderated by patient population. 

What does this mean?

Therapist adherence to DBT as it was designed to be delivered predicts fewer suicide attempts in their clients. This highlights the importance of delivering DBT with fidelity. The study also provides evidence that therapist adherence helps bolster patient retention. It also highlights that when working with patients presenting with higher severity, the model feels easier for therapists to deliver the adherently. 

DBT Adherence at DBTICI

At DBT Institute of Central Illinois, we hold DBT adherence as a core standard of our work. Adherence to the treatment model is not only consistent with our values as clinicians—emphasizing integrity, fidelity, and evidence-based practice—but it is also central to our responsibility to the patients and families we serve. By maintaining a high level of treatment fidelity, we ensure that clients receive the full benefit of DBT as it was designed and empirically validated. This commitment extends beyond individual sessions to the broader community, as providing adherent DBT helps reduce suffering, promote resilience, and strengthen the mental health resources available within Central Illinois.

We gratefully acknowledge the DBT-Linehan Board of Certification for providing the research content in this section, which was shared through their email communication.