ABSTRACT
DBT addresses the complexity and multiplicity of clients' problems by organizing treatment around a hierarchical list of treatment targets, referred to as the target hierarchy. The treatment utilizes the target hierarchy in two main ways. First, the hierarchy lists, in order of importance, the primary treatment targets for Stage 1, providing a method for coherently addressing the extensive comorbidity in this client population. Structuring the treatment around targets also allows for the systematic management of high-risk behaviours such as parasuicide or serious aggression. The organization of the hierarchy with the riskiest behaviours at the top ensures that therapist and client regularly review and, more importantly, directly treat these behaviours. During pre-treatment, the DBT individual therapist works with the client to link these treatment targets to the client's overall goals for treatment. Second, the target hierarchy guides the session agenda and thus determines the structure and focus of any given session or interaction with the client. Effective targeting also reduces confusion and lack of clarity over direction and assists the therapist to remain focused during each session.
