Structuring DBT Sessions

Question 1

Approach to DBT Session

Answer 1

The structure of sessions is provided by the hierarchy of

• goals inherent in the treatment,
• the use of a diary card,
• collaborative agenda setting,
• balancing change with acceptance, and
• two forms of chain analysis – (a) behavioral analysis where the links leading to a problem behavior are determined and (b) solution analysis in which alternatives (e.g., skills that can be utilized) are generated for various points along the chain to break the links.

Question 2

Examples of target behaviors

Answer 2

Obvious life-threatening behaviors include suicide attempts (overdose, wrist- cutting, etc.), and NSSI behaviors

Therapy-interfering behaviors such as lateness, failure to do homework or diary card, missed sessions, and not observing the clinician’s limits are also subject to analysis.

Other “quality of life”-interfering behaviors to analyze include substance use, binge/restrictive eating, social and vocational difficulties, and interpersonal problems.

Question 3

How to conduct a behavioral chain analysis

Answer 3

Identify target behavior
Identifying the consequences of the behavior
Identifying the precipitants
Identifying the vulnerability
Identifying the trigger