Implementering av DBT i en rural kontekst

Abstract

Background and purpose: Dialectical behaviour therapy (DBT) is a widespread evidence-based method of treating emotionally unstable personality disorder, but the method has barely been studied in a rural context. The purpose of this study is to identify rural challenges for the four treatment channels of DBT, to pinpoint implicit urban starting points in DBT, and to suggest possible adaptations of DBT in rural areas, based on Finnmark as a case. Method: The authors, who are clinicians with extensive experience in psychiatric healthcare in Finnmark, integrates findings from previous research of culturally adapted DBT for rural cultures with local clinical experience in accordance with the declaration of evidence-based psychological practice. Our methodical basis is traditional literary study, case study, autoethnography and theory generation. Results: DBT in its original format falls short in rural areas without adaptations. We found that key challenges for implementations of DBT in our local clinical practise are geographical distances, lack of personnel, difficulties in maintaining anonymity in group therapy, difficulties with group guidance and lack of continuity in treatment due to high turnover. Vi lay out possible adjustments, such as sectional skill training, short periodic admissions at DPS with intensive skill training, pragmatic use of phone consultations, digital treatment (and guidance) and inclusion of other departments in treatments. Conclusion: DBT is a principle-driven method which is originally designed for an urban setting, but which is possible to adapt to a rural context such as Finnmark. Possible challenges are geographical distance, lack of continuity, personnel shortage and lack of anonymity (group treatment). Keywords: rural, DBT, pragmatic psychology, geographical narcissism, urban bias