Fundamentals of Dialectical Behavior Therapy (DBT)

DBT is a very structured treatment in which clients learn to stabilize life situations and emotions through skill building and implementation in 4 different areas.

DBT Skills



Mindfulness Skills are beneficial in helping us become aware of the sources of stress, help us to understand them and how they are affecting our emotions and bodies. They help send a message to the brain letting it know that it can relax and calm down rather than remaining in a constant state of stress.

Emotion Regulation


Emotion Regulation Skills are useful because when our emotions go unmanaged or are managed poorly, they can turn into reactions that can damage relationships, result in job loss, and financial and legal problems. This training teaches identification and understanding of emotions, along with skills to keep emotional intensity in a more manageable range so that they are not overwhelming and do not cause problems in life. It also teaches the effects of poor eating, sleep, medical compliance and substance use of emotional vulnerability/intensity.

Distress Tolerance


Distress Tolerance Skills are beneficial because they help individuals to recognize that life is made up of both positive and negative events and emotions. At times the negative situations and feelings outweigh the positive. Distress tolerance skills help us learn to accept negativity as a natural part of life and teach us how to get through it without it taking over our mood and behaviors.

Interpersonal Effectiveness


Interpersonal Effectiveness Skills are communication and relationship skills. These are taught because often times, our relationships are negatively affected by the management of our emotions. This skill training will help to teach how to establish and restore good relationships and communication patterns. It teaches the benefit of healthy relationships and how to create and keep them.



All clients are required to contract with their therapist to work together for one year. This establishes a commitment to treatment on both the client’s and the therapist’s part. This also ensures that there is enough time for the therapist to educate the client on all four skill sets during the course of treatment. The contract can be broken if necessary. The client is free to end the contract at any time for any reason. It is expected that the client will inform the therapist in person so that the therapist can be aware of and have a chance to correct any errors that were made during treatment. Once treatment has been terminated, the client is not permitted to return until his or her year contract date has passed.

Skills Training

In order to participate in DBT, you must engage in skills training sessions along with an individual therapy session. This means that there will be two sessions a week. Skills training is usually provided in a group format on Wednesday evenings. Special arrangements for skills training may be able to be made for those that are not available at the designated times.

Diary Card

To ensure that you are using the skills that you learn in therapy, you will be required to fill out a Diary Card. On the Diary Card, there is a chart with harmful coping methods, and the DBT skills. You are to take the Diary Card home with you and record which type of skills you use each day. Every week in therapy you will present your Diary Card and receive a new one. The documentation on that week’s Diary Card will serve as the foundational focus on the individual session.

Therapy Vacation

If the therapist believes that you are not making progress in treatment due to your dependence on harmful coping methods, as opposed to the DBT skills, the therapist will require for you to go on a Therapy Vacation. This means that the therapist will refer you to another therapist that specializes in whatever your specific harmful coping method is (ex. Drug and Alcohol treatment, Eating Disorder Specialist, etc.). Once you have made sufficient progress there, you may return to Rock Creek Wellness and proceed with DBT therapy.

72 Hour No Contact

The therapist encourages the use of phone coaching when in distress and is willing to make the necessary arrangements to provide emergency sessions to help clients use healthy coping strategies learned in treatment. The goal is to help clients eliminate suicidal ideations and self-harming behaviors in the least restrictive environment possible. If a client engages in either of the previously mentioned behaviors in a non-life threatening manner, an assessment will be conducted followed by either a hospitalization or a 72 hour no contact arrangement. If a session falls during the 72 hour time period, it will be cancelled and a no show fee will be charged. Clients are expected to notify the therapist immediately so the 72 hours can begin. If the therapist is not notified and the behavior is learned about during a session, the session will be immediately terminated.

Additional Services

· Phone Coaching: This allows you to receive help in situations when you are not in session. There is no additional cost for phone coaching. However, it may only last a maximum of five minutes and the text limit is 2 per day. The expectation of coaching is to message or request the therapist through and leave a message. You need to explain briefly what the problem is and what DBT skills you are using that aren’t working. Lastly, you need to indicate what skills you’re going to use until the therapist can message you back. The therapist on call will return your message as soon as possible and coach you through these skills in order to help you address your problem.

· If you experience a mental health emergency at any time and need immediate attention, please contact your physician or contact Mercer County Crisis Services at 724-662-2227 or 888-275-7009 option 9.