by David McPhee, PhD

A reader named Richard sent me this question by email. With his permission, I’m posting it here so he can get answers not just from me, but from Quora in general. It’s a great question.

DBT is the gold standard for Borderline Personality Disorder (BPD), and there are thousands of articles about both DBT and BPD here on Quora, already, so I’m just going to answer the question asked, then add resources at the end.

Yes, it can be done effectively online. I just now took a course for my continuting education/license renewal, in Telemental Health. They quoted statistics showng equivalent results for various therapies whether in-person or online, though they didn’t mention DBT specifically.

Still, DBT is a big therapy, and its application can range from full-time residential treatment to intensive outpatient experiences including both individual and group therapy all the way down to getting therapy with a provider who is influenced by Linnehan’s theories and techniques, but doesn’t offer DBT per se. Providers like me.

Is online DBT (or any) therapy effective? Absolutely.

Is it just as effective as in-person for Sally Metcalfe in Kalamazoo who is dealing with BPD-like symptoms and suffering? Less effective? More effective? The only way to know is to talk to Sally and her therapist, and even then the data will be pretty subjective.

For Sally it may be less effective because she craves that in-person energy, and some of those subtle non-verbal cues that are hard to read on a screen. Still effective, but a little less so. Or it may be more effective for Sally because she just feels safer at home, and the distance boundary that telemental health creates is a huge plus for her — gives her the special comfortable space she needs and reduces her anxiety.

If you are in pain, and can stir up a little trust in the therapist and the therapy, and show up and take a few risks, and the therapist is adequate, the work can be effective whether it’s on TV or in a comfy office, or even by telephone, or even, yes, by asynchronous letters and emails. The question isn’t whether a motivated client and a decent therapist can be effective together, as long as they are communicating, but how effective.

If someone I loved was ready for therapy and lived somewhere that only online DBT was available, I’d move Heaven and Hades to help them get it. Online therapy works, maybe better or faster for some, or slower or a little less for others, but it works.

When you can’t pick the perfect, don’t throw out the good and be left with nothing.

PS: where I live they have elephant therapy, and they can go to the university and get certified and qualifed in it (the therapists, not the elephants). I promise you that if I were struggling with depression or something and only elephant therapy was available, I’d sign up immediately. It’s got a good track record and some research, and it might not be as just-perfect for me as CBT or EFT or ACT or any of the popular alphabet therapies, but it works, it’s effective, it’s available, and I need help. When can I get an appointment?

Here are sources for DBT worksheets by Marsha Linnehan. They are from Kaiser Permanente and apparently have been authorized for distribution and use by private individuals: They cover Skills Training: Distress Tolerance, Interpersonal Effectiveness, Mindfulness and Emotional Regulation.

DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this worksheet ...

If you’re willing to do a bit of digging, you can find these and a lot more useful and potentially effective resources like this at Kaiser-Permanente’s massive website: dbt - Google Search [link added]