Individual therapy involves developing a relationship and working one-on-one with a therapist. Clients and therapists work together to identify goals such as reducing or eliminating self-harm, improving interpersonal relationships, or managing difficult emotions. The focus then becomes learning and applying skills and strategies that can help the client achieve those goals.
Sessions with a DBT therapist are generally structured according to the following hierarchy:
- Suicidal and self-harm urges, thoughts, and actions.
These issues are assessed in order to better understand when, how, and why they happen. Together with clients, therapists then explore ways to reduce or eliminate them through problem-solving and skill building.
- Therapy interfering behaviours.
These behaviours include anything the client or therapist do that interfere with therapy itself. For example, they may involve often arriving late or cancelling appointments, not completing homework, yelling, "shutting down," or ignoring the therapist.
- Quality of life.
This is where clients learn to develop and maintain a "life worth living." Barrier to goals are identified and problem-solved. Therapists will often use particular strategies to help clients achieve their goals, such as using diary cards (a method for tracking progress), practising skills, and taking detailed looks at "chains" of behaviour. The emphasis is on replacing problematic behaviours with effective ones.