Getting DBT online down under: The experience of Australian and New Zealand Dialectical Behaviour Therapy programmes during the Covid-19 pandemic.

Dialectical Behaviour Therapy (DBT) is an intensive and multi-modal intervention developed for individuals with multiple comorbidities and high-risk behaviours. During pandemic-related lockdowns, many DBT services transitioned to delivering treatment via telehealth, but some did not. The current study sought to explore the experience of DBT teams in Australia and New Zealand who did and did not transition to telehealth during the early stages of the COVID19 pandemic, as the majority of research on DBT via telehealth has originated from North America, and focussed on therapists who did make this transition. DBT team leaders in Australia and New Zealand completed a survey with open-ended questions about the barriers they encountered to delivering DBT via telehealth, and for those teams that implemented telehealth, the solutions to those barriers. Respondents were also asked about specific barriers encountered by Indigenous and Pacific people service users. Of the 73 team leaders who took part, 56 reported providing either individual therapy, skills training or both modalities via video-call during lockdown. Themes emerging from perceived barriers affecting just DBT providers included the assessment & management of emotions and high-risk behaviours, threats to privacy and information security posed by telehealth, logistical issues related to remote sessions, and the remote management of therapy-interfering behaviour. Themes emerging from perceived barriers affecting both providers and service users included disruptions to therapeutic alliance, lack of willingness, lack of technical knowledge, lack of private spaces to do DBT via telehealth, and lack of resources. The solutions most frequently cited were the provision of education and training for therapists and service users in the use of telehealth, and the provision of resources to access telehealth. These findings are relevant to clinical delivery of DBT, as well as planning and funding for DBT telehealth services.