How do you write a progress note for DBT?

Record the diary card review with counts, which target you addressed first under the DBT target hierarchy, the intervention (such as a chain analysis or skills coaching), the client’s response, a risk assessment when urges or life-threatening behavior are present, and the plan with homework. Link each change to a treatment-plan goal.

What is the DBT target hierarchy?

In individual DBT sessions, life-threatening behaviors such as suicidal and self-harm behavior come first, then therapy-interfering behaviors such as missed sessions or incomplete diary cards, then quality-of-life-interfering behaviors such as conflicts, substance use or job problems. Skills building runs throughout. The note should show which targets the session covered and in what order.

How do you document a chain analysis in a progress note?

Summarize the target behavior, the vulnerability factors, the prompting event, the key thoughts, emotions and actions that led to the behavior, and the consequences. Then record the solution analysis: the skills or changes the client will use at each weak link. A few lines are usually enough.

Should DBT skills group sessions have their own notes?

Usually yes. A skills group is a separate service, so it typically has its own group note recording the module and skill taught, attendance and participation, and homework. The individual DBT note can refer to group attendance and skills use without repeating the group content.

What should a DBT progress note include about self-harm?

Record urges and any self-harm since the last session from the diary card, with dates and ratings, the risk assessment (current thoughts, plan, intent, access to means, protective factors and your risk formulation), the safety plan and the skills the client used or will use. Record crisis resources given, such as 988, and consultation with your team.

Progress Notes for DBT: Example and Template

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Overview

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Short answer: a DBT progress note follows the session agenda. Record what the diary card showed since the last session (urges and target behaviors, with counts), which target you worked on first under the DBT target hierarchy, the intervention (such as a chain analysis, solution analysis or skills coaching), how the client responded, a risk assessment whenever life-threatening behavior or urges came up, and the plan, including homework and any phone coaching use.

In standard DBT, individual sessions are organized by a target hierarchy: life-threatening behaviors first, then therapy-interfering behaviors, then quality-of-life-interfering behaviors, with skills building throughout. Comprehensive DBT also includes a weekly skills group (mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness), between-session phone coaching and a therapist consultation team. Your note should show which components the client is receiving and link the session to treatment-plan goals.

What to document in a DBT progress note

What to document in each progress note section for DBT, with fictional example wording
Section	What to document	Example wording
Session Summary	Diary card review: urges and target behaviors since the last session, with counts and ratings	“Diary card complete 6 of 7 days. Self-harm urges rated 3–4/5 on 2 days; no self-harm. One episode of shouting at a roommate.”
Session Summary	Program components attended	“Attended skills group (emotion regulation module); one phone coaching call on Saturday.”
Interventions	Which target was addressed first and the intervention used	“Agenda set by the target hierarchy: self-harm urges first, then the shouting episode (quality-of-life target). Chain analysis of the shouting episode.”
Interventions	Skills taught, coached or rehearsed	“Coached TIPP (paced breathing) and opposite action; rehearsed in session.”
Client Response	Engagement, links identified, skill practice and distress ratings	“Identified vulnerability factors (4 hours of sleep, skipped lunch) and the link where they could have walked away. Distress 6/10 to 3/10 after paced breathing.”
Client Response	Risk assessment when urges or life-threatening behavior are present	“Recent self-harm urges prompted a full suicide and self-injury risk assessment; see the worked note below for current thoughts, plan, intent, history, means, protective factors, risk formulation and safety actions.”
Plan Updates	Homework, coaching agreement and next targets	“Daily diary card; TIPP when distress is above 6/10; PLEASE skills for sleep and meals. Review solution analysis next session.”

If the diary card or session shows suicidal thoughts, self-harm or urges to act, assess and record current thoughts, plan, intent, preparatory behavior, past attempts, access to means, protective factors, your risk formulation and the safety plan. The 988 Suicide & Crisis Lifeline takes calls and texts at 988; for imminent danger, call 911 or go to the nearest emergency department.

How to Document Progress Notes for Dialectical Behavior Therapy

Session Summary

Overview of session focus, topics discussed, and client presentation

When documenting the Session Summary in DBT, focus on capturing the client’s reported symptoms, presenting concerns, identified triggers, and observed mood or affect during the session to provide a comprehensive clinical snapshot.

Document client-reported emotional states and intensity of distress during the session.
Note specific triggers or events discussed that contributed to dysregulated behavior or mood shifts.
Record the client’s primary presenting concerns as articulated in their own words.
Describe observed mood and affect, including congruence with reported emotions.
Summarize any changes in symptom frequency or severity since the last session.

Interventions

Therapeutic techniques and interventions applied during the session

The Interventions section should detail the specific DBT techniques, therapeutic modalities, and clinical observations applied during the session to address client needs and promote skill acquisition.

List DBT skills taught or reviewed, such as mindfulness, distress tolerance, emotion regulation, or interpersonal effectiveness.
Describe therapist-guided behavioral chain analysis conducted with the client.
Note use of validation strategies to acknowledge client experiences and emotions.
Record any role-play or experiential exercises implemented during the session.
Document therapist observations regarding client engagement and skill application in session.

Client Response

Client's reaction to interventions and observable progress

In the Client Response section, document the client’s reactions to interventions, clinical impressions of their progress, and any diagnostic considerations emerging from the session.

Describe client’s ability to understand and apply DBT skills during the session.
Note any verbal or nonverbal indicators of resistance, insight, or motivation.
Evaluate progress toward treatment goals related to emotional regulation and interpersonal effectiveness.
Record any emergent safety concerns or changes in risk level.
Include clinical impressions regarding symptom changes or diagnostic clarification.

Plan Updates

Changes to treatment plan, goals, and next session focus

Plan Updates should outline next steps in treatment, including assigned homework, modifications to the treatment plan, referrals, and scheduling of upcoming sessions tailored to the client’s evolving needs.

Specify homework assignments aimed at practicing DBT skills between sessions.
Document any changes to treatment goals or therapeutic focus based on client progress.
Note referrals made for additional services or support as needed.
Confirm scheduling of the next individual or group DBT session.
Outline any planned adjustments to frequency or modality of treatment delivery.