DBT Teams: Development and Practice

The DBT consultation team is a group of DBT therapists who meet regularly to consult with one another about their cases, observe each other's sessions, and provide mutual support. Sayrs and Linehan argue that the team is not an administrative add-on but a core component of DBT itself, functioning as therapy for the therapist . The rationale is that DBT requires therapists to hold dialectical tensions—acceptance and change, flexibility and fidelity—that are difficult to sustain alone, especially when treating high-risk, high-emotion clients. Without a team, therapists are vulnerable to burnout, drift from the treatment model, and the same emotion-driven behavior patterns their clients exhibit. The book cites Linehan's earlier work establishing that the team is required for fidelity to the treatment .

Consultation agreements are the explicit commitments team members make to one another about how they will participate and hold each other accountable. Sayrs and Linehan describe agreements that include: attending meetings consistently, observing each other's sessions according to a schedule, consulting about cases even when not asked, accepting consultation non-defensively, being willing to be observed and to observe, and maintaining confidentiality . The agreements transform the team from a discussion group into a structured accountability system. The book provides specific guidance on how to introduce, negotiate, and revise agreements, including what to do when a member repeatedly violates them. The agreements are framed dialectically: they balance the therapist's autonomy and competence against the team's responsibility to ensure fidelity.

Observation is the mechanism by which the team gains accurate information about what therapists actually do in session, rather than relying on self-report. The book describes a rotating observer role in which a team member watches a colleague's session—either live or by recording—and brings observations back to the team for consultation. The observer is not an evaluator or supervisor but a consultant whose observations become shared material for the team's problem-solving. Sayrs and Linehan emphasize that observation must be conducted in a spirit of mutual respect and that therapists should experience it as supportive rather than surveilling. The book provides protocols for scheduling observations, structuring the feedback conversation, and using observation data to address both fidelity drift and therapist distress.

Sayrs and Linehan argue that the consultation team is the primary structural protection against burnout. Treating suicidal, self-harming, and chronically dysregulated clients is emotionally demanding, and therapists who work in isolation are at high risk of compassion fatigue, cynicism, and withdrawal. The team provides a setting in which therapists can acknowledge their own emotional reactions without shame, receive validation and support, and be helped to apply DBT skills to their own experience . The book also addresses the specific problem of 'team burnout,' in which the team as a whole loses energy and focus, and offers strategies for renewal. It emphasizes that team functioning requires the same dialectical balance—acceptance of the therapist's limits and commitment to change—that characterizes the treatment itself .

DBT Teams is a companion volume to Linehan's treatment manuals, particularly Cognitive-Behavioral Treatment of Borderline Personality Disorder (1993) and the DBT Skills Training Manual (2nd ed., 2015). The earlier manuals describe the treatment structure and the skills modules but treat the consultation team relatively briefly, assuming it would be established by programs implementing DBT. Sayrs and Linehan's book provides the detailed guidance that was missing: how to form a team, how to write consultation agreements, how to structure meetings, how to handle common problems, and how to sustain the team over time. It thus fills a practical gap in the DBT literature and is intended for use alongside the treatment manuals, not as a replacement for them .

The book addresses a range of documented difficulties. It covers starting a team from scratch, including recruiting members and establishing initial agreements; integrating new members into an existing team; handling teams that have lost focus or stopped observing each other; managing conflict between team members; addressing a member who consistently violates agreements; and dealing with team dynamics that mirror client dynamics, such as polarization and avoidance . The authors describe common failure modes—including the team that becomes a social support group with no accountability, the team that becomes a supervision session with one expert dominating, and the team that avoids conflict entirely—and offer structured remedies. Each chapter includes practical tools, sample agreements, and vignettes illustrating typical problems and solutions .