50 DBT Questions to Ask Clients in Therapy Sessions

Dialectical Behavior Therapy (DBT) was originally developed to treat Borderline Personality Disorder, and I often use it with clients who benefit from a structured, skills-based approach. In my experience, DBT works best when delivered as part of a multidisciplinary team, which provides support and collaboration throughout the treatment process. Typical DBT programming includes individual therapy, weekly skills group sessions, and team consultation meetings, though I tailor the structure and pacing to fit each client’s unique needs. Because treatment is individualized, the length of DBT can vary depending on the client’s goals, progress, and presenting concerns. Keep reading to explore 50 common DBT therapy questions I use in sessions to help clients build skills, manage emotions, and improve relationships.

DBT questions can be applied across a variety of interventions and throughout the different phases of treatment. In my practice, I often modify these questions to fit the individual needs, developmental level, and goals of each client. When using DBT questions, I always keep the seven core assumptions of DBT in mind:

• 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

For more valuable resources, view our DBT Tools and Resources hub

Getting Ready for Your First DBT Therapy Session with a New Client

When I prepare for a client’s first DBT session, I consider whether we have met previously or if this will be our initial meeting. Before diving into skills or interventions, I spend time providing psychoeducation about DBT—explaining what the treatment involves, the potential benefits, and the limitations clients might encounter.

I also make sure clients understand the different components of DBT, including skills groups, individual therapy, and case management with a multidisciplinary team. Once clients have a clear picture of what to expect, I review consent and confirm that they are ready to participate in treatment.

In the first session, I typically introduce the Biosocial Theory, explain how diary cards are used, review client and clinician expectations, discuss phone coaching, and begin developing a personalized treatment plan tailored to the client’s goals and presenting concerns. This foundation helps set the tone for collaboration, safety, and effective skill-building throughout the course of DBT.

Common DBT Questions I Ask Clients

In my practice, I use DBT questions throughout all phases of treatment (learn how to create a DBT treatment plan), but they are especially important in the early stages when introducing clients to core skills such as mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Thoughtful questioning helps clients engage with these skills, notice their experiences, and reflect on how the skills can be applied in real-life situations.

DBT Questions for Mindfulness

I incorporate mindfulness into DBT in a variety of ways, including observing thoughts and sensations, conducting mental body scans, practicing thought defusion, and using mindful breathing exercises. Many clients have at least some familiarity with mindfulness, and some may have practiced it previously. When I ask DBT questions about mindfulness, my goal is to support their experience, deepen their awareness, and help them strengthen their ability to use mindfulness practices effectively in and outside of session.

1. How can you see yourself incorporating mindful practices into your daily routine?
2. Do you have any reservations or hesitations about mindfulness practices?
3. What benefits do you hope to gain from using mindfulness skills?
4. Are there any barriers that could keep you from incorporating mindfulness skills into your life?
5. Are there any mindfulness skills or practices you’re excited about using?
6. Do you focus more on internal or external stimuli?
7. Are there any emotions in particular that you find challenging to sit with?
8. What is your understanding of mindfulness?
9. What has been your experience with mindfulness?
10. Which mindfulness practice or skill do you see yourself using the most?

DBT Questions for Distress Tolerance

The goal of Distress Tolerance Skills in DBT is to help clients navigate emotional crises without making the situation worse. In my sessions, I also emphasize learning to accept their current reality, especially in moments when they feel powerless or unable to change what’s happening. I use DBT questions throughout the various Distress Tolerance modules to check in with clients, explore their understanding of the skills, and ensure they are able to apply the techniques effectively in real-life situations.

11. Are there any behaviors or habits in your life that you would like to reduce or stop?
12. What physical sensations do you experience when you are in an emotional crisis?
13. Are there environmental triggers that contribute to emotional crises?
14. How likely do you feel you are to try engaging in a new enjoyable activity?
15. What are three new enjoyable or distracting activities that you can try in the coming days?
16. Are there any activities that you would want to avoid engaging in that others may find enjoyable?
17. How do you see yourself incorporating grounding skills into your daily routine? Where could you benefit from using them?
18. Can you describe a time where the RESISTT Technique could have been helpful to you?
19. What values are important to you in your life?
20. How do your values influence your behaviors?
21. 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. 
22. How have you used distress tolerance skills since our previous session?

DBT Questions for Emotion Regulation

Emotion Regulation is another essential component of DBT treatment. In my practice, these modules help clients identify, understand, and label their emotions while learning strategies to reduce the intensity and frequency of unpleasant emotional experiences. I’ve found this part of DBT particularly valuable for clients who have limited awareness or understanding of their emotional states, as it provides a framework for recognizing patterns and developing more adaptive responses.

23. What questions do you have about primary and secondary emotions?
24. Do you have any short term goals?
25. What is a long term goal you are working towards?
26. What changes can you make to your behaviors to promote your physical health?
27. Are there any areas of your physical health that concern you?
28. What myths about emotions resonates with you the most?
29. What emotions are you uncomfortable feeling?
30. What behaviors allow you to avoid your distressing emotions?
31. What changes will you notice within yourself when you are able to regulate your emotions in a healthier way?
32. How do you see the use of emotion regulation skills impacting your quality of life?
33. After reviewing a list of cognitive distortions, review the distortions that you can relate to.
34. Which cognitive distortion do you feel impacts you the most?
35. 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.)

DBT Questions for Interpersonal Effectiveness

Interpersonal Effectiveness Skills are designed to help clients build healthy, functional, and assertive relationship skills that they can apply across the different relationships in their lives. In my sessions, I introduce new concepts and strategies gradually, and I make a point of using targeted DBT questions to ensure clients fully understand the material and can practice it effectively in real-world situations.

36. What changes would you like to work towards regarding your communication skills?
37. How do you feel your communication skills impact your relationships?
38. What are some characteristics of a healthy relationship?
39. Can you describe a healthy relationship in your life?
40. What are traits associated with unhealthy relationships that you have experienced?
41. How do you feel assertive skills could help you in your relationships?
42. Can you describe the difference between assertiveness and aggressiveness to you?
43. What are some of the relationship qualities that build trust?
44. How important is trust to you in your relationships?
45. Whom do you trust in your life?
46. How successful do you feel you are at setting boundaries?
47. What is an example of a boundary you would like to set in a relationship you have?
48. What are some barriers you have experienced when you have tried to establish boundaries in the past?
49. How do you feel in situations of conflict?
50. How do you feel you could improve the way you respond to conflict?

Final Thoughts On Asking the Right DBT Questions in Therapy

Thank you for reading this resource on 50 DBT questions to ask clients in counseling sessions. In my experience, clarity, precision, and compassion are essential components of effective DBT treatment. By keeping in mind that clients are doing the best they can in the moment, I can focus on identifying which skills will most effectively support their day-to-day functioning.

I often use DBT questions to help clients consolidate material learned in skills groups while encouraging support and validation among group members. The specific questions I choose depend on each client’s clinical presentation, their goals, and the setting in which I am working. With the strong empirical support behind DBT, I have found it to be a powerful approach when applied thoughtfully with the appropriate clientele.

For clinicians interested in deepening their DBT skills, I encourage pursuing continuing education and specialized training. Supervision has also been invaluable in my practice, helping me apply these techniques safely and effectively while refining my approach for each client. I also recommend checking out this resource I created, DBT exercises to do with your clients in therapy sessions.

View all of our DBT Therapy Worksheets

Resources:

• DialecticalBehaviorTherapy.com. “DBT Mindfulness: Exercises, Videos and Worksheets.” Accessed December 8, 2025. https://dialecticalbehaviortherapy.com/mindfulness/