Free DBT Toolkit: Diary Card, Chain Analysis, Session Notes, and Treatment Plans
Original DBT templates for individual therapists, skills group leaders and consultation teams, each with a completed example, a PDF and its own page, free to use with any client.
Last updated: November 11, 2026
Free Therapist Training›Free DBT Toolkit
A few working documents support the day-to-day work of DBT. The client fills in a diary card every day and brings it to each weekly individual session. Going over the card is the session's first step, and the stage 1 target hierarchy decides what the session works on first: life-threatening behaviors, then therapy-interfering behaviors, then quality-of-life-interfering behaviors, then building skills. The highest-priority behavior gets a chain analysis, DBT's main assessment method. Each week the therapists meet as a consultation team, which backs them up and keeps them motivated and skilled.
The templates on this page are original designs from the Sentio MFT program for that work. Each comes with a completed example for an invented client and has its own page with a PDF and a Google Docs copy. They are built around practices that Marsha Linehan's treatment manual and later DBT texts describe, such as the daily diary card, the stage 1 target hierarchy and chain analysis. Their practice steps point to Sentio's free deliberate practice training for DBT with Tali Boritz and Shelley McMain. Eight templates appear in full, ready to copy, and the teen diary card and the coaching contact log link to their own pages.
These templates are original designs from the Sentio MFT program for you to adapt. Marsha Linehan's own DBT skills handouts and worksheets are published by Guilford Press for the book's buyers to use with their clients, and the DBT-Linehan Board of Certification certifies DBT clinicians and programs.
What Is in the Toolkit?
| Template | Use it for | Where it fits in DBT |
|---|---|---|
| DBT diary card | A weekly card the client fills in each evening to track urges, target behaviors, emotions, medication and skills. | Individual therapy, gone over first in each session |
| Chain analysis worksheet | Analyzing one episode of a target behavior link by link, and planning where to break the chain next time. | Individual therapy, after the diary card review |
| DBT session note | Writing the note for one individual DBT session, with each target category in priority order. | Individual therapy, stage 1 |
| DBT treatment plan | Writing a treatment plan with goals, baselines and dated objectives for each target in the hierarchy. | Pretreatment, then stage 1 reviews |
| DBT target hierarchy quick reference | Putting a stage 1 client's targets in order and deciding what each session takes up first. | Stage 1, individual therapy |
| DBT validation levels quick reference | Choosing a validation level and wording a response at that level. | Validation, one of DBT's two core strategies |
| Consultation team agenda and notes form | Running the weekly team meeting in priority order and recording the help each therapist asked for, what the team offered and who follows up. | Consultation team mode, which supports the therapists |
| Recording review form and practice set | Reviewing 5 to 10 minutes of a recorded session, choosing one skill to rehearse, and rehearsing it with new client statements at three levels. | Supervision, consultation team or self-review of therapist skills |
| DBT diary card for teens | A weekly card in plain words for teens, tracking sleep, school, home, friends, feelings, urges and skills. | DBT for adolescents, gone over first in each individual session |
| DBT coaching contact log | Logging each between-session coaching call or text, and the patterns to raise in session and with the consultation team. | Phone coaching mode (generalizing skills to daily life) |
DBT Diary Card
The diary card is the client's daily record of urges, target behaviors, emotions, medication and skills, filled in each evening and gone over at the start of every individual session. It has two open columns for the targets you and the client agree on, and a teen version covers school, home, friends and sleep. The diary card page has the PDF, a Google Doc to edit, a completed example and how-to steps for clients.
This is an optional template from the Sentio MFT program's free DBT toolkit, an original design for you to adapt.
Download the PDFMake a copy in Google Docs
| Name: | Week starting: | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Day | Target 1: | Target 2: | Self-harm | Thoughts of suicide | Alcohol or drugs | Sadness | Anger | Fear | Shame | Joy | My pick: | Medicine as prescribed? | Skills I used and how much each helped | Notes on the day |
| Mon | ||||||||||||||
| Tue | ||||||||||||||
| Wed | ||||||||||||||
| Thu | ||||||||||||||
| Fri | ||||||||||||||
| Sat | ||||||||||||||
| Sun | ||||||||||||||
| What I want on my next session's agenda | Coaching calls or texts this week | Days I filled this in on the day |
|---|---|---|
How to rate
Urges, thoughts and emotions, 0 to 5: 0 none; 1 came and went; 2 on and off, easy to set aside; 3 strong, took effort to set aside; 4 very strong, hard to think of anything else; 5 as strong as it gets.
Acted on it, Y or N: after each urge or thought rating, write Y if you acted on it that day or N if you did not.
Skills, 0 to 3: 0 no help; 1 helped a little; 2 helped quite a bit; 3 helped a lot.
How to fill in the card
- Fill in your row every evening, at about the same time.
- Rate each urge, and any thoughts of suicide, at their strongest that day from 0 to 5. Then write Y if you acted on it or N if you did not.
- Rate each emotion at its strongest that day from 0 to 5. Use My pick for one more emotion you and your therapist choose.
- Write Y or N for your medicine. List each skill you used with a number from 0 to 3 for how much it helped, or write none.
- In Notes, write a few words about what happened, especially before a strong urge.
- If you miss a day, fill it in as soon as you can. Write the days you filled in on time in the box at the bottom of the card.
- Before your session, add what you want on the agenda and any coaching calls or texts. Bring the card to every session.
If you are in crisis
[Your clinic's crisis instructions: who to contact during office hours, after hours, and in an emergency.]
In the United States, call or text 988, or chat at 988lifeline.org, to reach the 988 Suicide & Crisis Lifeline. If you are in immediate danger, call 911.
See a completed example
Lena is an invented client: 28, a receptionist at a dental office, about three months into standard DBT with weekly individual therapy and skills group, phone coaching, and a therapist on a consultation team. She is in stage 1. Self-harm is her life-threatening target, and suicidal thinking is monitored on the card. Her therapy-interfering targets are filling in the card late or partly, arriving late, and leaving group early when ashamed; her quality-of-life targets are drinking four or more drinks on weekend nights and missing work after conflicts. Her open columns name missing work and leaving group early (her group meets on Wednesday evenings), and her extra emotion is loneliness. This is her card for the week before session 14, on a Tuesday.
| Name: Lena | Week starting: Monday, the week before session 14 | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Day | Target 1: Missing work | Target 2: Leaving group early | Self-harm | Thoughts of suicide | Alcohol or drugs | Sadness | Anger | Fear | Shame | Joy | My pick: Lonely | Medicine as prescribed? | Skills I used and how much each helped | Notes on the day |
| Mon | 0 N | No group | 1 N | 0 N | 1 N | 1 | 0 | 1 | 2 | 2 | 1 | Y | None | Quiet day at work. |
| Tue | 1 N | No group | 3 N | 0 N | 2 N | 2 | 3 | 2 | 4 | 1 | 2 | Y | Self-soothe 3, distract 2 | Fight with my roommate about bills. Called for coaching, and the urge passed. |
| Wed | 0 N | 2 N | 1 N | 0 N | 1 N | 1 | 1 | 1 | 2 | 1 | 1 | Y | None | Group tonight. Stayed to the end. |
| Thu | 3 N | No group | 4 Y | 2 N | 2 N | 4 | 2 | 3 | 5 | 0 | 4 | Y | None | My supervisor criticized me in front of coworkers. Went home and did not call. Self-harmed tonight, did not need medical care. Thoughts of suicide, no intent. |
| Fri | 5 Y | No group | 2 N | 0 N | 4 Y, five drinks | 4 | 1 | 2 | 4 | 0 | 4 | Y | None | Called in sick, still ashamed about yesterday. Stayed in bed most of the day. |
| Sat | No work | No group | 2 N | 0 N | 3 N | 2 | 1 | 1 | 3 | 2 | 2 | Y | Self-soothe 2, called my brother 3 | Called my brother back. Better day. |
| Sun | No work | No group | 1 N | 0 N | 1 N | 1 | 0 | 1 | 1 | 2 | 1 | Y | None | Calm day. Urges low. |
| What I want on my next session's agenda | Coaching calls or texts this week | Days I filled this in on the day |
|---|---|---|
| What happened with my supervisor. I'm scared I'll lose my job. | Tuesday evening: one call after the fight with my roommate. The urge passed. No other calls or texts. | Mon, Tue, Sat and Sun. I filled in Wed, Thu and Fri in the waiting room. |
How Lena's Therapist Used the Card in Session 14
Session 14 opened with the card. Thursday's self-harm was the highest-priority behavior of the week, so it set the session's first target. Her therapist assessed risk with the clinic's structured protocol, the Linehan Risk Assessment and Management Protocol (LRAMP), reviewed and updated her safety plan, and led a chain analysis of Thursday, from the criticism at work to the self-harm that night. The missed coaching call is a link in that chain, so the solution analysis set a coaching plan: call or text when an urge reaches 3, before acting. Lena's own agenda item, her supervisor and her job, fit there too, as a plan for talking with her supervisor.
The rest of the agenda followed the hierarchy. The three days filled in late came next, as therapy-interfering behavior, and Lena chose to fill in the card at bedtime with a phone reminder. Friday's sick day and drinking came third, as quality-of-life targets, and Lena took home a chain analysis worksheet on Friday's drinking to bring to session 15. Skills came last, with her therapist reinforcing Tuesday's coaching call and Saturday's call to her brother. Her therapist also planned to check the coaching plan at session 15 and brought the case to the consultation team that week.
Chain Analysis Worksheet
The chain analysis worksheet lays out one episode of a target behavior, link by link: the behavior, the prompting event, the vulnerability factors, each link with a 0 to 5 intensity rating and a more skillful step, the consequences, a plan for next time and repair. In individual therapy it follows the diary card review and takes the highest-priority target behavior, and clients can fill it in with the therapist in session or as homework. The chain analysis worksheet page has the PDF, a Google Docs copy, a completed example and guidance on the solution analysis that follows the chain.
This is an optional template from the Sentio MFT program's free DBT toolkit, an original design for you to adapt.
Download the PDFMake a copy in Google Docs
| Name | Date filled in |
|---|---|
Pick one time the behavior happened and stay with that one time. Write plain facts, the way you would tell them to someone who was not there. Go in order, one part at a time. If strong urges come up while you write, stop and use your safety plan.
1. The behavior
| What did you do? When and where did it happen? How long did it last, or how strong was it? |
|---|
2. What set it off
| What event started the chain? Write the day and the time. |
|---|
3. What made you vulnerable
| What made that day harder than usual? Think about sleep, food, sickness, medication and stress that had been building up. |
|---|
4. The links in the chain
Start with what happened right after the event that set it off, and end with the moment just before the behavior. Put one thing on each line: a thought, a feeling, a body sensation, an urge, something you did, or something that happened around you. In the third column, name your strongest feeling or urge at that point and rate it from 0 (not there at all) to 5 (as strong as it has ever been). In the last column, write a more skillful step you could take at that point next time.
| Link | What happened next: a thought, feeling, body sensation, urge, action or event | How strong (0 to 5) | A more skillful step that could fit here next time |
|---|---|---|---|
| 1 | |||
| 2 | |||
| 3 | |||
| 4 | |||
| 5 | |||
| 6 | |||
| 7 | |||
| 8 |
If you need more links, add them on another page.
5. What came after
Write what happened because of the behavior. Include anything that felt better, even for a short time.
| Who | Right away: the first minutes and hours | Later: the next day and the days after |
|---|---|---|
| You | ||
| Other people |
6. Your plan for next time
| Break the chain: pick one or two links from part 4. What will you do at those points next time? |
|---|
| Lower your vulnerability: what will you do this week about sleep, food and stress? |
|---|
| Plan for what set it off: can you prevent it? If not, how will you get ready for it? |
|---|
7. Repair
| Did the behavior hurt you, someone else, or something you care about, like your job or a friendship? What will you do to repair it, and when? |
|---|
If you fill it in at home, bring it to your next session.
If you are in crisis
[Your clinic's crisis instructions: who to contact during office hours, after hours, and in an emergency.]
In the United States, call or text 988, or chat at 988lifeline.org, to reach the 988 Suicide & Crisis Lifeline. If you are in immediate danger, call 911.
See a completed example
Lena, 28, is an invented client in standard DBT: weekly individual therapy and skills group, phone coaching with her individual therapist, and a therapist who meets with a consultation team. She is in stage 1, about three months into treatment, and self-harm is her life-threatening target. Her diary card showed self-harm on Thursday night, so in session 14 on Tuesday her therapist assessed current risk first and then worked through the chain with her, filling in the worksheet as they went.
The behavior row is kept non-graphic. In session, Lena and her therapist pin down exactly what she did, because the chain depends on that detail.
| Name | Date filled in |
|---|---|
| Lena | Tuesday, in session 14 |
1. The behavior
| What did you do? When and where did it happen? How long did it last, or how strong was it? |
|---|
| Self-harm, about 9:30 p.m., at home; did not need medical care |
2. What set it off
| What event started the chain? Write the day and the time. |
|---|
| Thursday, about 3:15 p.m., at the front desk. My supervisor told me in front of two coworkers that I had double-booked a patient again and that she was tired of fixing my mistakes. |
3. What made you vulnerable
| What made that day harder than usual? Think about sleep, food, sickness, medication and stress that had been building up. |
|---|
| Slept about five hours on Wednesday night. Skipped breakfast and lunch and had only coffee at work. Still upset about Tuesday's argument with my roommate about bills. |
4. The links in the chain
| Link | What happened next: a thought, feeling, body sensation, urge, action or event | How strong (0 to 5) | A more skillful step that could fit here next time |
|---|---|---|---|
| 1 | Thought: "Everyone heard that. They all think I'm useless." | Shame 3 | Check the facts: two coworkers heard one comment about one mistake. |
| 2 | Face hot, chest tight. Kept my eyes on the screen and did not talk to anyone for the rest of my shift. | Shame 4 | Opposite action for shame: keep greeting patients at the desk. |
| 3 | On the bus home, about 5:15 p.m. Thought: "I'm going to get fired. I can't do anything right." | Shame 5 | Check the facts: no one has said anything about firing me. |
| 4 | Urge to self-harm started on the bus. | Urge 3, shame 5 | Call or text for coaching from the bus, while the urge is at 3. |
| 5 | Got home about 5:45 p.m. Told my roommate I was tired and went to my room. | Shame 5, urge 3 | Sit in the kitchen with my roommate, or text my brother. |
| 6 | Thought about calling my therapist for coaching. Then thought: "She'll think I'm failing at this too." Did not call. | Urge 4 | Call anyway. Asking for help is one of the skills I'm working on. |
| 7 | Skipped dinner. Lay in bed and went over the day again and again: what she said, who heard, every mistake I've made this month. | Shame 5, urge 4 | Get up, leave my room and use a distress tolerance skill from my list. |
| 8 | About 9:15 p.m. Thought: "I can't stand this. I need it to stop." | Urge 4 | Remind myself the urge will come down. Use a skill from my list for 20 minutes and call for coaching. |
5. What came after
| Who | Right away: the first minutes and hours | Later: the next day and the days after |
|---|---|---|
| You | Relief. The shame dropped for about an hour. Then I felt ashamed of the self-harm too and could not sleep until after 1 a.m. | Still ashamed on Friday. Called in sick and stayed in bed most of the day. Drank five drinks that evening. Missing work puts my job at risk, and I want to keep it. |
| Other people | No one knew. I stayed away from my roommate all evening. | A coworker had to cover the front desk on Friday. My supervisor does not know what upset me. My brother texted twice on Friday and I did not answer. |
6. Your plan for next time
| Break the chain: pick one or two links from part 4. What will you do at those points next time? |
|---|
| Links 4 and 6: when the urge reaches 3, call or text for coaching before I act, using the coaching text I wrote in session. Links 2 and 5: opposite action for shame, at the desk and at home. I'll practice it once a day with the scene from work. |
| Lower your vulnerability: what will you do this week about sleep, food and stress? |
|---|
| Lights out by 11 p.m. on work nights. Eat breakfast, and keep a snack at the desk for days I can't take lunch. |
| Plan for what set it off: can you prevent it? If not, how will you get ready for it? |
|---|
| I can't stop my supervisor from correcting me, so I'll plan for it. If it happens again: a five-minute break away from the front desk, then a coaching text before I leave work. On Monday I'll ask her for 10 minutes to go over the scheduling mistake and ask her to bring mistakes to me in private. We planned what I'll say in session. |
7. Repair
| Did the behavior hurt you, someone else, or something you care about, like your job or a friendship? What will you do to repair it, and when? |
|---|
| Thank the coworker who covered for me on Friday and offer to cover her lunch break next week. Called my brother back on Saturday (done). |
Therapist's follow-up in session 14
- Risk: assessed at the start of the session with the clinic's structured protocol (the LRAMP). No suicidal thinking today and no current suicidal intent or plan; suicidal thoughts were last rated 2 on Thursday night, with no intent.
- Safety plan: reviewed and updated together, with a new step for criticism at work (a five-minute break away from the front desk, then a coaching text before she leaves work) and her brother added as a contact.
- Coaching plan until session 15: call or text when an urge reaches 3, before acting, using the coaching text written in session.
- Consultation team: case brought to the team this week with the updated plans and a question: what would make calling easier for her when shame is high?
- Next: a chain analysis worksheet on Friday's drinking as homework. Session 15 opens with the diary card and a risk check, then reviews the coaching plan, the new safety plan step and the talk with her supervisor.
DBT Session Note
The session note records one individual DBT session in the order the session runs: the diary card review, the four target categories from life-threatening behaviors to skills, then the interventions, the client's response, homework, coaching contacts, an item for the consultation team and the plan for the next session. Use it after each individual session, or as a checklist beside your clinic's own note format. The session note page has the PDF, a Google Docs copy, a DAP version and a completed example.
This is an optional template from the Sentio MFT program's free DBT toolkit, an original design for you to adapt.
Download the PDFMake a copy in Google Docs
| 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. |
See a completed example
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. |
DBT Treatment Plan
The treatment plan records what client and therapist agree in pretreatment: the client's own goals for a life worth living, the treatment agreements, and a goal, baseline, measurable objectives, interventions, measure of progress and target date for each target in the hierarchy, with the safety plan, review dates and signatures. Write it in pretreatment and update it once the first weeks of diary cards give baselines. The treatment plan page has the PDF, a Google Docs copy and a completed example.
This is an optional template from the Sentio MFT program's free DBT toolkit, an original design for you to adapt.
Download the PDFMake a copy in Google Docs
Client and agreements
| Item | What to record |
|---|---|
| Client | Name or code, and age. |
| Diagnosis | From the intake assessment. |
| Stage | Pretreatment, or stage 1, 2, 3 or 4. |
| Plan dates | When the plan was written, and the date of each update. |
| Goals for a life worth living | The client's own long-term goals, in the client's words. |
| Agreements made in pretreatment | What the client agreed to (modes of treatment, length of the commitment, the targets to work on, attendance, the diary card), what the therapist agreed to, and when both committed. |
Targets by hierarchy
| Target | Goal | Objectives, with baseline | Interventions | How progress is measured | Target date |
|---|---|---|---|---|---|
| 1. Life-threatening behaviors | |||||
| 2. Therapy-interfering behaviors | |||||
| 3. Quality-of-life-interfering behaviors | |||||
| 4. Behavioral skills to increase |
Safety, reviews and signatures
| Item | What to record |
|---|---|
| Crisis or safety plan | Where the written safety plan is kept and when it was last reviewed, the coaching plan, and the crisis contacts. |
| Review dates | When the plan will be reviewed with the client, and when the treatment agreement ends or is renewed. |
| Signatures | Client and therapist, each with the date. |
See a completed example
Lena, 28, is an invented client who works full time as a receptionist at a dental office and shares an apartment with a roommate. Her intake assessment gave a diagnosis of borderline personality disorder; she has a history of self-harm and periods of suicidal thinking, with no suicide attempt in the past two years. Her therapist wrote the plan with her in pretreatment and updated it after the first month, once four weeks of diary cards gave a baseline for each target.
Client and agreements
| Item | Lena's plan |
|---|---|
| Client | Lena, 28 (Client 21). |
| Diagnosis | Borderline personality disorder, from the intake assessment. |
| Stage | Stage 1, after three pretreatment sessions. |
| Plan dates | Written at session 3, the last pretreatment session. Updated at session 7 with baselines from her first four weeks of diary cards. |
| Goals for a life worth living | In her words: "Keep my job and finish my medical billing certificate. Get my own apartment. Be closer to my brother." |
| Agreements made in pretreatment | Lena: one year of standard DBT (weekly individual therapy, a weekly skills group and phone coaching); work on the targets in this plan; attend sessions and group as scheduled; fill in a diary card every day and bring it to each session. Therapist: provide the best treatment possible, follow professional ethics, take part in the weekly consultation team, and offer phone coaching within the therapist's limits. Both committed verbally at session 3. |
Targets by hierarchy
| Target | Goal | Objectives, with baseline | Interventions | How progress is measured | Target date |
|---|---|---|---|---|---|
| 1. Life-threatening: self-harm. Suicidal thinking is monitored on the diary card. | No self-harm. | Baseline: self-harm on 8 days in the first four weeks of cards, about twice a week. (a) Self-harm on no more than 2 days in the four weeks before the month 3 review. (b) No self-harm in the eight weeks before the month 6 review. | Chain and solution analysis of each self-harm; distress tolerance skills; coaching before acting; safety plan; risk assessment with the clinic's protocol after any self-harm or rise in suicidal thinking. | Days with self-harm, and daily ratings of urges and suicidal thinking (0 to 5), on the diary card; reviewed every session and totaled every four weeks. | (a) Month 3. (b) Month 6. |
| 2. Therapy-interfering: diary card filled in late or partly; arriving late; leaving group early when ashamed. | A full card every week, on time to every session, and staying for all of each group. | Baseline: card filled in on the day on about 3 days in 7; late to 2 of 4 sessions; left group early twice in four weeks. (a) Card filled in on the day on at least 6 of 7 days, every week for four weeks. (b) On time to every session and staying for all of each group, four weeks in a row. | Orienting to the card's purpose; problem solving the barriers to filling it in; chain analysis of lateness and leaving group; opposite action for shame. | Days filled in on the day, asked at each card review; session start times; group attendance from the skills trainers. | (a) and (b) Month 3. |
| 3. Quality of life: drinking four or more drinks on weekend nights; missing work after conflicts. | Weekends without heavy drinking, and steady attendance at work so she keeps her job. | Baseline: four or more drinks on 2 nights most weekends; 2 workdays missed after conflicts in four weeks. (a) No more than 1 night with four or more drinks per weekend, four weekends in a row. (b) No nights with four or more drinks and no workdays missed after a conflict in the eight weeks before the month 6 review. | Chain and solution analysis of heavy drinking nights and missed workdays; a plan for weekend evenings; problem solving for conflicts at work. | Drinks each day and missed workdays on the diary card. | (a) Month 3. (b) Month 6. |
| 4. Behavioral skills: opposite action for shame; distress tolerance skills for urges; asking for help. | Skills in place of self-harm, heavy drinking and missed work. | Baseline: a skill recorded on about 2 days in 7; no coaching contacts in four weeks. (a) A distress tolerance skill on every day an urge reaches 3 or higher. (b) A coaching call or text before acting in every week with an urge of 3 or higher. (c) Opposite action for shame practiced on at least 3 days a week. | Weekly skills group; skills coaching in sessions and by phone; rehearsal in session; homework. | Skills recorded on the diary card; coaching contacts. | (a) and (b) Month 3. (c) Month 6. |
Safety, reviews and signatures
| Item | Lena's plan |
|---|---|
| Crisis or safety plan | Written with Lena at session 2, reviewed at session 7, and kept on her phone and in the record. It lists her warning signs (shame after criticism, urges at 3 or higher), skills she can use on her own, people and places that help, a coaching call or text before acting, and crisis contacts: the clinic's after-hours line and the 988 Suicide & Crisis Lifeline. |
| Review dates | Every four weeks, with the diary card totals; a full review at month 6; at month 12, when the one-year agreement ends, renew it or consider referral, depending on progress. |
| Signatures | Lena and her individual therapist, at session 3 and again at session 7. |
DBT Target Hierarchy Quick Reference
The target hierarchy quick reference lists the stage 1 targets of DBT in order in one table, with what each category covers, examples and what each means for the session agenda, plus the stages of DBT and the skills group's own order. Its fill-in table records one client's target behaviors in each category and how each is measured. Use it in pretreatment when you and a client agree on targets, and whenever a diary card shows several targets at once. The target hierarchy page has the PDF, a completed example and an explanation of why the order runs as it does.
This is an optional template from the Sentio MFT program's free DBT toolkit, an original design for you to adapt.
Download the PDFMake a copy in Google Docs
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.
See a completed example
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.
DBT Validation Levels Quick Reference
The validation levels quick reference lists Linehan's six levels of validation, what the therapist does at each and a sample response to one new client statement, with three more statements to answer at a level you choose. Use it to prepare for sessions, in supervision or with a consultation team. The validation levels page has the PDF, a completed example and guidance on choosing a level.
This is an optional template from the Sentio MFT program's free DBT toolkit, an original design for you to adapt.
Download the PDFMake a copy in Google Docs
The six levels of validation
Client statement: Marco, 34, a line cook in his third month of DBT, was often left out of family plans growing up. "My sister had her engagement dinner Saturday. I found out from Instagram. Fine. I'm used to being the one nobody wants around."
| Level | What the therapist does | Sample response to Marco |
|---|---|---|
| 1. Staying awake | Listens to and observes the client's words, feelings and behavior with full attention and evident interest, making an active, nonjudgmental effort to understand. | (Sets the diary card aside and turns toward him.) "Tell me about Saturday. What did you see?" |
| 2. Accurate reflection | Reflects back the client's feelings, thoughts and assumptions in language close to the client's own, adding organization but no interpretation. | "Your sister had her engagement dinner on Saturday, and you found out about it on Instagram." |
| 3. Articulating the unverbalized | Accurately puts into words the client's unspoken thoughts, feelings or patterns of behavior. | "I'm guessing 'fine' is covering a lot of hurt. Maybe some anger, too." |
| 4. Validating in terms of past learning or biology | Conveys that the response makes sense given its causes, such as the client's learning history or biology. | "You were left out of family plans for years growing up. Of course this one lands as more proof that nobody wants you around." |
| 5. Validating in terms of the present | Conveys that the client's emotions, thoughts or actions are reasonable or meaningful given the current situation and normal human functioning. | "Finding out about your sister's engagement dinner from Instagram would hurt almost anyone." |
| 6. Radical genuineness | Responds as a genuine equal, without treating the client as fragile or as only a person with a disorder, and responds to the client's strengths and capacities. | "Ouch. If I found out that way, I'd be hurt too, and angry. You care about her, and you're someone who can tell her how this landed." |
Practice statements
1. Ivy, 26, a graduate student, at the start of a session that began eleven minutes late: "Eleven minutes. I counted. I sat out there thinking you'd finally had enough of me."
| Level | Your response at that level |
|---|---|
2. Walt, 47, a bus mechanic, explaining a blank diary card: "I left the card in my truck all week. I didn't want to look at seven days of zeros in the skills column."
| Level | Your response at that level |
|---|---|
3. Jonah, 19, who lives with his parents and works at a grocery store: "My mom went through my phone again, so I screamed at her and slammed my door. Now everyone in the house acts like I'm the problem."
| Level | Your response at that level |
|---|---|
See a completed example
Client statement: Priya, 41, an accountant who was often mocked for speaking up at school, starts the skills group next week. "I can't do the group. Eight strangers staring at me while I talk about my feelings? I'll freeze, say something stupid, and they'll all see what a mess I am."
| Level | What the therapist does | Response to Priya |
|---|---|---|
| 1. Staying awake | Puts down the pen, faces Priya and asks, with evident interest, what she pictures. | "Walk me through it. What do you picture when you walk into that room?" |
| 2. Accurate reflection | Reflects the fear in words close to Priya's own, with no interpretation. | "You're picturing eight strangers looking at you, and you're afraid you'll freeze and say something stupid." |
| 3. Articulating the unverbalized | Names the shame under the fear, which Priya has not said. | "I wonder if the worst part is the thought of people seeing you struggle. That sounds like shame as much as fear." |
| 4. Validating in terms of past learning or biology | Links the fear to being mocked for speaking up at school. | "You were mocked when you spoke up at school. After that, it makes sense that a room of strangers feels dangerous." |
| 5. Validating in terms of the present | Conveys that nerves before a first group are how most people react. | "Most people feel nervous walking into a room of strangers, and more so when they expect to talk about something personal." |
| 6. Radical genuineness | Speaks as an equal and points to a strength Priya has shown. | "I'd be nervous too. And you've pushed back on me in here when you disagreed, so I've seen you speak up when it matters." |
Which levels fit best here, and why. Levels 5 and 6. Priya's nerves fit the situation: a first meeting with a group of strangers makes most people nervous. That makes Level 5 available, and therapists are taught to prefer Level 5 to Level 4 whenever possible because it is thought to be more present-focused and less pathologizing. Level 6 follows Linehan's advice to validate at the highest level the therapist can, and it treats Priya as a capable equal. Her prediction that the group will see "what a mess I am" goes beyond the facts, so no response agrees with it. Once she feels understood, the therapist can turn to change by orienting her to how the group runs: like a class, with homework review in the first half and new skills in the second.
Consultation Team Agenda and Notes Form
A weekly agenda and notes form for the therapist consultation team, the DBT mode that supports the therapists. Use it to set the meeting's roles, rank agenda items so that a client's life-threatening behavior comes first and team business last, and record the help each therapist asked for, what the team offered and who follows up. The consultation team agenda page has the PDF, a Google Docs copy, the team agreements in plain words and a completed example meeting.
This is an optional template from the Sentio MFT program's free DBT toolkit, an original design for you to adapt.
Download the PDFMake a copy in Google Docs
Weekly meeting agenda
- Mindfulness. Open with a short mindfulness practice, often 5 to 10 minutes, led by a member.
- Roles. Name this week's meeting leader, observer and note-taker, one role per person, alongside the team leader.
- Attendance. Note who is present in person or by video, and who is late or absent.
- Agenda items. Each member names their items: the client code, the issue in one line, the kind of help wanted and the minutes needed.
- Order. Rank the items before discussing any of them, then fit the minutes to the meeting. A client's life-threatening behavior comes first; therapy-interfering behavior next, whether the client's or a therapist's own; other clinical questions after that; team business last.
- Discussion. Take the items in order. The member states the issue and the help wanted, the team asks assessment questions before offering solutions, and the note-taker records what the team offered and the follow-up.
- Check-in. Before the meeting ends, the observer asks each member whether they got the help they asked for. Items not reached go on next week's list.
- Follow-ups. The note-taker reads back each follow-up with its owner and date.
Kinds of help: support (the team validates how hard this is), assessment (questions that clarify what is going on), solutions (ideas to try), rehearsal (practicing a response with a teammate), decision (the team needs to agree on something) or information (the team only needs to know).
Meeting notes
Record clients by code only, with no names or identifying details.
| Meeting | Details |
|---|---|
| Date | |
| Meeting length | |
| Members present (in person or by video) | |
| Late or absent | |
| Team leader | |
| Meeting leader | |
| Observer | |
| Note-taker | |
| Mindfulness practice and who led it |
Agenda items in priority order
| Order | Member and client code | Issue | Help asked for | Minutes |
|---|---|---|---|---|
| 1 | ||||
| 2 | ||||
| 3 | ||||
| 4 | ||||
| 5 |
What the team offered
| Order | What the team offered | Follow-up: owner and date |
|---|---|---|
| 1 | ||
| 2 | ||
| 3 | ||
| 4 | ||
| 5 |
Check-in at the end of the meeting
| Member | Got the help asked for? | Note |
|---|---|---|
Agreement moments
| Where the team polarized, slipped from an agreement or found a synthesis |
|---|
See a completed example
The completed notes come from one meeting of an invented team of four. R.N. is the team leader, and C.D., J.O. and P.W. are therapists. Every client is invented and appears by code only; Client 21 is Lena, the client in the toolkit's other examples, on the day after her session 14. The team took a client's suicidal crisis first, Lena's self-harm second, a therapist's own therapy-interfering behavior third and scheduling last.
Meeting notes
| Meeting | Details |
|---|---|
| Date | Wednesday, March 4 |
| Meeting length | 90 minutes |
| Members present (in person or by video) | R.N., C.D. and J.O. in person; P.W. by video |
| Late or absent | None |
| Team leader | R.N. |
| Meeting leader | P.W. |
| Observer | C.D. |
| Note-taker | J.O. |
| Mindfulness practice and who led it | Five minutes of listening to sounds in the room, led by R.N. |
Agenda items in priority order
| Order | Member and client code | Issue | Help asked for | Minutes |
|---|---|---|---|---|
| 1 | C.D., Client 7 | Life-threatening: suicidal crisis on Saturday after an eviction notice. No self-harm and no attempt. | Assessment, solutions, support | 30 |
| 2 | P.W., Client 21 | Life-threatening: self-harm on Thursday night after criticism at work, without calling for coaching; did not need medical care. Safety and coaching plans updated at Tuesday's session. | Solutions, rehearsal | 25 |
| 3 | J.O., Client 12 | Therapy-interfering, J.O.'s own: three of Client 12's coaching calls returned late this week, one the next morning. | Solutions | 15 |
| 4 | R.N., no client | Team business: next week's meeting falls on the clinic's training day. | Decision | 5 |
What the team offered
| Order | What the team offered | Follow-up: owner and date |
|---|---|---|
| 1 | Client 7 called for coaching on Saturday and used skills during the call. At Monday's session C.D. assessed risk with the clinic's protocol and reviewed and updated the safety plan with her. The team asked assessment questions first: what the protocol showed, what changed in the safety plan and how committed Client 7 is to it. R.N. and P.W. validated C.D.'s worry about the coming weekend. Suggestions: a chain analysis of Saturday's crisis at Friday's session; a written weekend coaching plan that says when Client 7 will call and which skills she will try first; one planned check-in call from C.D. on Saturday morning. | C.D.: chain analysis and coaching plan at Friday's session. Client 7 goes first on next week's agenda. |
| 2 | P.W. asked what would make calling easier for Client 21 when shame is high, and for help keeping validation and change in balance when it is. Assessment: before calling, Client 21 thinks her therapist will see her as failing, and in Tuesday's session P.W. moved on when her shame showed. Suggestions: have Client 21 send the new coaching text once during session 15 as practice; when shame about asking for help shows up in the room, name it and stay with it for a few more exchanges. Rehearsal: R.N. played Client 21 for three rounds, saying “Can we not do this part?”, while P.W. practiced naming the shame and keeping the topic of calling in the room, with feedback after each round. R.N. made the third round harder by going quiet. | P.W.: practice text and in-session work at session 15. Report next week. |
| 3 | The team thanked J.O. for naming it. Assessment: the calls came in during back-to-back sessions, J.O. had never told Client 12 when calls get returned, and J.O. has felt worn down by a full caseload. Suggestions: tell Client 12 when calls are returned and how quickly; check messages after each session; repair with Client 12 at the next session. R.N. offered to look at J.O.'s caseload together this week. | J.O.: talk with Client 12 at Tuesday's session and report next week. R.N.: caseload review with J.O. by Friday. |
| 4 | The team agreed to meet on Thursday next week at the usual time. | R.N.: send the calendar change today. |
Check-in at the end of the meeting
| Member | Got the help asked for? | Note |
|---|---|---|
| C.D. | Yes | Steadier about the weekend. Client 7 goes first next week. |
| P.W. | Yes | Wants two more rounds next week, starting with the harder version. |
| J.O. | Yes | Has a plan for returning calls and a time with R.N. to look at caseload. |
| R.N. | Yes | Meeting moved. |
Agreement moments
| Where the team polarized, slipped from an agreement or found a synthesis |
|---|
| Item 1: members split between asking C.D. to call Client 7 every evening and respecting C.D.'s limits. The synthesis was one planned call on Saturday morning plus the coaching plan (dialectical and observing-limits agreements). |
| Item 3: members began suggesting fixes before asking questions. R.N. named it, and the team went back to assessment (assess before offering solutions). |
Recording Review Form and DBT Practice Set
A recording review form for supervision, a consultation team or self-review, with a practice set of new client statements. Use it to watch 5 to 10 minutes of a recorded session, with the client's written consent, pick one skill to rehearse, and rehearse problem assessment, problem solving or informal emotional exposure at three levels alongside the matching Practice Time episode. The recording review and practice page has the PDF, a Google Docs copy and a completed review.
This is an optional template from the Sentio MFT program's free DBT toolkit, an original design for you to adapt.
Download the PDFMake a copy in Google Docs
Recording review form
Use the form only with a session the client has agreed in writing to have recorded and reviewed. Pick one segment of 5 to 10 minutes and identify the client by code only.
| Segment | Details |
|---|---|
| Client code | |
| Session number and date | |
| Segment start and end times | |
| Client's written consent to recording and review (date signed) | |
| Reviewed by (self, supervisor or team) | |
| What happened just before the segment | |
| Target being worked on (category and specific behavior) | |
| What the therapist was trying to do |
What the therapist did
Write what you can see and hear, with the time on the recording: the therapist's words, the client's response and what happened next.
- Validation and its level: statements that convey that the client's response makes sense. Note the time, the words and the level, 1 to 6.
- Behavioral specificity in problem assessment: questions that pin down one episode link by link, such as when and where it happened, what came first, what the client thought, felt (and how strongly) and had the urge to do, and what happened next. Note any gap the therapist skipped or filled with a general label.
- Generating and troubleshooting solutions: a solution tied to a specific link, the client's own ideas asked for, a check on what could get in the way, and a solution tried out in the session.
- Staying with emotion in informal exposure: when shame, fear or another emotion shows up in the room, the therapist notices it, names it or asks about it, and keeps the client in contact with the cue for a few more exchanges. Note the time and how long the therapist stayed.
- Balance of acceptance and change: movement between validation and change strategies such as assessment and solutions. Note any stretch of one without the other and how the client responded.
| Dimension | What the therapist did (times and words) | Next time |
|---|---|---|
| Validation and its level | ||
| Behavioral specificity in problem assessment | ||
| Generating and troubleshooting solutions | ||
| Staying with emotion in informal exposure | ||
| Balance of acceptance and change |
One skill to rehearse
| Next step | Entry |
|---|---|
| What worked (two or three moments, with times) | |
| The one skill to rehearse next | |
| Why this skill | |
| Matching Practice Time episode (16, 17 or 18) | |
| Practice plan: statements, level, partner and when |
DBT practice set
New client statements for rehearsing three DBT change strategies, each matched to a free Practice Time episode. Every client is invented.
How to rehearse in pairs or in a team
- Choose a skill and a level. Use the skill the review picked. Start at beginner unless the beginner statements already feel easy.
- Take roles. One person plays the client and one plays the therapist. In a team, a third person coaches, and everyone rotates through the roles.
- Read and respond. The client reads the context aloud, then says the statement as that client would. The therapist answers as in a session, in a few sentences, aiming at the skill.
- Give feedback. The client says in one sentence how the response landed. The coach, or the client in a pair, names one thing that worked and one thing to change.
- Repeat. Run the same statement again with the change, then move to the next statement.
- Adjust. Move up a level when the therapist handles both statements at a level well. Make it easier when the therapist freezes or drifts from the skill twice in a row: drop a level, give the therapist a moment to plan, or have the coach show one response first. Make it harder by having the client stay in role and push back for two or three more exchanges, or by asking the therapist to validate and use the skill in the same response.
Problem assessment (Practice Time Ep 16)
A skillful response stays with one episode of the target behavior and asks a specific question that moves the chain forward: when it happened, what set it off, or what the client thought, felt and had the urge to do next. It gathers enough of the chain to show which link to work on before turning to solutions.
| Level | Context | Client says |
|---|---|---|
| Beginner | A 34-year-old man whose diary card shows drinking on Saturday. | “Saturday got away from me. I said I'd stay in, and then I was at the bar until it closed.” |
| Beginner | A 22-year-old student who missed skills group on Wednesday. | “I was all ready to come to group. I had my coat on. And then I just didn't.” |
| Intermediate | A 41-year-old woman whose card shows a shouting match with her sister. | “It's the same thing every time. She pushes my buttons and I lose it. There's nothing to figure out.” |
| Intermediate | A 19-year-old who walked out in the middle of a shift at work. | “I don't know why I left. The whole week was too much. It wasn't one thing, it was everything.” |
| Advanced | A 30-year-old woman whose card shows self-harm on Tuesday. Her therapist has already assessed current risk this session. She will not look up. | “Do we have to go through it all again? I know what happened. I messed up. Can we just move on?” |
| Advanced | A 52-year-old man, irritated after missing two sessions in a row. | “You want it minute by minute? Fine. I woke up, I didn't feel like coming, I didn't come. Specific enough?” |
Problem solving (Practice Time Ep 17)
A skillful response works on one link the chain has found and builds solutions with the client, asking for the client's own ideas first. It matches the solution to the link (skills training for a missing skill, stimulus control for a cue, exposure for an unwarranted emotion, cognitive modification for faulty thinking, contingency management for an environment that rewards the problem) and, where it can, tries the solution out in the session.
| Level | Context | Client says |
|---|---|---|
| Beginner | A 27-year-old woman whose chains show her urges peak when she looks at her ex's posts in bed after midnight. | “So it always starts on my phone, in bed, late. What do I even do about that?” |
| Beginner | A 45-year-old nurse whose chains show he skips lunch on long shifts and snaps at coworkers by midafternoon. | “I guess not eating is part of it. I just never have time on those shifts.” |
| Intermediate | A 36-year-old woman who knows her skills but goes blank when shame hits. | “I know I'm supposed to use a skill right then. But in the moment they're just gone. I can't think of a single one.” |
| Intermediate | A 24-year-old man who drinks heavily at parties when he feels anxious. | “I could stop going to parties, but then I'd have no friends. And I'm not standing there with a soda while everyone stares.” |
| Advanced | A 33-year-old man whose partner left for the weekend after a fight. | “There's no solution. She's leaving either way. Why would I practice some skill for a relationship that's already over?” |
| Advanced | A 29-year-old woman whose urges to self-harm rise after calls with her mother. Current risk has been assessed and her safety plan is up to date. | “The only thing that works is never talking to her again. You keep wanting me to try something. I've tried everything.” |
Informal emotional exposure (Practice Time Ep 18)
A skillful response notices the emotion as it shows up in the room, names it or asks about it, briefly orients the client to staying with it, and keeps the client in contact with the cue (the topic, the request or the feedback) for a few more exchanges, with validation along the way.
| Level | Context | Client says |
|---|---|---|
| Beginner | A 38-year-old woman, asked to read her diary card aloud, hesitates. | “Can you just read it yourself? I hate hearing myself say this stuff.” |
| Beginner | A 26-year-old man, asked to practice in session how he will ask his manager for a day off. | “This is embarrassing. Can we skip the practice part? I get the idea.” |
| Intermediate | A 31-year-old woman looks at the floor after the therapist praises a skill she used. | “Please don't do that. It makes me feel like a little kid getting a sticker.” |
| Intermediate | A 47-year-old man laughs and changes the subject each time his father's funeral comes up. | “Ha. Anyway, that's ancient history. So, my week was mostly fine.” |
| Advanced | A 35-year-old woman who has never used phone coaching, asked to practice a coaching call in session right now. | “I can't. I'm not calling you on a Saturday to bother you. Please don't make me do this.” |
| Advanced | A 40-year-old man, after the therapist points out that he arrived late again. | “Wow. So now you're keeping score too. I thought this was the one place I wouldn't get lectured.” |
See a completed example
Lena, 28, is the invented client who appears across the toolkit's examples; she has been in standard DBT for about three months. Her individual therapist reviews eight minutes of session 14 in supervision. On the form she appears as Client 21. The segment comes from the chain analysis of Thursday's self-harm, which followed criticism from her supervisor in front of coworkers. Later in the session the two went back and filled in the evening, as the completed chain analysis worksheet shows.
Recording review form
| Segment | Details |
|---|---|
| Client code | Client 21 |
| Session number and date | Session 14, Tuesday |
| Segment start and end times | 18:00 to 26:00 (8 minutes) |
| Client's written consent to recording and review (date signed) | Signed at the second pretreatment session, for recording and review in supervision |
| Reviewed by (self, supervisor or team) | The therapist and a supervisor, in weekly supervision |
| What happened just before the segment | Diary card review: Lena filled in the card on four of the seven days and finished it in the waiting room. The therapist asked about Thursday's suicidal thoughts (rated 2, no intent), assessed risk with the clinic's protocol and named Thursday's self-harm as the first target. |
| Target being worked on (category and specific behavior) | Life-threatening behavior: self-harm on Thursday night (did not need medical care), worked through a chain analysis. |
| What the therapist was trying to do | Find the links from the supervisor's criticism to the self-harm, and the point where a coaching call could have changed the chain. |
What the therapist did
| Dimension | What the therapist did (times and words) | Next time |
|---|---|---|
| Validation and its level | 19:40 “Being criticized in front of your coworkers is the kind of thing that makes most people want to disappear” (Level 5). 21:15 “So when you got home the shame was still at a 5, and the urge was building” (Level 2). No validation after 22:40. | When the shame shows up in the room, validate it before the next question, at Level 3 or Level 5. |
| Behavioral specificity in problem assessment | Pinned the prompting event to about 3:15 p.m. Thursday, at the front desk, and got ratings for shame (5) and the urge (4). 21:40 asked “Then what happened?” about the evening and heard “I just sat in my room.” After the exit at 22:40, the hours between getting home at about 5:45 p.m. and the self-harm at about 9:30 p.m. stayed blank. | Ask for the next link in that gap: what she was thinking, what she did, and when the urge rose. |
| Generating and troubleshooting solutions | 24:10 Suggested calling or texting for coaching the next time shame rises at work. Lena said “Maybe.” No check on what would stop her from reaching out, and no practice of the call or text. | Ask what would get in the way of reaching out, then write and rehearse the coaching text in the session. |
| Staying with emotion in informal exposure | 22:40 Asked why she did not call for coaching, Lena looked down, her voice dropped, and she said “Can we not do this part?” The therapist said “Okay” and moved to Friday's drinking within about 20 seconds. | Name the shame, orient her to staying with it for a minute, and keep the topic of asking for help in the room for a few more exchanges. |
| Balance of acceptance and change | 18:00 to 22:40: questions mixed with two validating statements, and Lena answered in full sentences. After 22:40: change strategies only (questions about Friday, then a suggested solution), and her answers shrank to a word or two. | When her answers shorten, return to validation before the next change strategy. |
One skill to rehearse
| Next step | Entry |
|---|---|
| What worked (two or three moments, with times) | 18:20 brought the chain back to Thursday when Lena started on Friday's sick day. 19:00 to 21:30 pinned the prompting event to a time and got shame and urge ratings. 19:40 Level 5 validation of the shame at work. |
| The one skill to rehearse next | Staying with shame in the room (informal emotional exposure) when Lena moves away from talking about asking for help. |
| Why this skill | The missed coaching call is the link the chain points to, and the therapist left it as soon as shame showed up. The blank evening and the weak solution both followed from that moment. |
| Matching Practice Time episode (16, 17 or 18) | Ep 18: Informal Emotional Exposure |
| Practice plan: statements, level, partner and when | Watch Ep 18 before next week's supervision. Rehearse the informal emotional exposure statements with the supervisor playing the client: the two beginner statements, then the two intermediate ones, then the advanced statement about practicing a coaching call. Review the same moment in the next recorded chain analysis. |
More Templates: A Teen Diary Card and a Coaching Log
DBT Diary Card for Teens
The teen diary card is a weekly card in plain words for teens in DBT, with columns for sleep, school, homework, arguments at home and time with friends next to feelings, urges and skills, and a box for a talk with a parent or caregiver. Agree with the teen and family on who sees it before the first week. The teen diary card page has the PDF, a Google Doc to edit and a completed example.
Download the PDFMake a copy in Google Docs
DBT Coaching Contact Log
The coaching contact log is the therapist's record of between-session coaching: one block per call or text, with the target, the skills coached and the ratings at the start and end, and a weekly summary to check against the diary card. Use it for any client who has phone coaching. The coaching log page has the PDF, a Google Docs copy and a completed example.
Learn and Practice DBT
Sentio's free DBT training goes with the templates. The webinar, the Practice Time episodes and the case formulation training below are free to watch, and the webinar recording is free to share.
Deliberate Practice in DBT: the webinar
A full webinar with Tali Boritz and Shelley McMain, in dialogue with Tony Rousmaniere and Alexandre Vaz, on rehearsing validation, chain analysis and the balance of acceptance and change. The training page has the video, the authors' biographies and a note that the recording is designed to pair with a supervisor, a peer or a consultation team.
Practice Time: DBT episodes
Episodes on DBT change strategies: problem assessment, problem solving and informal emotional exposure, as Linehan's manual describes them. The toolkit's practice set gives you new client statements for each one, and Practice Time has episodes for other models.
Ep 16: Problem AssessmentEp 17: Problem SolvingEp 18: Informal Emotional Exposure
The book: Deliberate Practice in Dialectical Behavior Therapy
Tali Z. Boritz, Shelley McMain, Alexandre Vaz and Tony Rousmaniere wrote the book in the American Psychological Association's Essentials of Deliberate Practice series. Its exercises are the full set the webinar demonstrates.
Case formulation and treatment planning
A free training by Alexandre Vaz on building a case formulation that a treatment plan can follow, which pairs with the treatment plan template. The free therapist training hub has deliberate practice training for other therapy models.
For Supervisors, Consultation Teams and Faculty
Two templates serve the people who train DBT therapists. The consultation team agenda and notes form keeps the weekly team meeting on its priorities. The recording review form turns a short segment of a recorded session into one skill to rehearse, and its practice set gives new client statements for rehearsing problem assessment, problem solving and informal emotional exposure in supervision, in a team meeting or in class.
For supervision paperwork that is not specific to DBT, the free clinical supervision toolkit has a supervision session agenda and note, a goals worksheet and evaluation forms. Sentio's clinical supervisor training runs over six or twelve months, and Sentio also offers a DP Consultation Group. The toolkit comes from the Sentio MFT program, which trains therapists with deliberate practice.
Frequently Asked Questions
Are these Marsha Linehan's DBT forms?
No. Each template is an original design from the Sentio MFT program, with its own layout, wording and rating scales. Linehan's own handouts and worksheets are published by Guilford Press in DBT Skills Training Handouts and Worksheets, now in a revised edition.
Can I post Linehan's diary card or worksheets online?
Not without Guilford's written permission. Guilford's license for the second edition's handouts and worksheets limits copying to the person who bought the book, for personal use and use with individual clients, and it excludes internet sites, blogs and file-sharing sites. Guilford describes the revised edition's materials as licensed for personal use or use with clients. The templates on this page are free to copy, adapt and share.
Do I need DBT certification to use these templates?
No. Any clinician can use them. The DBT-Linehan Board of Certification, an independent nonprofit, certifies individual clinicians and programs through its own process.
Where can I get DBT skills handouts and worksheets?
From Marsha Linehan's DBT Skills Training Handouts and Worksheets, Revised Edition (Guilford Press, 2025), which goes with her DBT Skills Training Manual, Revised Edition. Guilford also offers Guilford Digital for DBT, a subscription platform with digital diary cards and her skills library.
Can I change the templates?
Yes. Change anything to fit your clients, your program and the record requirements of your setting. Each template has a Google Docs version ready to copy and edit and a PDF to print.
Is there a cost?
No. Every template is free to read, copy, print and use with any client.
References
988 Suicide & Crisis Lifeline. (n.d.). Get help. Retrieved November 9, 2026, from https://988lifeline.org/get-help/
Boritz, T. Z., McMain, S., Vaz, A., & Rousmaniere, T. (2023). Deliberate practice in dialectical behavior therapy. American Psychological Association. ISBN 978-1-4338-3789-0. https://www.apa.org/pubs/books/deliberate-practice-dialectical-behavior-therapy
Carson-Wong, A. (2016). The effect of therapist use of validation strategies on change in client emotion in an individual DBT treatment session [Doctoral dissertation, Rutgers, The State University of New Jersey]. https://doi.org/10.7282/T3MP55JQ
DBT-Linehan Board of Certification. (n.d.). Certification. Retrieved November 9, 2026, from https://dbt-lbc.org/certification/
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
Linehan, M. M. (1997). Validation and psychotherapy. In A. C. Bohart & L. S. Greenberg (Eds.), Empathy reconsidered: New directions in psychotherapy (pp. 353-392). American Psychological Association. https://doi.org/10.1037/10226-016
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
Linehan, M. M. (2025). DBT skills training handouts and worksheets (Rev. ed.). Guilford Press. ISBN 978-1-4625-5634-2. https://www.guilford.com/books/DBT-Skills-Training-Handouts-and-Worksheets/Marsha-Linehan/9781462556342
Linehan, M. M. (2025). DBT skills training manual (Rev. ed.). Guilford Press. ISBN 978-1-4625-5635-9. https://www.guilford.com/books/DBT-Skills-Training-Manual/Marsha-Linehan/9781462556359
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
Sayrs, J. H. R., & Linehan, M. M. (2019). DBT teams: Development and practice. Guilford Press. ISBN 978-1-4625-3981-9. https://www.guilford.com/books/DBT-Teams/Sayrs-Linehan/9781462539819
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
About These Templates
Prepared by Tony Rousmaniere, PsyD, and Alexandre Vaz, PhD, for the Sentio MFT program's free therapist training. Every client in the examples is invented. Corrections and suggestions: mabundez@sentio.org.