Free Therapist Training›Free DBT Toolkit›Target Hierarchy
Last updated: November 11, 2026
The DBT target hierarchy is the order in which a stage 1 client's problems get attention in individual therapy: life-threatening behaviors, then therapy-interfering behaviors, then quality-of-life-interfering behaviors, then increasing behavioral skills. The quick reference sets that order out in one table, with what each category covers, examples and what each means for the session agenda. Its fill-in table records one client's target behaviors in each category and how each is measured, and two short reference sections give the stages of DBT and the skills group's own order.
The quick reference comes from the free DBT toolkit of the Sentio MFT program, which trains therapists with deliberate practice. The categories and their order follow Marsha Linehan's DBT; the layout and the fill-in table are original, free to copy and adapt.
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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Stage 1 targets in order of priority (individual therapy)
| Priority | Target category | What it covers | Examples | What it means for the session agenda |
|---|---|---|---|---|
| 1 | Life-threatening behaviors | Behavior that could result in death: suicidal ideation, suicide communications, any self-injury, and homicidal or violent crisis behavior. | Suicidal or homicidal crisis behavior, nonsuicidal self-injury, suicidal ideation. | Imminent risk: crisis intervention first, per your clinic's protocol. Otherwise, a chain analysis. |
| 2 | Therapy-interfering behaviors | Anything that gets in the way of effective treatment, from the client, the therapist or both. | Lateness, missed sessions, a forgotten or incomplete diary card; a therapist's unreturned calls. | Next in line when it occurred since the last session or occurs in session. |
| 3 | Quality-of-life-interfering behaviors | Other behaviors and problems that stand between the client and a reasonable quality of life. | Mood, anxiety, substance use and eating disorders; unemployment; interpersonal conflict. | Next after categories 1 and 2; the main focus when nothing in categories 1 and 2 occurred since the last session. |
| 4 | Increasing behavioral skills | New skills to use in place of ineffective behavior, in service of the client's goals. | Mindfulness, distress tolerance, interpersonal effectiveness, emotion regulation. | Lowest priority; most skill learning happens in the skills group. |
Any behavior in categories 1 to 3 that occurred since the last session, or occurs in session, becomes a focus, with the most weight on the highest-priority one. When none occurred, the issues the client wants to work on set the focus.
This client's targets
| Client | Stage | When agreed |
|---|---|---|
| Goals for a life worth living, in the client's words |
|---|
| Target category | This client's target behaviors | How each is measured |
|---|---|---|
| 1. Life-threatening | ||
| 2. Therapy-interfering | ||
| 3. Quality-of-life-interfering | ||
| 4. Behavioral skills |
For reference: the stages of DBT
| Stage | Client's situation | Goal |
|---|---|---|
| Pretreatment | Every client, before stage 1 | Orientation, commitment to treatment and agreement on goals |
| Stage 1 | Behavior out of control, such as suicidal behavior, self-harm, or drug or alcohol use | From behavioral dyscontrol to behavioral control |
| Stage 2 | Behavior under control with ongoing suffering, often from past trauma and invalidation | From quiet desperation to full emotional experiencing |
| Stage 3 | Building a life: life goals, self-respect, peace and happiness | A life of ordinary happiness and unhappiness |
| Stage 4 | Some clients who still lack fulfillment or connection once stage 3's goal is reached | From incompleteness toward a lasting capacity for joy and freedom |
For reference: stage 1 targets for the skills group
- Decrease behaviors likely to destroy therapy.
- Increase skill acquisition, strengthening and generalization.
- Decrease therapy-interfering behaviors.
The skills being taught set the group's agenda, with homework review in the first half and new skills in the second. Problems that are not about skills, such as suicide threats, go to the individual therapist.
What Does a Completed DBT Target Hierarchy Look Like?
Lena, 28, is an invented client. She works full time as a receptionist at a dental office, shares an apartment with a roommate and is close to her younger brother. She has been in standard DBT for about three months, with weekly individual therapy and skills group, phone coaching and a therapist on a consultation team, and she is in stage 1. Her diagnosis from the intake assessment is borderline personality disorder. She has a history of self-harm and periods of suicidal thinking, with no suicide attempt in the past two years. She and her therapist agreed on her targets in pretreatment.
| Client | Stage | When agreed |
|---|---|---|
| Lena, 28 (invented) | Stage 1, about three months into standard DBT | In pretreatment |
| Goals for a life worth living, in the client's words |
|---|
| "Keep my job and finish my medical billing certificate. Get my own apartment. Be closer to my brother." |
| Target category | This client's target behaviors | How each is measured |
|---|---|---|
| 1. Life-threatening | Self-harm. Suicidal thinking, monitored on the diary card. | Diary card, every day: urge to self-harm (0 to 5), self-harm (yes or no), thoughts of suicide (0 to 5) and any intent. Any self-harm or rise in suicidal thinking is assessed with the clinic's risk protocol. |
| 2. Therapy-interfering | Filling in the diary card late or only partly. Arriving late. Leaving skills group early when ashamed. | Days the card was filled in on the day, out of 7. Arrival times at individual sessions and group. Early departures, from the skills group leader's attendance record. |
| 3. Quality-of-life-interfering | Drinking four or more drinks on weekend nights. Missing work after conflicts. | Diary card: drinks each day. Work days missed, with a note on what happened the day before. |
| 4. Behavioral skills | Opposite action for shame (emotion regulation). Distress tolerance skills for urges. Asking for help, including a coaching call before acting on an urge. | Diary card: shame (0 to 5) and skills used each day. Coaching calls made before acting on an urge. |
What the Hierarchy Put First in Session 14
| Category | What the diary card showed | What session 14 takes up |
|---|---|---|
| 1. Life-threatening | Thursday at work, her supervisor criticized her in front of coworkers. Shame rose to 5 and the urge to self-harm to 4. She went home, did not call for coaching and self-harmed that night (did not need medical care). Suicidal thoughts 2, no intent. | Risk assessment with the clinic's protocol. Review and update of her safety plan. Chain analysis of Thursday, with solution analysis. A coaching plan for the next strong urge. |
| 2. Therapy-interfering | She filled in the card on four of the seven days and completed the rest in the waiting room. | Brief problem solving on when and where she fills in the card each day. |
| 3. Quality-of-life-interfering | Friday she called in sick and drank five drinks in the evening. | Whether Friday belongs to Thursday's chain, and a plan for the coming weekend nights. |
| 4. Behavioral skills | Tuesday, after a conflict with her roommate about bills, she used a coaching call and skills, and the urge passed. Saturday she used skills and called her brother. Sunday her urges were at 1. | Reinforcing Tuesday's call and Saturday's skills and linking them to her goals. Building opposite action for shame for moments like Thursday's. |
Session 14, her next individual session, falls on the following Tuesday. Afterward, her therapist brings Lena's week to the consultation team and checks on the safety plan and the coaching plan at session 15.
What Are the Stages of DBT?
DBT has four stages, sorted by the severity of the client's behavior, and each stage has its own goals, all aimed at a life the client finds worth living. Pretreatment comes first for every client: orientation to DBT, commitment to treatment and agreement on goals.
Stage 1 is for clients whose behavior is out of control, such as suicidal behavior, self-harm, or drug or alcohol use, and its goal is to move from behavioral dyscontrol to behavioral control. Stage 2 is for clients who have gained that control but go on suffering, often because of past trauma and invalidation; it moves from quiet desperation to full emotional experiencing. Stage 3 centers on building a life, with the goal of ordinary happiness and unhappiness. Stage 4, needed only by some clients, moves from a sense of incompleteness toward a lasting capacity for joy and freedom.
The target hierarchy belongs to stage 1. Stage 2 targets have no fixed hierarchy and are prioritized through the case formulation, and little has been written or researched about stages 3 and 4.
Why Does Stage 1 Run in This Order?
The order puts the client's life first, then the treatment, then the rest of the client's life. Life-threatening behaviors are those that could result in death, including suicidal or homicidal crisis behavior and any self-injury. Therapy-interfering behaviors are anything that keeps the client from receiving effective treatment, and they can come from the client, the therapist or both. Quality-of-life-interfering behaviors are the other behaviors and problems that stand between the client and a reasonable quality of life.
Increasing behavioral skills is the lowest-priority target in individual therapy; the skills group teaches the skills, and individual therapy helps the client apply them. Skills come into sessions on higher targets anyway: when a chain analysis turns up a skills deficit, the matching solution is skills training.
Priority decides where the weight goes. The therapist may work on several targets in one session while putting the most weight on the highest-priority problem behavior of the past week, and a target's priority need not match the session time spent on it.
How Do the Diary Card and the Hierarchy Set a Session's Agenda?
The diary card supplies the week's facts and the hierarchy supplies the order. The client fills in the card every day and brings it to each weekly individual session, and going over it is the session's first step. Reviewing it shows the therapist what happened since the last session and which targets need attention that day. A card that is not completed, or not brought to session, counts as therapy-interfering behavior.
Imminent risk of suicidal behavior or self-injury means crisis intervention comes first. Otherwise, behaviors in the first three categories that occurred since the last session, or occur in session, become the focus, through a detailed analysis plus in-session work and homework aimed at avoiding them next time. In outline, the session moves from the diary card to the hierarchy, then to a chain analysis of the top-priority target behavior with solution analysis woven in, then to skills. If nothing in the first three categories occurred, the issues the client wants to work on set the focus.
DBT does not require a formal session agenda, though laying out the tasks at the start can help, and forcing an agenda instead of weaving in the needed components is a common novice mistake. In Lena's week, Thursday's self-harm put the life-threatening target first in session 14, ahead of the late diary card and Friday's missed work and drinking, and the coaching call she used on Tuesday became a skill to build on.
The skills group sets its agenda another way. Its stage 1 hierarchy, adapted from Linehan's 1993 manual, runs: decrease behaviors likely to destroy therapy, then increase skill acquisition, strengthening and generalization, then decrease therapy-interfering behaviors. The skills being taught set the agenda, with homework reviewed in the first half and new skills taught in the second, and problems that are not about skills, such as suicide threats, go to the individual therapist. The group builds capability by teaching skills, and individual therapy helps each client apply them to their own situations.
Practice the Skill
Once the hierarchy has picked the target, the next step is assessing it. In DBT, problems are assessed mainly through chain analysis, which pins down what controls a particular episode of a target behavior. Practice Time Episode 16 walks through formal problem assessment as Linehan's manual describes it, and Practice Time also has DBT episodes on problem solving and informal emotional exposure.
Keep reading
DBT Diary Card, a weekly card the client fills in each evening, with Lena's completed week
DBT Progress Note Template, a session note organized by the target hierarchy, with a completed example for Lena
DBT Treatment Plan Example, goals and objectives for each target in the hierarchy, with a completed example for Lena
Free DBT Toolkit, every template in one place, each with a PDF and a completed example
Frequently Asked Questions
What is the DBT target hierarchy?
The DBT target hierarchy is the order of priority for stage 1 targets in individual therapy: life-threatening behaviors first, then therapy-interfering behaviors, then quality-of-life-interfering behaviors, then increasing behavioral skills. When several targets occurred since the last session, the therapist may work on more than one but puts the most weight on the highest-priority behavior of the past week.
What are examples of DBT target behaviors?
Target behaviors are the specific behaviors in each category that a client agrees to work on, set in pretreatment and linked to the client's long-term goals. One stage 1 client's list might include self-harm and suicidal thinking, arriving late and leaving group early, heavy weekend drinking and missing work, and skills such as opposite action for shame.
What counts as therapy-interfering behavior in DBT?
Anything that gets in the way of the client receiving effective treatment counts, and it can come from the client, the therapist or both. Client examples include arriving late, cancelling sessions, being intoxicated in session and leaving the diary card incomplete or at home. Therapist examples include forgetting or being late for appointments, failing to return calls and changing policies arbitrarily.
What are examples of quality-of-life-interfering behaviors?
Quality-of-life-interfering behaviors are the other behaviors and problems that stand between a client and a reasonable quality of life. Examples include mood, anxiety, substance use and eating disorders, unemployment, interpersonal conflicts, unstable housing, neglected medical problems and domestic violence. For clients with substance dependence, substance abuse is the highest-priority quality-of-life target. Adolescent examples include school problems and intense conflict with parents.
What are the stages of DBT?
DBT has four stages, sorted by the severity of the client's behavior, after a pretreatment phase of orientation and commitment. Stage 1 moves from behavioral dyscontrol to behavioral control. Stage 2 moves from quiet desperation to full emotional experiencing. Stage 3 builds a life of ordinary happiness and unhappiness. Stage 4, which only some clients need, moves from incompleteness toward a lasting capacity for joy and freedom.
Does the skills group use the same target hierarchy?
No. The skills group has its own stage 1 hierarchy: decrease behaviors likely to destroy therapy, then increase skill acquisition, strengthening and generalization, then decrease therapy-interfering behaviors. The skills being taught set its agenda, and problems that are not about skills, such as suicide threats, go to the individual therapist.
References
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press. ISBN 978-0-89862-183-9. https://www.guilford.com/books/Cognitive-Behavioral-Treatment-of-Borderline-Personality-Disorder/Marsha-Linehan/9780898621839
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/
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/
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
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
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
About This Template
Corrections and suggestions: mabundez@sentio.org.
