Dialectical Behavior Therapy (DBT) in Latin America

Behavioral Tech celebrated its very first training in Latin America last October. With a great deal of hard work and collaboration, we joined co-host Fundación Foro in welcoming 130 people to the Dialectical Behavior Therapy Intensive Training™ in Buenos Aires, Argentina. This training was spearheaded by Fundación Foro director Pablo Gagliesi, MD, whose enthusiasm for bringing DBT to Argentina went on to be a driving force for the creation of another DBT training in Latin America. Along with dedicated psychologist Vinicíus Dornelles, Psicólogo Me., Behavioral Tech looks forward to welcoming the next group in late 2015 in Puerto Alegre, Brazil.

foto-pablo
Pablo Gagliesi, MD (Argentina)
Director, Fundación Foro

Vinicius
Vinicíus Dornelles, Psicólogo Me. (Brazil)
Coordinator, Grupo de Estudos e Pesquisa em Personalidade (GEP)

Dr. Gagliesi and Dr. Dornelles shared their experiences in bringing DBT to their respective countries and their hopes for their communities are nothing short of inspirational. We share their vision for better access to care in Latin America.

When and how did you learn about DBT?

Pablo: Towards the end of the 1990s, I was working in a [leading] programme based on emergency home visits, and at the same time, I was practising as a psychiatrist and psychotherapist for an agency.  We had many challenges with patients “chronically attached to emergency.”  I was also supervising together with colleagues who belonged to a generation motivated to see a change in the way we did things in my country, and [it] was then that a psychiatrist shared with me a paper by Dr. Linehan.

At that time, it was not easy to get hold of the papers, and I had to run to a special place to photocopy them and return them immediately.  I still recall, sitting outside in the street reading until it was late, a theory that made a lot of sense to me. 

A few weeks later, the agency sent a few of us to the American Psychiatric Association Congress, a luxury for us that faded quickly after a major crisis in my country in 2001.  It was during that congress that I bought a book and saw Dr. Linehan.

I read the book between flights and travels, and when I returned to Buenos Aires, I started together with a colleague a study group.  I also offered the book to someone close to me; she followed the criteria of BPD and had followed all possible treatments available.  She started reading the book, and it is still today that she says to me, “The best ever treatment was a book.”  She is an excellent professional and successful human being.

Vinicíus: During my Psychology graduation, I had a Psychopathology class in which I was enchanted by the work done with borderline personality disorder patients, and right there I started to deepen my studies in the treatment approaches for that population.  I wondered if one day I would be capable of putting a DBT team together to work with borderline patients.

I continue to direct my career to the work with borderline patients, so I’ve done my master’s dissertation [on] this subject. I developed a neuropsychological evaluation of borderline personality disorder (BPD) patients. After it, I continued studying BPD and the different treatment approaches. Although I had a great interest in DBT, I still lacked the basis to assemble a team and initiate DBT’s clinical practice as a whole.  It was only in 2012 (exactly three years ago) that my contact with DBT started to become reality.

During a Latin American Congress about cognitive behavior therapy (CBT), I saw that there was another person, an Argentinian man, Pablo Gagliesi, who would talk about DBT.  At the end of it, I introduced myself to him; he promptly asked me if I was Vinicius and gave me two DBT books and said, “You have to assemble a team in Brazil.”  It was with this kindness that … our deepened, DBT training started.

What part of the DBT Intensive Training did you find to be the most valuable to your personal and professional life?

Pablo:  It was not until I participated in the Intensive Programme [sic] that everything began to make sense –.  It has truly been a life-changing experience for me.  I [first] took the Intensive training in Minneapolis, MN, and the teamwork was to me very enriching, not to mention the role-plays, which are still in my memory.

Vinicíus:  The first one was the case consultations, because it helped us to improve technically as DBT therapists, and it gave us a broader view of the consultation team. Besides that, we were granted the opportunity to know about other great work that is being done by our Latin American fellows. The second part that was very important to me was the specific work done by the team and consultation meeting. It was a great moment when our team could train a lot and talk about all the things we thought about the team in a validating way. That moment was very touching and of great personal growth for my team and me. Besides that, this moment was useful so we could have the real notion of our roles in a consultation team and the real importance of it.

Is there anything that surprised you about the Intensive Training?

Pablo: It has to be the role-playing for sure; it transformed my life.  I remember on the first day, I arrived late and the trainers did a Chain Analysis [with me]. I recall exactly what happened; it was the first time that we did such a thing on ourselves.  I understood then that DBT was something we had to apply among us. 

Vinicíus:  First, the affective and close approach of the trainers was very surprising and positive.  Besides that, I believed that what also caused me surprise during the training was the work [and how much] all the teams have been developing.  It was an amazing experience to live through the growing intimacy among the teams because of this work.

Have you seen the same enthusiasm from others who attended the training?

Pablo:  For sure, I know that many others enjoyed and experienced a lot of value from this programme.

Vinicíus:  There’s great enthusiasm with the arrival of DBT in Latin America. This was clearly noticeable in the people taking the training and in the conversations we held during breaks.  We’re talking about a treatment approach that incorporates many of our great cultural values and that has a solid evidence base about its effectiveness. So, it’s only natural that there’s great excitement with the coming of DBT here.

Even though many Latin American countries are currently going through an intense political and economic crisis, as is the case in Brazil, we [have] never before had such a political and economic importance in the global scene as we have today. This translates to a significant increase in training opportunities, work, and promotion of new jobs in the most diverse scenarios and fields.  We can glimpse a plan in [the] medium and long term of the arrival of DBT, not only in private health treatment [options], but also in public health, allowing many improvements in the quality of life of our patients.

What changes do you hope to see in treating clients as a result of the Intensive?

Pablo: The changes happened to us.  And I believe that translated into the clinical practice.  I know that [as a result of training], we were convinced that when the treatment is done well, it works.

I am typically disorganised, and when I came back, I was sure that it was a behavioural problem I had to resolve.  So I did, and we aligned with protocols and process guides and agendas.  Being structured while keeping the magic of creativity.

Vinicíus:  The main result I expect is to become more effective at helping my patients to build lives that are worth living.  Besides that, I would like to develop each time more [the skill of] listening to my patients [in an] emphatic [sic] and humane [way].  I expect being much more effective with my team, in the means of building our teamwork and feeling that I can, together with everybody’s work, increase each time more our motivation to work and continuous training.

What change do you hope to see in your community as a result of these trainings?

Pablo:  Argentina is one of the countries with [the most] psychologists per inhabitant in the world.  Most are psychoanalysts from different schools.  We have always been different by practising Cognitive Therapy and DBT; we were far away from what the rest were doing.

It was most likely for that reason that our team has grown enormously in the last 10 years.  We get invited to conferences by universities and agencies to talk about our project, and we have won a respectful place in the world of mental health.  The difference was a gain.

Vinicíus:  I expect the training in Brazil [will] allow us to develop teams in different regions of the country.  After that, I would really like to create a communication channel between these teams, so that we can learn about each other’s work and maintain a continuous training of these teams in Brazil.  I have a great hope that DBT ends up entering Brazilian public healthcare proposals, so that independent of financial conditions, all patients that need treatment can have access to it.  There’s always a first step for everything, and I’m honestly very happy and honored that my team, Grupo de Estudos e Pesquisa em Personalidade  GEP, is starting this process.

What resources are needed to reach more people who seek treatment?

Pablo: We need to find the opportunity to convince politicians and those in charge of our public health system that DBT saves lives and is financially doable.  We know how to do it, but sometimes we don´t have the chance to do it.

Vinicíus: I believe that having more access to materials in the Portuguese language is fundamental to increasing the reach of DBT in our context.  Another factor that would be decisive is the construction of effectiveness studies of DBT in the Brazilian population; that could improve greatly the adoption of this model of treatment by the clinicians in Brazil.  Moreover, the development of partnerships with government health organizations would [stimulate] a lot of training of professionals and treatment for patients who can’t afford it in the private care.

I believe that more important than the delivery of resources, we would be writing DBT history in Brazil together.  Giving to DBT, as we popularly say around here, “the face of Brazil.” 

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