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Although this is intended to encourage participation, Peer Counselors and Disability Advocates like Raquel Santiago, a certified peer counselor and first responder in San Francisco argues that this rule tends to penalize patients since even hospitalizations for medical purposes are not exempt.

Raquel also argues that any patient or therapist getting involved in DBT must be ready for a committment and be ready and willing to openly share what is going on in their lives.

These behavors are known as therapy-interfering behaviors.

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Overview Linehan observed "burn-out" in therapists after coping with non-motivated patients who repudiated cooperation in successful treatment.

Her first core insight was to recognize that the chronically suicidal patients she studied had been raised in profoundly invalidating environments, and, therefore, required a climate of unconditional acceptance (not Rogers’ positive humanist approach, but Hanh’s metaphysically neutral one), in which to develop a successful therapeutic alliance.

Her first core insight was to recognize that the chronically suicidal patients she studied had been raised in profoundly invalidating environments and therefore required a climate of unconditional acceptance (not Carl Rogers’ humanistically "positive" version, but Thich Nhat Hanh’s metaphysically neutral one) in which to develop a successful therapeutic alliance.

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