Clinic finds growth through use of dialectical therapy

From The Portland Business Journal, November 11, 2007

Portland Dialectical Behavior Therapy Program PC serves about 300 patients annually

Mental health issues made work a torturous event for attorney Melissa Turner.

She felt ravaged by stress and feelings of inadequacy. She frequently missed deadlines and failed to maintain appropriate boundaries with co-workers and clients.

She eventually quit and bounced in and out of therapy programs and emergency treatment for bipolar disorder. Things finally turned around for Turner, 54, after she started in dialectical behavior therapy, which blends cognitive behavioral therapy with a philosophy of Eastern mindfulness. She’s now landed a career helping injured workers find new vocations.

Turner is a patient at fast-growing Portland Dialectical Behavior Therapy Program PC. The clinic has found its niche with a popular model of talk therapy that shows widespread promise in treating tough patients and helping many go back to work following episodes of acute mental illness.

“We are very focused on helping change translate to the workplace and the home,” said Soonie Kim, psychologist and founder of Portland Dialectical Behavior Therapy Program PC.

The business has more than doubled its revenue since 2003, and will end 2007 with more than $1.5 million in revenue. During the past six months alone, Kim has boosted the practice’s employee count 33 percent — to 28 therapists and support staff — to keep up with demand.

The 11-year-old practice doubled its space with an Oct. 1 move to a space at Johns Landing. It serves about 300 patients and is debt free.

Kim has also positioned the business as a training resource for other mental health providers who want to offer dialectical behavior therapy. About 20 percent of revenue comes from training contracts with the state and with some of Oregon’s largest private nonprofit provider groups.

The Portland clinic is one of a few nationwide that uses dialectical behavioral therapy as its primary mode of treatment. Kim said the biggest factors in the practice’s recent growth are a growing body of research that has validated dialectical behavior therapy — an advantage in garnering insurance payments for care — and a critical mass of word-of-mouth and clinical referrals.

Studies performed by the National Institutes of Health and the National Institutes for Drug Abuse have reinforced the approach’s effectiveness.

A unique aspect of the clinic’s program is that therapists are on call for patients at all hours for telephonic coaching.

“We partner to send certain clients to them,” said Laurie Lockert, clinical consultant at Cascadia Behavioral Healthcare Inc., which deals with patients with mental illness and addiction. “Patients have 24-hour access to their therapists there, while community mental health just doesn’t have those resources.”

Dialectical behavior therapy was initially developed in Seattle in the early 1990s by University of Washington psychologist Marsha Linehan. It’s since proven effective as a treatment for substance abuse, eating disorders, trauma, anti-social personality disorders, bipolar disorder, manic depression and other conditions.

Dialectical behavioral therapy works to strike a balance between fostering self-acceptance and the need to change. It is a school of practice within cognitive behavioral therapy, but the Eastern mindfulness helps people get into the current moment, and avoid harmful or impulsive behaviors, practitioners said.

“There’s more of a here-and-now focus than on a patient’s history,” said Portland DBT therapist and training coordinator Mark Schorr. “It’s not geared toward gaining insights as much as learning relevant emotional, behavioral and interpersonal skills.”

Oregon’s new mental health parity rules will help certain difficult-to-treat patients access care beyond the traditional six or 10 sessions covered by commercial health plans, Kim said. About 75 of the practice’s clients have employer-sponsored health insurance.

“People usually need six months,” said Schorr. “These are problems that have taken a lifetime to generate.”