Navigating the Path to Wellness: A Step-by-Step Guide to Dialectical Behavior Therapy


Dialectical Behavior Therapy (DBT) has emerged as a powerful, evidence-based treatment for various mental health disorders, such as borderline personality disorder, substance abuse, and eating disorders. Developed by psychologist Marsha M. Linehan, DBT is a multifaceted approach that combines individual therapy, skills training, and phone coaching to help clients develop healthy coping strategies, improve emotional resilience, and foster lasting change. In this comprehensive article, we will guide you through the steps involved in DBT, offering a detailed overview of each stage in the process and highlighting the importance of each component in achieving successful treatment outcomes.


Assessment and Orientation

The first step in the Dialectical Behavior Therapy (DBT) process is assessment and orientation, which involves thoroughly evaluating the client's symptoms, history, and current situation. This stage is crucial for determining whether DBT is an appropriate treatment option and developing a tailored treatment plan that addresses the client's unique needs and challenges.


During the assessment process, the therapist will gather information on the client's mental health history, current symptoms, and any co-occurring disorders that may be present. This comprehensive evaluation helps the therapist understand the client's struggles and the factors contributing to their emotional suffering.


Once the assessment is complete, the orientation phase begins. In this stage, the therapist introduces the client to the principles and structure of DBT, including its main components, such as individual therapy, skills training, and phone coaching. The therapist and client also discuss expectations, treatment goals, and the commitment required for a successful therapeutic process.


Individual Therapy

Individual therapy is a core component of DBT and typically occurs weekly. In these one-on-one sessions, the therapist works closely with the client to address their specific challenges, reinforce the skills they learn in skills training sessions, and help them apply these skills to real-life situations.


A key aspect of individual therapy is using a treatment hierarchy, which prioritizes the client's goals and first targets the most critical issues. This structured approach ensures that therapy is focused on the most pressing concerns and that progress is made systematically and efficiently.


Throughout the individual therapy sessions, the therapist utilizes various DBT techniques, such as validation, problem-solving, and behavioral chain analysis, to help the client develop self-awareness, emotional regulation, and coping skills. The therapist also provides ongoing support and encouragement, fostering a strong therapeutic alliance essential for lasting change.


Skills Training

Skills training is another integral part of DBT, typically conducted in a group setting. These weekly sessions focus on teaching clients various skills and techniques designed to help them manage their emotions, cope with distress, and improve their interpersonal relationships.


DBT skills training is organized into four modules: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Each module covers specific skills and techniques that clients can use to address their unique challenges and enhance their overall well-being.


Throughout the skills training sessions, clients can practice new skills, share their experiences, and receive feedback and support from the group facilitator and peers. This collaborative learning environment allows clients to build a strong foundation of skills to support their recovery and growth.


Phone Coaching

Phone coaching is an additional component of DBT that allows clients to receive support and guidance between therapy sessions. This service allows clients to contact their therapist for assistance in applying the skills they have learned to real-life situations and challenges.


Phone coaching aims to provide clients with immediate support when they are facing a crisis or struggling with a difficult situation. By offering timely guidance and reinforcement of DBT skills, phone coaching can help clients navigate challenging moments without resorting to maladaptive coping strategies.


In addition to providing support during crises, phone coaching can be a valuable tool for helping clients generalize the skills they learn in therapy to their everyday lives. This ongoing support and reinforcement can maintain progress and ensure long-term success.


Ongoing Evaluation and Adjustments

Throughout the DBT process, ongoing evaluation and adjustments are essential to ensure the treatment is effective and meets the client's needs. Regular assessment of the client's progress, challenges, and achievements allows the therapist to tailor the treatment plan and make necessary modifications to support the client's growth and recovery.


The ongoing evaluation may involve

  • monitoring the client's symptoms,
  • tracking their use of skills and coping strategies, and
  • assessing their overall satisfaction with the treatment process.

By clearly understanding the client's progress and needs, the therapist can make informed decisions about adjustments to the treatment plan and continue to provide targeted, effective support.


Adjustments to the treatment plan may include changes to the frequency or focus of individual therapy sessions, modifications to the skills training curriculum, or the introduction of additional therapeutic techniques or interventions. These adjustments ensure that the DBT process remains flexible and responsive to the client's evolving needs and goals.


Transition and Termination

The transition and termination phase begins as clients progress through DBT and achieve their treatment goals. This stage involves preparing clients for the end of formal therapy and ensuring they have the necessary skills and resources to maintain their progress and continue their growth independently.


During the transition phase, the therapist and client will review the progress made throughout treatment, reflect on the client's achievements, and discuss any remaining challenges or concerns. This process helps clients consolidate their learning and clearly understand the skills and strategies that have been most beneficial for them.


Termination of therapy is approached gradually, with the therapist and client collaboratively deciding on the appropriate time to end treatment. This decision is typically based on the client's progress, stability, and ability to independently apply the skills they have learned. The therapist provides ongoing support and guidance throughout the termination process, ensuring the client feels well-equipped to navigate life's challenges beyond therapy.


Final Thoughts

The steps of Dialectical Behavior Therapy—assessment and orientation, individual therapy, skills training, phone coaching, ongoing evaluation and adjustments, and transition and termination—form a comprehensive and structured treatment process designed to support clients in achieving lasting change and improved well-being. Following these steps, therapists can provide targeted, evidence-based support that empowers clients to overcome challenges, develop healthier coping strategies, and build a more fulfilling life.


Grouport Offers Online DBT Skills Groups

Want to practice dialectical behavior therapy skills in a supportive group setting? The Grouport DBT series by Grouport Therapy offers a 12-week program that can help you develop new skills to replace negative behaviors and emotions.


Our group meets once a week at a scheduled time, and you'll receive access to session links via email after enrolling and paying for the program. By joining our DBT skills group, you can improve relationships, manage anxiety, and reduce emotional suffering, regaining hope for the future.


Don't hesitate to take the first step towards a better life. Our next session is waiting for you. Join our Grouport DBT series today and start improving your mental health alongside a supportive group of individuals.

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