Dialectical Behavior Therapy has its roots in the treatment of borderline personality disorder. DBT is often used with a multidisciplinary team and uses different therapeutic interventions and strategies. This allows clinicians to receive support throughout their clinical work. DBT treatment often includes individual therapy, skills group sessions, and team meetings each week. DBT can be tailored to each individual that receives treatment which means that the length of treatment can vary for each individual. Keep reading to learn 50 common DBT therapy questions to ask your clients in sessions.
View all of our DBT Therapy Worksheets
DBT questions can be used with a number of different interventions within the different phases of treatment. Questions can be modified for each client that you work with. It is important to keep in mind the 7 assumptions of DBT:
- Clients are doing the best they can
- Your client wants to improve
- Clients need to learn new behaviors in therapy and in the context of their everyday life
- Clients cannot fail in DBT
- Your client may not have caused all their problems, however, they have to solve them anyway
- Clients need to do better, try harder, or be more motivated to change
- The lives of people who are suicidal are unbearable as they are currently living
Getting Ready for Your First DBT Therapy Session with a New Client
When you are getting ready for your first DBT session with a client, you may have met previously or you may be meeting for the first time. Before clients can begin engaging in DBT treatment, time should be spent providing psychoeducation about this treatment modality, the benefits they could experience, and the limitations of treatment.
Time should also be spent helping the client understand the different components of DBT treatment including skills groups, individual therapy, and case management with a team of mental health professionals. Once your client has a better understanding of what to expect, they can consent to participate in DBT treatment.
Your first session with clients should include introducing the Biosocial Theory, introduction to diary cards, reviewing client and clinician expectations, discussing phone coaching, and working to develop your client’s personalized treatment plan
Common Questions to Ask DBT Clients
DBT questions should be asked throughout the different phases of treatment with your client. This is especially true in the beginning stages of treatment when you are introducing your client to mindfulness, emotion regulation skills, distress tolerance skills, and relationship effectiveness.
There are a number of ways that Mindfulness is incorporated into DBT treatment. This includes observing, mental body scans, thought defusion, and mindful breathing, to name a few. Mindfulness is a topic that your client may have heard of, or even practiced already. DBT questions should be aimed to support your client’s experience with mindfulness and allow them to develop their ability to use mindfulness practices.
Examples of DBT Discussion Questions for Mindfulness:
- How can you see yourself incorporating mindful practices into your daily routine?
- Do you have any reservations or hesitations about mindfulness practices?
- What benefits do you hope to gain from using mindfulness skills?
- Are there any barriers that could keep you from incorporating mindfulness skills into your life?
- Are there any mindfulness skills or practices you’re excited about using?
- Do you focus more on internal or external stimuli?
- Are there any emotions in particular that you find challenging to sit with?
- What is your understanding of mindfulness?
- What has been your experience with mindfulness?
- Which mindfulness practice or skill do you see yourself using the most?
The goal of Distress Tolerance Skills is to allow your client to make it through an emotional crisis without worsening the situation. This can also include learning to accept their current reality if they feel as though they are unable to control the situation. DBT questions can be asked throughout the different modules associated with Distress Tolerance Skills to ensure that your client has grasped the material covered.
Examples of DBT Discussion Questions Distress Tolerance:
- Are there any behaviors or habits in your life that you would like to reduce or stop?
- What physical sensations do you experience when you are in an emotional crisis?
- Are there environmental triggers that contribute to emotional crises?
- How likely do you feel you are to try engaging in a new enjoyable activity?
- What are three new enjoyable or distracting activities that you can try in the coming days?
- Are there any activities that you would want to avoid engaging in that others may find enjoyable?
- How do you see yourself incorporating grounding skills into your daily routine? Where could you benefit from using them?
- Can you describe a time where the RESISTT Technique could have been helpful to you?
- What values are important to you in your life?
- How do your values influence your behaviors?
- Think of a challenge or emotional crisis you experienced recently. Walk me through how you could have used TIPP as an emotion regulation skill in that moment.
- How have you used distress tolerance skills since our previous session?
Emotion Regulation is another important component of DBT treatment. These modules are focused on helping clients learn to name and understand their emotions and work to decrease the frequency that they experience unpleasant emotions. This can be a particularly informative component of DBT treatment for clients who have a limited understanding of their emotions.
Examples of DBT Discussion Questions for Emotion Regulation:
- What questions do you have about primary and secondary emotions?
- Do you have any short term goals?
- What is a long term goal you are working towards?
- What changes can you make to your behaviors to promote your physical health?
- Are there any areas of your physical health that concern you?
- What myths about emotions resonates with you the most?
- What emotions are you uncomfortable feeling?
- What behaviors allow you to avoid your distressing emotions?
- What changes will you notice within yourself when you are able to regulate your emotions in a healthier way?
- How do you see the use of emotion regulation skills impacting your quality of life?
- After reviewing a list of cognitive distortions, review the distortions that you can relate to.
- Which cognitive distortion do you feel impacts you the most?
- What would it be like for you to speak to yourself as you would a friend when you are in emotional distress? (ie. being compassionate, understanding, encouraging, etc.)
Interpersonal Effectiveness Skills aim to help clients develop healthy and effective relationship skills that can be brought into the different relationships in their lives. Similar to other components of DBT, you may introduce new concepts and strategies which means that you need to be thorough with your questions to ensure that they grasp the new material you introduced.
Examples of DBT Discussion Questions for Interpersonal Effectiveness:
- What changes would you like to work towards regarding your communication skills?
- How do you feel your communication skills impact your relationships?
- What are some characteristics of a healthy relationship?
- Can you describe a healthy relationship in your life?
- What are traits associated with unhealthy relationships that you have experienced?
- How do you feel assertive skills could help you in your relationships?
- Can you describe the difference between assertiveness and aggressiveness to you?
- What are some of the relationship qualities that build trust?
- How important is trust to you in your relationships?
- Whom do you trust in your life?
- How successful do you feel you are at setting boundaries?
- What is an example of a boundary you would like to set in a relationship you have?
- What are some barriers you have experienced when you have tried to establish boundaries in the past?
- How do you feel in situations of conflict?
- How do you feel you could improve the way you respond to conflict?
Final Thoughts On Asking the Right Questions in DBT Therapy
Thank you for reading this resource on 50 Questions to ask Clients in DBT Therapy Sessions. Clinicians who use DBT in their clinical work know that clarity, precision, and compassion are key components of effective treatment. By remembering that clients are doing the best they can at this moment, we can work to understand what skills could help them improve their day-to-day functioning.
DBT questions can be used to bring the material together that was introduced in a skills group and allow group members to provide each other with support and validation.Further examples of DBT questions that you could use in your clinical work would be dependent on relevant clinical information, including your client and your clinical setting. With the amount of empirical data supporting the use of DBT, there is no doubt that this can be a powerful theoretical approach to use with the appropriate clientele.
If you are interested in learning more about Dialectical Behavioral Therapy so that you can integrate into your own clinical practice, we encourage you to seek out continuing education courses and other training opportunities.
TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health worksheets here.
View all of our DBT Therapy Worksheets