How to conduct DBT Counseling? Pre-assessment Worksheet

How to get started as a DBT Counselor

Learn core concepts and techniques of DBT in a simplified way, equip yourself with useful worksheets for DBT Counseling sessions.


What is DBT Counseling?

DBT, or dialectical behavior therapy, is a comprehensive cognitive behavioral therapy. It is intended to help those who respond poorly to other therapeutic modalities. Problem-solving and acceptance-based techniques are the main objectives of this therapy. It functions in a dialectical methodology framework. Dialectical processes are those that bring notions that are at odds with one another, like change and acceptance, together.

A synthesis or integration of opposites is referred to as being “dialectical.” Between the ostensibly opposing tactics of acceptance and change, there is a main dialectic in DBT. DBT therapists, for instance, embrace their patients for who they are while simultaneously recognizing that they must change in order to accomplish their objectives. The techniques and skills taught in DBT are also balanced in terms of accepting change and using it to benefit oneself. The four skill modules consist of two sets of acceptance-oriented skills (mindfulness and distress tolerance), as well as two sets of skills that are change-oriented (emotion regulation and interpersonal effectiveness.

The major objective of therapists who employ dialectical behavior therapy (DBT) is to establish a balance between the advantages of change and the validation (acceptance) of who you are as well as your obstacles. Your therapist will work with you to develop fresh techniques for better emotion control. 

Dialectical behavior therapy can have a somewhat different format depending on the therapist, but in general, DBT sessions fall into one of the following four categories:

  • DBT pre-assessment.
  • Individual therapy.
  • Skills training in groups.
  • Telephone crisis coaching.

Read Blog: Application and purpose of Dialectical Behavior Therapy (DBT) in counseling

DBT Counseling pre-assessment

Before beginning DBT, your therapist could offer an assessment. Through questions and an explanation of how DBT functions, they will ascertain whether DBT is a good fit for you. They will ask you to commit to the course of treatment if you decide that DBT is the best therapy for you.

Individual DBT counseling

Each week, you and your therapist will meet for individual DBT therapy. Every session lasts between 40 and 60 minutes. 

The aims of each individual DBT therapy session are as follows: 

  • To lessen, if necessary, suicidal and self-harming behaviors in order to keep you safe. 
  • To restrict actions that interfere with effective therapy. 
  • To remove obstacles to your success, such as mental health concerns or interpersonal problems, in order to assist you in achieving your goals and enhancing the quality of your life. 
  • To assist you in replacing harmful behaviors with new skills. 

You’ll probably be asked by your therapist to keep a diary in order to monitor your feelings and activities and to look for patterns of behavior. You will bring this journal to your appointments so you and your therapist may discuss it.

DBT Counseling skills training in groups

You will learn skills in a group setting during these sessions with your therapist. Contrast this with group therapy, in which you talk about your issues with others. Consider it more along the lines of a classroom-style teaching and learning experience. 

DBT techniques are meant to improve your practical talents. Your therapist will teach you the following four skills: 

  • Mindfulness: The discipline of mindfulness involves staying totally present, attentive, and unconcerned with the past or the future.
  • Distress Tolerance: Understanding and controlling your emotions in trying or stressful situations without acting out is known as “distress tolerance.” 
  • Interpersonal effectiveness: It is the ability to respect yourself and others while knowing how to set limits and ask for what you want and need. 
  • Emotion regulation: It refers to comprehending, becoming more conscious of, and exercising more control over your emotions.

Become a DBT Counselor and Set up your Practice

Telephone crisis coaching

DBT frequently uses telephone crisis coaching to assist you in your day-to-day activities. This implies that you can call your therapist for support at specific times in between sessions. 

Here are several situations where you might want to give your therapist a call: 

  • when you require assistance with a sudden crisis, such as the desire to kill oneself. 
  • when you’re attempting to apply the DBT techniques you’ve learnt but need guidance. 
  • But your therapist will clearly define when you can phone them, for example, during a predetermined window of time during the day. 

Crisis coaching is available when needed. The calls are typically quick, therefore they shouldn’t be used in place of individual or group sessions to complete the job.

DBT Counseling Treatment Stages

There are four stages of DBT therapy. The intensity of the client’s actions defines the stages, and therapists work with their clients to achieve the objectives of each stage in their progression toward leading a life they believe is worthwhile. 

  • In Stage 1, the client is miserable and acting out; they may be attempting suicide, self-harming, abusing drugs or alcohol, or engaging in other self-destructive behaviors. Clients frequently compare their initial DBT treatment to “being in hell” when they first begin it. The objective of Stage 1 is for the client to transition from an uncontrolled state to one of behavioral control.
  • In Stage 2, individuals are experiencing quiet desperation; though their conduct is under control, they are nonetheless in pain, frequently as a result of past trauma and invalidation. Their capacity to feel things is restricted. Helping the client transition from a condition of quiet desperation to full emotional experiencing is the aim of Stage 2. 
  •  In Stage 3, The difficulty in Stage 3 is learning how to live, including how to establish life goals, develop self-respect, and locate peace and contentment. The client is expected to experience regular happiness and unhappiness in their lives.
  • Stage 4: Some clients need to go for stage 4. For clients who have a  life of average happiness and dissatisfaction and fail to reach a further aim of fulfillment or a sense of connectedness to a wider whole, Linehan has proposed a Stage 4. The aim of therapy at this stage is to help the patient transition from a feeling of incompleteness to a life that includes a continual capacity for joy and freedom.

How to find a DBT Counselor?

A therapist can be a psychiatrist (a medical doctor who can prescribe medications), psychiatric nurse, psychologist, social worker, or family therapist.

Finding the ideal therapist can take a while, and DBT treatment is no exception. Don’t give in to discouragement. You might ask your primary healthcare practitioner, friends, or family members for recommendations for a therapist who practices dialectical behavior therapy. 

Through regional and state psychological organizations, you may also conduct a search for therapists online. 

A state-certified and licensed mental health practitioner must treat your area of concern for any therapist you are considering visiting (for example, eating disorders, borderline personality disorder, self-harm, etc.). 

The majority of therapists’ websites list the ailments and issues they handle. Before making a decision, contact the therapist’s office with any inquiries via phone or email.

The following inquiries to a potential DBT therapist may be beneficial: 

  1. What kind of DBT training have you received? 
  2. Do you offer complete DBT or a modification of it? Why not, if not for thorough DBT? 
  3. Do you participate in a DBT consulting team? 
  4. What rules do you have about calls and emails during the workweek? 
  5. What initial time commitment will you make of mine for the duration of the therapeutic process?

DBT was created by Dr. Marsha Linehan to treat BPD, a mental health condition marked by an extreme fear of abandonment, problems with one’s self-image, and problems controlling one’s emotions and relationships. Suicidal and self-destructive actions are also linked to BPD. 

Up to 10% of those with BPD will commit suicide, according to studies. 

According to some estimates, the lifetime prevalence of BPD is 5.9%. It can reach 20% in psychiatric inpatient settings. 

DBT is effective in treating BPD, according to numerous research and organizations. 

Since its creation, mental health practitioners have modified DBT to treat a variety of other diseases and problems, such as:

  • eating disorders
  • mood disorders, such as depression and bipolar disorder
  • post-traumatic stress disorder (PTSD)
  • substance misuse

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DBT is a successful therapy for BPD as well as for other difficult-to-treat conditions like eating disorders and substance abuse. 

Individual therapy, group work, and phone consultations are all components of this planned course of treatment. People will gain the ability to control, accept, and establish goals for themselves that will enhance their quality of life. 

But DBT might not be appropriate for everyone. If a person feels that DBT is not helping them, they should think about trying one of the many alternative types of treatment. They can get suggestions on their options from a doctor or mental health expert. 

DBT Free Worksheet

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