Dialectical Agreement: The DBT team agrees to accept, at least pragmatically, a dialectical philosophy. There is no absolute truth; therefore, when polarities arise, the task is to search for the synthesis rather than for the truth. Because our patients’ inextricably-linked identities transact with their various environments, we consider identity, marginalization, and the struggles caused by systems of oppression through an intersectional lens. The dialectical agreement does not proscribe strong opinions, nor does it suggest that polarities are undesirable. Rather, it simply points to the direction team members agree to take when passionately held polar positions threaten to divide the team.
Consultation-to-the-client Agreement: The DBT team agrees that team members do not serve as intermediaries for clients with other professionals, including other members of the team. The team agrees that clients will have more opportunity to learn when a DBT provider consults with clients on how to interact with other team members. When providers intervene on behalf of clients, clients lose that opportunity to learn to resolve problems themselves. Thus, when a clinician says things that are unhelpful or ineffective to the client, the task of the other team members is to help their clients cope with this provider’s behavior, not necessarily to reform the provider. This does not mean that the team members do not conduct therapy for the therapist, plan treatment for their clients together, exchange information about the clients (including their problems with other members of the team), and discuss problems in treatment. DBT providers strive to provide such learning opportunities, and only intervene on behalf of clients when it is effective to do so.
Consistency Agreement: Failures in carrying out treatment plans can be problematic; at the same time, they present opportunities for clients to learn to deal with the real world. The job of the DBT team is not to provide a stress-free, perfect environment for clients. Thus, the DBT team, including all members of the team, agrees that consistency of team members with one another is not necessarily expected; each member does not have to teach the same thing, nor do all have to agree on what are “proper rules” for therapy. Team members can each make their own decisions about how to proceed in therapy, within the DBT frame. Similarly, although it can make for smooth sailing when all members of an institution, agency, or clinic communicate the rules accurately and clearly, mix-ups are viewed as inevitable and isomorphic with the world we all live in. Any time a team member, team, or agency delivers treatment inconsistently (both in relation to other providers and to themselves), it is seen as a chance for clients (as well as team members) to practice the skills taught in DBT.
Observing-Limits Agreement: The team agrees that all members are to observe their own personal and professional limits. Furthermore, team members agree not to judge limits different from their own as too narrow or too broad, and instead determine if the limits are effective in a given situation. The team may suggest that a member broaden or narrow limits to become more effective, and at the same time will accept each other’s differing limits without judgment. Team members will do their best to communicate their limits effectively to clients and teammates, and at the same time, clients are expected to ask about, learn, and accept providers’ limits.
Phenomenological Empathy Agreement: DBT team members agree, all other things being equal, to search for nonpejorative or phenomenologically empathic interpretations of clients’ behavior. The agreement is based on the fundamental assumption that clients are trying their best and want to improve, rather than to sabotage the therapy or “play games” with their provider. When a teammate is unable to come up with such an interpretation, other team members agree to assist in doing so, meanwhile also validating any frustration or other emotions that may arise for the provider. Thus, DBT team members agree to hold one another nonjudgmentally in the DBT frame. They agree to also search for a nonpejorative interpretation of the behavior of teammates, clients’ family members, and any other relevant individuals, as well.
Fallibility Agreement: There is an explicit agreement in DBT team that all team members are fallible. Thus, there is little need to be defensive, since it is agreed ahead of time that team members have probably done whatever problematic things they are accused of. The task of the team is to apply DBT principles to one another, in order to help each member stay within DBT. As with clients, however, problem solving with team members must be balanced with validation of the inherent wisdom of their stances. Because, in principle, all team members are fallible, it is agreed that they will inevitably violate all of the agreements discussed here. When this is done, they will rely on one another to point out the polarity and will move on to search for the synthesis. This is especially true for naming (internalized) ableism, ageism, sexism, transphobia, racism, homophobia, and the like as a therapy-interfering behaviors. Antiracist Agreement: Therapists must assess their competencies in antiracism prior to beginning treatment with racially marginalized patients, or as soon as possible once they enter the therapeutic relationship. This agreement is incumbent on White DBT therapists without exception, and is encouraged for all DBT therapists. Therapists will share their self-evaluation of competencies in antiracism with consultation team members, in order to facilitate effective team support for therapist’s growth in this competency area. Therapists will make every reasonable effort to increase their competencies in antiracism, including but not limited to: engaging in consultative discussion, openly receiving feedback from others about racist behavior, completing self-reflective exercises about race-related values, attitudes, and beliefs, increasing race-specific knowledge through educational activities, completing homework assigned by consultation team members in order to foster growth in specific antiracist competencies, and making repairs to team members and/or patients when therapist racist behavior is identified.