In DBT you will work with your therapist on targets – things that are most pressing and need to be dealt with before anything else.
These are usually grouped into 3 categories:
- life-threatening or harmful behaviours such as self-harm, suicide atttempts or reckless behaviour thay may cause harm;
- behaviour that would interfere with therapy sessions, such as not attending meetings, not completing worksheets, or misusing the contact between sessions;
- behaviours that interfere with your quality of life, such as substance or alcohol misuse, binge eating, reckless sexual behaviour, or legal/financial/employment/relationships problems
At the beginning of your therapy, you will work with your therapist to determine what behaviours need to be prioritised, and you may use a diary card to help in that process.
A diary card can help you see what behaviours, moods or emotions are occuring most frequently, and what consequences they are having in your life. You can download a diary card in this lesson, and it is also found in the handout/worksheet section of the course.
It’s not uncommon in people with BPD to find there are multiple behaviours that need to be dealt with. In the beginning stages of DBT, you may feel that this is a lot to deal with, but this is the stage where the foundations of recovery are made. By dealing with these difficult issues first, you will be free to move on to the next stage and begin your recovery journey in earnest.
At stage 1, life-threatening behaviour that poses an immediate risk takes priority. Self-harm or suicide attempts are the most serious behaviours, so they will take priority over other harmful behaviours such as drug or alcohol misuse, which is harmful over time.
At this stage, the therapist will work with you and most likely use risk assessment and suicide assessment tools. It might sound frightening, or feel overwhelming, but bear in mind that the therapist is there solely to help you, and this is just part of that process.
Next you will work with the therapist on common things that interfere with therapy. These include things like not completing the worksheets or diary card, not attending sessions, or misusing the inter-session contact you have been offered.
Remember, if you don’t go to a session, turn up late or refuse to take part, it’s going to be very difficult for you to work through your symptoms and problems efficiently.
At the third set of targets, you will work with the therapist to look at all the things that don’t fit into the first two categories. With the imminent risk of harm assessed, and a good ethic of coming to sessions and taking part, it’s now time to look at other things such as family problems, risky behaviours, financial worries, not taking medication and more.