Jergensen, K. (2018). Practice what you preach: An exploration of DBT therapists personal skill utilization in burnout prevention. Clinical Social Work Journal, 46(3), 187-199. http://dx.doi.org/10.1007/s10615-017-0633-6 Hypothesis(es) and/or Research Question: This study was exploratory in nature seeking to better understand how skill use by the practitioner influences their experience of stress and burnout symptomology, specifically examining the extent that DBT therapists personally utilize the DBT skills in their lives and how this may serve as a mediating factor for stress reduction, stress management, and burnout prevention. Sample: A convenience sample of 135 current DBT practitioners (e.g., mental health therapists currently providing individual DBT therapy, DBT skills group, or both) was used. The majority of the sample identified as female (89.6% identified as female, 8.9% identified as male, and 0.7% identified as transgendered), and their age varied greatly (ranged from 27 years old to 72 years old; M=45.98, SD = 11.24). To recruit participants, the survey used was posted on an online international list serve for DBT practitioners, who then were able to anonymously respond to the survey. Participants were not limited by location and were not asked to identify their educational background or degree. Measures: The survey overall consisted of fifty-two questions. Demographic information (including the participants’ age, sex, and work experience was collected). Additional questions assessed participant burnout, stress level, the extent participants used the DBT skills in their daily lives, how they felt those skills assisted in stress management, and how helpful they found the consultation team in reducing stress. To measure the extent to which DBT therapists utilize the DBT skills in their own life, participants indicated their use of thirty-five listed DBT skills, and a composite score of the thirty-five skills was created to establish how many of the skills were being utilized by each respondent on a regular basis. To assess the frequency of use and usefulness of skills in assisting with stress management, a 5-point Likert scale was used: respondents identified how often they used (from “never” to “always”) and how helpful (“not at all helpful” to “extremely helpful”) they found the techniques in each of the DBT modules. Perceived daily stress was evaluated with questions about stress related to work (scored on a 10point Likert scale) and how often stress interfered in respondents’ daily life (scored on a 5-point Likert scale). The Bergen Burnout Indicator—Modified scale consisting if 24-items scored on a 7-point Likert scale was used to assess for burnout in each participant. Potential scores on this scale range from 24 to 168 with scores above 100 suggesting a likelihood of the participant experiencing burnout symptomology. In addition, qualitative data about skill use and stress was collected through open ended questions (e.g., “How do you feel the skills you have learned in facilitating DBT have contributed to your ability to manage stress in your daily life?”). Method: A link to the survey was sent in an email to all members of an international list serve for DBT practitioners with a request that they volunteer to participate. The survey remained available for over a month, and participants were able to respond anonymously to the survey (consisting of the measures described above) during that time. The survey took participants twenty to thirty minutes to complete. A mixed methods design (the validating quantitative data model in which qualitative data is collected to provide further validation for the quantitative data gathered) was used in order to address the exploratory nature of the study. Results: Overall practitioner’s use of skills was relatively high, most frequently using mindfulness skills being reported as the most frequently used and most helpful, followed by emotion regulation. Though distress tolerance skills were the least frequently used (likely due to the nature of these skills), they were still found to be very helpful. Interestingly while interpersonal effectiveness was less frequently used and found to be least helpful in reducing stress (when assessing the quantitative data), a majority of the qualitative responses directly noted how the skills enabled them to maintain balance in their personal and professional relationships. interpersonal relation- ships both in and outside of work. Though burnout was low overall, perceived stress in the workplace was a significant predictor of burnout. However, not only did DBT practitioners report benefits using skills in their personal lives but DBT skill use was also a significant predictor of decreased burnout for DBT practitioners. The qualitative data further supported these findings, with practitioners describing skill use as positively influencing their ability to handle stress and reduce burnout. Though this study was exploratory, it provides evidence of a relationship between DBT practitioners skill use and burn out. It suggests that other practitioners may also benefit from using DBT skills in their own lives and potentially guard against burnout. Limitations of the study: This sample was limited as it was a convenience sample and given that respondents could choose whether or not they wanted to participate, and so this sample may also be restricted by a characteristic of the individuals who volunteered to complete the survey. It is also limited to DBT practitioners, which limits the generalizability of the findings to other types of practitioners. Additionally, though the sample may be international, it is unclear how representative the sample is, as this was not assessed. As this study as exploratory, the method used was developed for this study and has not been previously tested or refined and needs to be replicated. There are also not comparative research findings. A less well recognized and tested burnout scale was also used, and this modified version of the scale has not been previously used, though modifications were not extreme this further limits the study. Furthermore, this study struggle to differentiate the effects of various demographic factors (e.g., the impact of age (vs number of years in practice) with in regard to the total skill use and use of the mindfulness techniques). Application to Course Material: Burnout is extremely high among partitioners and has significant effects on our work with clients. This is especially important to consider and guard against when working with high severity clients, as DBT practitioners typically are. Though we often consider the benefits of our skills for our clients and for teaching groups, this suggests that considering the impact of using these skills for ourselves both personally and professionally may be extremely beneficial. In addition, DBT is aimed at reducing suffering. These findings suggest that DBT skills could not only directly reduce suffering of clients, but also may help to reduce the suffering of clinicians, who are then able to better serve clients in their pursuit of reducing suffering. This study also further highlights the importance of doing our skills homework, as this has many benefits beyond just learning the skills: we will be better able to serve our clients.
