Free Therapist Training›Free DBT Toolkit›Session Note
Last updated: November 11, 2026
A DBT session note records one individual session in the order the session runs: the diary card review, then the behaviors since the last session from life-threatening behaviors to skills, then the agenda, the interventions, the client's response and the homework. The template sets these out item by item, with places for the risk assessment, the coaching contacts, an item for the consultation team and the plan for the next session.
The template comes from the free DBT toolkit of the Sentio MFT program, which trains therapists with deliberate practice. Its items match the structure of an individual DBT session, and its completed example follows Lena, an invented client in stage 1, through session 14.
This is an optional template from the Sentio MFT program's free DBT toolkit, an original design for you to adapt.
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| Item | What to record |
|---|---|
| Client code | The code your records use for the client. |
| Date | Date of the session. |
| Session number | Number of this individual session, counting pretreatment sessions. |
| Stage | Pretreatment, or stage 1, 2, 3 or 4. |
| Diary card | Completed fully, partly or not at all; brought or not; reviewed at the start of the session. What it showed for each target. |
| 1. Life-threatening behaviors since the last session | Suicidal and nonsuicidal self-injury, suicide communications, suicidal thinking, and any homicidal or violent crisis behavior, from the diary card and the client's report, with the day each occurred. Write "none" if none occurred. |
| Risk assessment | Method or protocol used (your clinic's protocol, or a structured form such as the LRAMP); current suicidal thinking; intent and plan; safety plan reviewed or changed; actions taken. |
| 2. Therapy-interfering behaviors | The client's and the therapist's, such as a late or incomplete diary card, lateness, cancelled or missed sessions, or leaving group early, and how each was addressed. |
| 3. Quality-of-life-interfering behaviors | Other behaviors since the last session that stand in the way of a reasonable quality of life, such as substance use, problems at work or school, relationship conflict, or a housing or money crisis. |
| 4. Skills used and taught | Skills the client used since the last session, and skills taught, strengthened or coached in the session. |
| Session agenda in priority order | The targets the session worked on, in hierarchy order, then any topic the client added. |
| Interventions | Chain analysis (which behavior, and its key links), solution analysis, validation, problem solving, exposure, commitment strategies, skills coaching. Name the link or target each one addressed. |
| Client's response | Engagement, emotion during the work, commitments made, and what had changed by the end of the session. |
| Homework | Each practice assignment, with when and how often. |
| Coaching contacts since the last session | Date, reason, skills coached and outcome of each contact, and whether the client reached out before acting on an urge. The coaching plan until the next session. |
| For the consultation team | What to bring to the team this week, and what to ask for. |
| Plan for the next session | Follow-up on risk, targets to continue, and what to check first. |
| Clinician | Name, credentials, signature and date. |
What Does a Completed DBT Session Note Look Like?
Lena, 28, is an invented client about three months into standard DBT: weekly individual therapy, a weekly skills group, phone coaching between sessions, and a therapist who meets with a consultation team. She works full time as a receptionist at a dental office. In the week before session 14, an urge after a conflict with her roommate passed with phone coaching and skills. On Thursday her supervisor criticized her in front of coworkers, and she self-harmed that night without calling for coaching. Her therapist wrote the session 14 note in the template's order.
| Item | Session 14 |
|---|---|
| Client code | Client 21 |
| Date | Tuesday |
| Session number | 14 |
| Stage | Stage 1 |
| Diary card | Brought and complete for all seven days; she filled in four days on the day and the other three from memory in the waiting room. Reviewed at the start of the session. It showed self-harm Thursday night, suicidal thinking at 2 (0 to 5) that night with no intent, a sick day and five drinks on Friday, and skills on two days, Tuesday and Saturday, with none on the other five. Her own agenda item: what happened with her supervisor. |
| 1. Life-threatening behaviors since the last session | Self-harm Thursday night, after her supervisor criticized her in front of coworkers that day; it did not need medical care. The urge to self-harm peaked at 4 on Thursday, and suicidal thinking reached 2 that night with no intent. Last Tuesday evening an urge to self-harm after a conflict with her roommate about bills passed with phone coaching and skills. Urges were down to 1 by Sunday. |
| Risk assessment | Method: the clinic's structured protocol (the LRAMP); risk assessed with it at the start of the session, the form completed after the session with the actions taken, and filed with the note. Current suicidal thinking: none today; last rated 2 on Thursday night. Intent and plan: she reports none. Safety plan: reviewed together; added a step for criticism at work (a five-minute break away from the front desk, then a coaching text before she leaves work) and added her brother as a contact. Actions taken: chain and solution analysis of the self-harm, safety plan updated, coaching plan set, risk check scheduled for the start of session 15, case to the consultation team this week. |
| 2. Therapy-interfering behaviors | Client: three days of the diary card filled in late. Addressed with brief problem solving: on the hardest days she avoids the card because writing down the urges brings up shame, so she will fill it in at bedtime with a phone reminder. Stayed to the end of group this week. On time for the session. Therapist: when she asked to skip the part about not calling for coaching, moved on to Friday's drinking within seconds, and her answers shrank; returned to the missed call later in the session. Segment to review in supervision. |
| 3. Quality-of-life-interfering behaviors | Called in sick on Friday, the day after the criticism, and drank five drinks that evening. Both appear linked to Thursday's chain. Planned the coming weekend evenings with her; a chain analysis worksheet on Friday's drinking is homework. |
| 4. Skills used and taught | Used: skills on two days: a coaching call and distress tolerance skills last Tuesday, and a distress tolerance skill and a call to her brother on Saturday; none on the other five days. Taught and rehearsed: opposite action for shame, practiced with the scene at work; asking for help, by writing a coaching text in the session and reading it aloud; what she will say to her supervisor. |
| Session agenda in priority order | 1. Thursday's self-harm: risk assessment, chain and solution analysis, safety plan. 2. The diary card filled in late. 3. Friday's sick day and drinking, and the coming weekend. 4. Skills: reinforcing Tuesday's call and Saturday's skills; opposite action for shame; asking for help. 5. Her own item, what happened with her supervisor, taken up in the chain and its solutions. |
| Interventions | Chain analysis of Thursday's self-harm, with the chain analysis worksheet filled in during the session. Vulnerability factors: about five hours of sleep, skipped meals, and Tuesday's argument still on her mind. Key links: the criticism in front of coworkers (prompting event), shame rising to 5, the urge at 4, going home without calling for coaching. Consequences: relief from the shame for about an hour that night, then shame about the self-harm, a sick day and five drinks on Friday. Solution analysis: a coaching call or text before acting when the urge reaches 3; opposite action for shame at work and at home; a sleep and meal plan; a planned talk with her supervisor; repair with the coworker who covered for her on Friday. Validation: her shame made sense after being criticized in front of others (level 5, validating in terms of the present). Reinforcement: Tuesday's coaching call, made while the urge was at 3, and Saturday's skills. Problem solving: a bedtime reminder for the diary card. Informal exposure: after the therapist oriented her, she read the coaching text aloud while staying with the shame. Commitment strategies: elicited her commitment to the coaching plan for the week. Skills coaching: opposite action for shame. |
| Client's response | Answered in full while the chain stayed on the events at work. Went quiet and asked to skip the part about not calling, then stayed with it on the second pass, once her shame was validated. Named not calling for coaching as the link she most wants to change. Shame during the exposure fell from 4 to 2. Committed to the coaching plan, the bedtime diary card and the talk with her supervisor. |
| Homework | Fill in the diary card every night at bedtime (phone reminder set). Practice opposite action for shame once a day with the scene at work and record it on the card. On Monday, ask her supervisor for 10 minutes to go over the scheduling mistake, as rehearsed. Fill in a chain analysis worksheet on Friday's drinking before session 15. |
| Coaching contacts since the last session | Last Tuesday, 8:20 p.m.: one 8-minute call after the conflict with her roommate, made before acting, with the urge at 3; coached on distress tolerance skills; the urge passed. No other contacts. Coaching plan until session 15: call or text when an urge reaches 3, before acting, using the coaching text from the session. |
| For the consultation team | Report Thursday's self-harm and the updated safety and coaching plans. Ask what would make calling easier for her when shame is high, and for help keeping validation and change in balance when it is. |
| Plan for the next session | Start with the diary card and a check on suicidal thinking and urges, using the protocol again if either has risen or self-harm has occurred. Review her use of the coaching plan, the new safety plan step and the talk with her supervisor. Go over the chain analysis worksheet on Friday's drinking unless a higher target comes first. Continue opposite action for shame. |
| Clinician | Individual therapist; signed and dated. |
Why Does a DBT Note Follow the Target Hierarchy?
A DBT note follows the target hierarchy because the session does. Going over the diary card is the first step of each individual session, and reviewing it lets the therapist see what happened since the last session and decide which targets need attention that day. The session then sets its priorities by the stage 1 hierarchy (life-threatening behaviors, therapy-interfering behaviors, quality-of-life-interfering behaviors, and increasing behavioral skills), does a chain analysis of the top-priority target behavior, weaves solution analysis into the chain, and turns to skills in hierarchy order.
The hierarchy also sets the session's emphasis. In the order Comtois, Carmel and Linehan (2025) give for standard DBT individual therapy, crisis intervention comes first when there is imminent risk of suicidal behavior or self-injury. Otherwise, any behavior from the first three target categories that occurred since the last session, as the diary card shows, or that occurs in the session becomes the focus; when there is none, the client's own concerns set it. The therapist may work on several targets in one session but puts the most weight on the highest-priority problem behavior of the past week. A note in the same order shows that choice at a glance: the agenda lists the targets by priority, and the interventions show where the session's time went.
DBT does not require a formal session agenda, and Miller, Rathus and Linehan (2007) describe forcing an agenda on a session as a common novice mistake. The note's agenda item records the priorities the session followed, in the order the hierarchy set them. Two items sit outside the hierarchy and still belong in every note: the coaching contacts, because phone coaching gives the client real-time help with skills in the hard moments of daily life, and the item for the consultation team, which keeps therapists motivated and competent.
How Does the Note Fit a DAP Format?
Each item of the DBT note belongs in one of the three sections of a DAP note, so a setting that requires Data, Assessment and Plan can keep the target hierarchy inside them. Keep the hierarchy's order within Data: life-threatening behaviors first, then therapy-interfering behaviors, quality-of-life-interfering behaviors and skills.
| DAP section | Items from the DBT note | Lena's session 14, in brief |
|---|---|---|
| Data | Diary card review; behaviors since the last session, in hierarchy order; risk assessment findings; coaching contacts; skills used; the session agenda; interventions and the client's response. | Card complete, three days filled in late. Self-harm Thursday night after criticism at work (did not need medical care); suicidal thinking at 2 that night; today no suicidal thinking, intent or plan. Sick day and five drinks on Friday. One coaching call last Tuesday. Chain and solution analysis, validation, reinforcement, informal exposure and skills rehearsal; she went quiet when the chain reached the missed call and engaged after validation; shame fell from 4 to 2. |
| Assessment | What the chain analysis shows; the risk formulation recorded on the clinic's protocol; progress against the treatment plan's baselines. | Short sleep and skipped meals raised her vulnerability; shame after public criticism, followed by not asking for help, led to the self-harm. Risk assessed and documented with the clinic's protocol; outpatient care continues with the updated safety and coaching plans. Diary card filled in on the day on 4 of 7 days, up from a baseline of about 3. |
| Plan | Homework; the coaching plan; safety plan changes; the item for the consultation team; the plan for the next session. | Bedtime diary card; daily opposite action practice; the talk with her supervisor on Monday; chain analysis worksheet on Friday's drinking. Call or text for coaching when an urge reaches 3. New safety plan step for criticism at work. Case to the consultation team this week. Session 15 opens with the card and a risk check. |
Practice the Skill
Many of the interventions in a DBT note come from solution analysis: choosing a link in the chain and building a solution for it. Ep 17 of Sentio's Practice Time walks through DBT problem solving as Linehan's manual describes it, and Sentio's free DBT deliberate practice training has the full webinar with Tali Boritz and Shelley McMain.
Keep reading
DBT Treatment Plan Example, goals, baselines and dated objectives for each target
DBT Diary Card, the card each individual session reviews first
DBT Chain Analysis Worksheet, the full chain behind a note's key links
Free DBT Toolkit, every template, each with a completed example
Frequently Asked Questions
What should a DBT progress note include?
This template's note mirrors the session. It includes the diary card review and the behaviors since the last session in the order of the stage 1 target hierarchy: life-threatening behaviors, therapy-interfering behaviors, quality-of-life-interfering behaviors and skills. Add the risk assessment your clinic's protocol calls for, the session's agenda in priority order, the interventions, the client's response, homework, coaching contacts, an item for the consultation team and the plan for the next session.
How do you document a chain analysis in a progress note?
Name the single instance of the behavior the chain analyzed, with its day, then summarize the prompting event, vulnerability factors, key links and consequences, and record the solution chosen for each link the session worked on. Rizvi (2019) starts every chain with a behaviorally specific description of a single instance of the target behavior, so the note names that instance. The full chain can stay on the chain analysis worksheet.
Is a DBT session note a psychotherapy note under HIPAA?
Not when it is kept in the client's record. Under 45 CFR 164.501, psychotherapy notes are notes by a mental health professional documenting or analyzing the contents of conversation during a private, group, joint or family counseling session that are kept separate from the rest of the medical record. The definition excludes medication prescription and monitoring, session start and stop times, the modalities and frequencies of treatment, clinical test results, and any summary of diagnosis, functional status, treatment plan, symptoms, prognosis and progress to date.
Can a DBT progress note use the DAP format?
Yes. Every item of the DBT note fits one of the three DAP sections. The diary card review, the behaviors since the last session, risk findings, coaching contacts, the session agenda, interventions and the client's response go under Data; the chain analysis findings, the risk formulation and progress against the treatment plan go under Assessment; and homework, the coaching plan, safety plan changes, the consultation team item and the next session go under Plan.
Does a DBT session need a formal agenda?
No. Miller, Rathus and Linehan (2007) note that DBT does not require a formal session agenda, though laying out the session's tasks at the start can help, and they describe forcing an agenda as a common novice mistake. The target hierarchy still sets the priorities, with the most emphasis on the highest-priority problem behavior of the past week, and the note records them in that order.
How does a DBT progress note track progress?
Through the diary card. DBT assesses outcomes continually with diary cards reviewed in every session, so the note records what the card showed for each target and compares it with the baselines and objectives in the treatment plan. A note might record, for example, a diary card filled in on the day on 4 of 7 days against a baseline of about 3 days in 7.
References
University of Washington Behavioral Research and Therapy Clinics. (n.d.). Dialectical behavior therapy. Retrieved November 9, 2026, from https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/
Comtois, K. A., Carmel, A., & Linehan, M. M. (2025). DBT Next Steps clinician's manual: Building a life worth living. Guilford Press. ISBN 978-1-4625-5811-7. https://www.guilford.com/books/DBT-Next-Steps-Clinicians-Manual/Comtois-Carmel-Linehan/9781462558117
Dimeff, L. A., & Linehan, M. M. (2008). Dialectical behavior therapy for substance abusers. Addiction Science & Clinical Practice, 4(2), 39-47. https://pmc.ncbi.nlm.nih.gov/articles/PMC2797106/
Heard, H. L., & Swales, M. A. (2016). Changing behavior in DBT: Problem solving in action. Guilford Press. ISBN 978-1-4625-2264-4. https://www.guilford.com/books/Changing-Behavior-in-DBT/Heard-Swales/9781462522644
Koerner, K. (2012). Doing dialectical behavior therapy: A practical guide. Guilford Press. ISBN 978-1-4625-0232-5. https://www.guilford.com/books/Doing-Dialectical-Behavior-Therapy/Kelly-Koerner/9781462502325
Linehan, M. M., Comtois, K. A., & Ward-Ciesielski, E. F. (2012). Assessing and managing risk with suicidal individuals. Cognitive and Behavioral Practice, 19(2), 218-232. https://doi.org/10.1016/j.cbpra.2010.11.008
Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. Guilford Press. ISBN 978-1-4625-3205-6. https://www.guilford.com/books/Dialectical-Behavior-Therapy-with-Suicidal-Adolescents/Miller-Rathus-Linehan/9781462532056
Rizvi, S. L. (2019). Chain analysis in dialectical behavior therapy. Guilford Press. ISBN 978-1-4625-3890-4. https://www.guilford.com/books/Chain-Analysis-in-Dialectical-Behavior-Therapy/Shireen-Rizvi/9781462538904
University of Washington Behavioral Research and Therapy Clinics. (2016). Linehan Risk Assessment and Management Protocol (LRAMP) (Version 1.0). https://depts.washington.edu/uwbrtc/wp-content/uploads/LSSN-LRAMP-v1.0.pdf
Definitions, 45 C.F.R. § 164.501. https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.501
About This Template
Corrections and suggestions: mabundez@sentio.org.
