DBT recognizes that clients entering treatment will typically have a number of different problems that need attention. It is important for the therapist to evaluate the individual and understand the specific issues that affect the person. DBT focuses on ensuring that the treatment follows empirically validated protocols but at the same time approaches each client as an individual. The therapist will adjust the sessions to the needs of the individual. DBT therapists attempt to prioritize their approach such that:
Very serious or even life-threatening issues, such as being suicidal or having a significant substance use disorder, are addressed first.
Actions that are counterproductive to improving in therapy, such as missing a significant number of individual or group therapy sessions, showing up late for sessions, canceling appointments, not completing homework assignments, causing dissent in group sessions, etc., are addressed next. Many of the types of clients who were originally treated with DBT, such as suicidal individuals or individuals with borderline personality disorder, often engage in behaviors counterproductive to success in therapy. In DBT, these behaviors are addressed directly.
Circumstances, behaviors, and other factors that increase the person’s quality of life are addressed next. These can include relationship issues, communication issues, psychological problems such as depression, work issues, etc.
Teaching, acquiring, and developing new skills to act in place of skills or behaviors that are contrary to the individual achieving life goals are worked on next. The therapy attempts to address issues in the order of their impact on the client’s life. The therapist will address as many different issues as needed to satisfactorily help the individual reach goals. This ensures that the treatment package is individualized and comprehensive.