The DBT team in Lund, Sweden has been working with DBT for 20 years. The team consists of 13 experienced DBT therapists of various professional backgrounds. Such as physicians, psychologists, social workers and psychotherapists. The team has been providing well-appreciated services and is conducting multiple research projects.

Over the years, the team experienced difficulties with reaching good outcomes with standard DNT for a certain group of patients: those with various cognitive difficulties. Many DBT teams exclude patients with comorbidity or developmental disorders. However, the DBT team in Lund has a commitment and a willingness to help these clients. None the less, the standard DBT-model was seen as inadequate.

By reviewing the stats of psychiatric patients in Sweden, we found that about 30 percent had some cognitive difficulties, and we lacked appropriate treatment. In the Swedish public healthcare system, all publicly funded healthcare is to be offered to all citizens in need, and should be adapted to the needs of the individual. These needs can often be complex. Different organizations are responsible for different needs. The rule of thumb is that the most defining need governs which organization that is given the main responsibility for the paint. So called Habilitation units have the main responsibility for individuals with cognitive difficulties and psychiatric clinics are main care giver for individuals with self-harm.

Staff from habilitation units are knowledgeable of intellectual disabilities and adequate environment adaptations. Often, however, they are more inexperienced and knowledgeable about psychiatric conditions and treatments. Similarly, psychiatric clinics know psychiatric conditions and DBT, but often lack models and knowledge about adaptations based on intellectual difficulties.

This means that patients with cognitive disabilities usually are not offered custom treatment and is left with a substantial suffering. This suffering also affects relatives, other families and results in an increased frequency of visits to the psychiatric emerge. When care providers can’t cooperate, the patient is the one suffering. For patients with cognitive difficulties, this suffering is often greater as these individuals have difficulties understanding what is happening around them.

Our goal for the DBT theme Lund, Sweden, was to be able to offer customized DBT within a clinical trial. This was when we encountered “The Skills System”.

The worksheets were translated into Swedish by our co-workers Dr Lena Nylander and DBT Therapist Pernilla Schultz. The DBT team invited Dr. Brown to them national DBT days to help us start the process of acquiring the adequate skills to provide the Skills System.

During two full-featured lecture days, DBT therapists, psychiatrists and habilitation staff learned about “Skills System” through Julie Brown’s enthusiastic and educational model.

“Through Julie Brown’s enthusiastic and educational model, all participants acquired a good foundation in understanding cognitive difficulties, how they express themselves, and understand why standard DBT becomes difficult for this group. Instead of giving up on this vulnerable group, Dr Brown inspired us to understand that learning can still be done, for example by allowing staff around the patient to adjust the treatment. Through clear and educational approaches we now have the opportunity to start working with individuals that we previously could not adapt treatment for.

Following Dr Brown’s lecture, the DBT team in Lund decided to offer DBT with Skills System as a treatment in the framework of a research project in which individuals with cognitive difficulties will be offered treatment in a pilot study. Recruitment and assessment of patients are ongoing at the time of writing and Dr Brown has been very helpful with supervision and input during this time and we look forward to forward cooperation.