Table 2.
Barriers to implementing DBT collected using a revised barriers to implementation (BTI)
| Barriers | Not a barrier (%) | Overcame (%) | Working on (%) | Could not overcome (%) |
|---|---|---|---|---|
| Team barriers | ||||
| Not enough DBT team members (n = 53) | 32 | 6 | 40 | 17 |
| DBT team members left (n = 52) | 44 | 17 | 19 | 4 |
| DBT team members did not get along (n = 52) | 64 | 10 | 8 | 0 |
| Conflict about leadership (n = 52) | 69 | 6 | 4 | 2 |
| No designated DBT team leader (n = 52) | 56 | 8 | 14 | 6 |
| No formal commitment to learning, implementing DBT from some team members (n = 53) | 43 | 17 | 13 | 9 |
| Mandated rather than voluntary participation in training and program development (n = 53) | 60 | 2 | 2 | 4 |
| Difficulty meeting with each other/sporadic attendance at consultation meetings (n = 53) | 28 | 15 | 25 | 13 |
| Administrative barriers | ||||
| Change in administrator (from supportive to non-supportive) (n = 52) | 50 | 6 | 12 | 2 |
| Funding cut (n = 52) | 39 | 2 | 4 | 10 |
| Staff cut (n = 52) | 44 | 0 | 6 | 6 |
| Productivity demands (n = 52) | 29 | 10 | 33 | 15 |
| Lack of resources for training (n = 52) | 8 | 12 | 39 | 31 |
| Theoretical/philosophy barriers | ||||
| Difficulty adopting DBT assumptions (n = 52) | 46 | 14 | 27 | 0 |
| Difficulty adopting DBT team agreements (n = 52) | 50 | 12 | 15 | 6 |
| Problems buying into DBT biosocial theory (n = 52) | 69 | 2 | 19 | 0 |
| Discrepant theoretical orientations (n = 51) | 49 | 16 | 24 | 0 |
| Non-behavioral orientation (n = 52) | 46 | 15 | 27 | 0 |
| Non-dialectical orientation (n = 52) | 48 | 12 | 29 | 2 |
| Mindfulness viewed negatively or not adopted (n = 52) | 73 | 6 | 10 | 0 |
| Conflict between VA policies and DBT philosophy (n = 52) | 31 | 8 | 31 | 19 |
| Structural barriers | ||||
| Lack of individual therapists (n = 50) | 10 | 4 | 54 | 26 |
| Lack of therapist availability to take on enough patients (n = 50) | 12 | 6 | 52 | 24 |
| Lack of clients or referrals (n = 50) | 78 | 6 | 12 | 0 |
| Too many clients or referrals (n = 50) | 48 | 2 | 34 | 10 |
| Clients accustomed to treatment they have had and are resistant to change (n = 49) | 27 | 8 | 55 | 2 |
| Not a match for client problems or needs (n = 50) | 80 | 8 | 10 | 0 |
| Lack of physical space (e.g., group room with a table) (n = 49) | 65 | 16 | 12 | 4 |
| Lack of materials (e.g., binders for handouts) (n = 50) | 50 | 20 | 20 | 6 |
| Only one group leader allowed (n = 50) | 68 | 8 | 10 | 10 |
| Unable to schedule a 2-h group (n = 50) | 49 | 16 | 16 | 8 |
| Unable to have time blocked out for DBT consultation team (n = 50) | 32 | 18 | 22 | 22 |
| Phone coaching barriers | ||||
| Not willing to take phone calls or extend limits when needed (n = 50) | 36 | 6 | 14 | 12 |
| Not allowed or able to take phone calls for coaching during business hours (n = 50) | 50 | 4 | 16 | 6 |
| Not allowed or able to take phone calls for coaching outside business hours due to using personal time (n = 50) | 14 | 8 | 4 | 42 |
| Not allowed or able to take phone calls for coaching outside business hours due to using personal phone/physical resources (n = 50) | 18 | 6 | 0 | 42 |
| No funding available for phone calls for coaching outside business hours (n = 47) | 13 | 6 | 4 | 49 |
Indicate no for VA, yes generally for other settings. All barriers add up to 100% including N/A responses not included in the table above