Questions to Ask a DBT Therapist Before Starting

The Problem With Finding DBT

Dialectical Behavior Therapy is one of the most effective treatments for emotional dysregulation, self-harm, and borderline personality disorder. It is also one of the most commonly diluted. Many therapists say they "do DBT" when what they actually do is borrow a few DBT concepts and sprinkle them into regular talk therapy.

The gap between comprehensive DBT and "DBT-informed" therapy is enormous. Comprehensive DBT is a structured, multi-component program that includes individual therapy, a skills group, phone coaching, and a therapist consultation team. If any of those components are missing, what you are getting is not the full treatment that the research supports.

That does not mean DBT-informed therapy is worthless. But if you need the real thing, especially if you are dealing with chronic suicidality, self-harm, or severe emotional instability, you deserve to know exactly what you are signing up for.

Questions About Program Structure

Do you offer comprehensive DBT or DBT skills-only?

This is the single most important question. Comprehensive DBT includes all four components: individual therapy, skills group, phone coaching, and a therapist consultation team. Skills-only DBT teaches you the four skill modules (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness) without the other components.

Good answer: A clear explanation of which format they offer and why. If they offer comprehensive DBT, they should be able to describe all four components. If they offer skills-only, they should be transparent about what is and is not included.

Watch out for: "I do DBT in individual sessions" without mentioning any other component. This is likely DBT-informed therapy, which may be useful but is not comprehensive DBT.

Do you have a DBT skills group, and is it required?

In comprehensive DBT, the skills group is not optional. It is where you learn the four core skill modules over a cycle that typically lasts 24 to 28 weeks. The group meets weekly for about two hours and functions more like a class than traditional group therapy.

Good answer: They offer a group, can describe its structure and schedule, and explain why it matters.

Do you provide phone coaching between sessions?

Phone coaching is one of DBT's most distinctive features. It allows you to contact your individual therapist between sessions for brief, real-time help applying skills during a crisis. This is not a therapy session over the phone. It is a short, focused conversation to help you use what you have learned when it matters most.

Good answer: Yes, with clear guidelines about when and how to use it.

Watch out for: A therapist who has never heard of phone coaching or dismisses it as unnecessary. This is a sign they are not trained in comprehensive DBT.

Do you participate in a DBT consultation team?

The consultation team is the component most people do not know about. DBT therapists meet weekly with other DBT therapists to support each other, maintain treatment fidelity, and troubleshoot difficult cases. It exists because the work is hard, and even skilled therapists need support to stay effective.

Good answer: Yes, and they can describe their consultation team.

Questions About Training

What DBT-specific training have you completed?

Formal DBT training typically involves an intensive training program through Behavioral Tech (the organization founded by Marsha Linehan) or a similar evidence-based training body. This is a multi-part training that includes practice, consultation, and demonstration of competency.

Good answer: They describe specific training programs, the number of hours completed, and ongoing education.

Watch out for: "I learned DBT in graduate school." Most graduate programs provide only a brief overview of DBT. Delivering it requires specialized post-graduate training.

How long have you been delivering DBT?

Experience matters, especially with a treatment this structured. A therapist who has run multiple skills group cycles and worked with many clients in comprehensive DBT is better equipped to handle the complexities of the treatment.

Do you use diary cards?

Diary cards are a fundamental tool in DBT. Clients fill them out daily, tracking emotions, urges, behaviors, and skill use. Individual therapy sessions begin with a review of the diary card, which guides the session agenda. A DBT therapist who does not use diary cards is missing a core element of the treatment.

Questions About What To Expect

What does a typical week look like in your DBT program?

In comprehensive DBT, a typical week includes one individual therapy session (usually 50-60 minutes), one skills group (usually two hours), daily diary card completion, and the option for phone coaching as needed. This is a significant time commitment, and you should know that going in.

How is the skills group structured?

Good DBT skills groups follow a structured curriculum through the four modules. Groups typically cycle through all four modules over about six months, and many programs recommend completing at least two full cycles. The group is psychoeducational, meaning the focus is on teaching and practicing skills, not on sharing personal stories the way a traditional therapy group would.

How long is the program?

Standard comprehensive DBT is a one-year commitment. Some programs offer shorter versions, and research supports adapted formats for certain populations. But the full program requires real commitment.

Good answer: They describe the expected duration honestly and explain why it takes that long.

Watch out for: An open-ended "as long as you need it" without any structure. DBT is designed to be time-limited with clear stages of treatment.

What Real DBT Looks Like vs. Watered-Down Versions

Understanding the difference helps you evaluate what a therapist is actually offering. For an even deeper dive into this topic, see our full guide on how to tell if your therapist is doing real DBT.

Comprehensive DBT includes:

• Weekly individual therapy following the DBT treatment hierarchy
• Weekly skills group covering all four modules
• Phone coaching availability between sessions
• A therapist consultation team meeting weekly
• Diary cards tracked daily and reviewed in sessions
• Clear treatment targets and a structured approach to addressing them

Watered-down DBT might look like:

• Individual therapy that uses some DBT language but no structured protocol
• Teaching a few coping skills from the distress tolerance module
• No skills group, no phone coaching, no consultation team
• No diary cards or structured tracking
• No clear treatment hierarchy or time frame

Red Flags and Green Flags

Moving Forward

The search for a good DBT therapist may take some effort, especially if you are looking for comprehensive DBT. Programs that offer all four components are not available everywhere, and waitlists are common. But the effort is worth it.

For a broader set of questions that apply to any type of therapist, see our guide to 15 questions to ask a therapist. And for a full comparison of DBT and CBT, see our detailed breakdown of DBT vs CBT.

Looking for Real DBT?

Comprehensive DBT can be life-changing for people who struggle with intense emotions. Knowing what to look for is the first step.

Learn More About DBT