5 Common Mistakes Even Experienced DBT Therapists Make (And How to Avoid Them)
Here is a social-work-math word problem for you — A professor of Cognitive Behavior Therapy (CBT) and Dialectical Behavior Therapy (DBT), watched 40 recorded sessions each semester. Now multiply that by 10 years. Then add another 20 years worth of supervising DBT therapists. How many times did that educator see the same 5 mistakes repeatedly?
The Answer: A shit-ton
The surprising part isn't that people make mistakes—it's that they're almost always the same five mistakes. The good news? Every one of them is fixable.
1. Starting the Session Before Looking at the Diary Card
It sounds simple, but it's one of the most common ways therapists accidentally lose the thread in a DBT session.
Many therapists greet the client, ask how their week went, spend a few minutes catching up, and then eventually look at the diary card.
By then, the client has already introduced several highly charged topics, emotions are elevated, and the session has drifted away from the data.
The diary card isn't paperwork.
It's your roadmap.
It tells you:
life-threatening behaviors
therapy-interfering behaviors
quality-of-life targets
urges
skills used
where to focus your limited session time
and, to me, the most important data — are we making progress?
The most effective DBT therapists review the diary card before the client walks in—or at least immediately upon beginning the session—so they're already thinking about the treatment hierarchy before the conversation starts.
Ask yourself: Could someone watch your sessions and immediately tell that the diary card drives the treatment?
If not, before your next session, try shooting a quick text to your client the morning of session and remind them to send you that diary card. Even if it is incomplete, you have something to start with.
2. Letting Clients Skip the Diary Card (or Homework)
We've all done it —
The client forgot.
They were busy.
They had a rough week.
They claim it only added to their stress.
They promise they'll do it next time.
So we shrug and move on.
Unfortunately, that teaches something we didn't intend: "The homework isn't actually important."
DBT isn't built on insight alone. It's built on practice. When clients don't complete diary cards or homework, that's not something to ignore—it's often the therapy-interfering behavior (TIB) that deserves the session's attention. That doesn't mean shaming clients. It means getting curious.
What got in the way?
What skills were missing?
Are they on board with why it was even important to do in the first place?
How do we solve that problem before moving on?
Sometimes the failure to do homework is the treatment target.
Ask yourself: Would a rater watching this session agree that I have addressed this missing diary card or homework as a TIB?
Next session, if a client is missing a diary card or their homework, ask these 4 questions:
Did you understand how to do it and why (a strong rationale is what most therapists miss)?
Did you think about doing it?
Did an emotion get in the way of you doing it?
Were there any contingencies (reinforcers or punishers) that got in the way?
3. Having Fuzzy Boundaries Around Coaching Calls
Phone coaching is one of the most misunderstood parts of DBT. Some therapists become available 24/7 and burn themselves out. Others become so restrictive that clients stop using coaching altogether.
Neither extreme is particularly effective.
Successful DBT therapists are incredibly clear about:
when coaching is available
when it isn't
how clients should request it
what coaching is for
what happens after self-harm
expectations for follow-up
Clients generally appreciate predictable boundaries. In fact, clear limits often increase coaching effectiveness because everyone knows the rules. Remember: boundaries aren't barriers—they're part of the treatment.
Ask yourself, have I been clear about what coaching calls are for and how to utilize them effectively?
If not, next session, try using this tool to clarify and set your limits.
4. Ignoring the Treatment Hierarchy
One of the fastest ways for DBT to become "just another therapy" is abandoning the hierarchy.
Clients often arrive with ten urgent problems.
It's tempting to tackle whichever one feels most pressing—or whichever the client wants to discuss. That is why DBT provides you with a decision-making framework.
Ask yourself:
Was there any life-threatening behavior?
Any therapy-interfering behavior?
Any quality-of-life interfering behavior?
Is this the highest-priority target today?
The hierarchy exists because solving the "wrong" problem can unintentionally reinforce behaviors that keep clients stuck.
The hierarchy isn't restrictive. It's what keeps DBT focused.
And remember, you have the luxury of flexibility within the structure — as long as you can justify your flex clinically.
Here is an example — I once had a client whose diary card noted that during the previous week, he skipped DBT group, self-harmed once, and sold some of his most prized baseball cards. On its surface, you would think that the hierarchy would point me to targeting the self-harm or the missed group (TIB). However, knowing that in the past, selling his possessions was a step he reliably took every time he eventually followed through on a plan for suicide, I knew that was the behavior to target as a precursor for life-threatening behavior.
If I had focused on the wrong problem, I would have wasted our time and potentially could have lost this client.
5. Spending the Entire Session on the Behavior Chain
Behavior chains are one of DBT's greatest strengths. They're also one of the easiest places to lose an entire session.
Many therapists become detectives. They try to uncover and connect the dots of every thought. Every emotion. Every environmental cue. Every vulnerability factor. Every minute leading up to the target behavior.
Before they know it, 50 minutes have passed.
The chain is beautifully detailed...and the client leaves without learning a single new skill.
The goal of a behavior chain isn't to build the perfect timeline.
It's to identify:
where the chain could have been interrupted
which skills were missing
what the client needs to practice next time
The chain is the bridge—not the destination.
Leave enough time to rehearse new behaviors, troubleshoot obstacles, and help clients walk out knowing exactly what they'll try differently.
If you are not able to end a session with troubleshooting solutions, you did not get far enough fast enough. Work on your pacing. In general, I try to stick to the following session timeline:
5 minutes for diary card review and choosing our agenda
20 minutes for behavior chain analysis
10 minutes for missing links analysis
10 minutes for problem-solving or skills teaching and/or practice
5 minutes for troubleshooting the plan
Great DBT Isn't About Perfection
If you recognized yourself in any of these mistakes, welcome to the club.
Most experienced DBT therapists have made every one of them.
The difference is that expert DBT therapists notice these patterns, make small course corrections, and continue sharpening their skills.
Like our clients, we don't need perfection.
We need practice.
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