ABSTRACT
DBT addresses the complexity and multiplicity of clients’ problems by organizing treatment around hierarchical lists of treatment targets, referred to as target hierarchies. Each DBT modality (e.g. individual psychotherapy, skills class) has a target hierarchy outline that emphasizes the treatment tasks of that modality. The hierarchy used in individual therapy also serves as the overarching target hierarchy for the treatment. The treatment utilizes this target hierarchy in two main ways. First, the hierarchy lists, in order of treatment focus, the primary targets for Stage 1, providing a method for coherently addressing extensive comorbidity. Structuring the treatment around targets also allows for the systematic management of high-risk behaviours such as suicide attempts, non-suicidal self-injury behaviour or serious aggression. The organization of this hierarchy with the riskiest categories of behaviours at the top ensures that therapists and clients regularly review and, more importantly, directly treat these behaviours. During pre-treatment, the DBT individual therapist works with the client to identify the client’s specific target behaviours, link these targets to the client’s overall therapy goals and organize the targets in the hierarchy. Second, the target hierarchy structures the agenda in any given individual therapy session. Such targeting reduces confusion and lack of clarity about what to analyze in the session and assists the therapist to remain focused, even when the client brings multiple problems to the session or engages in behaviours that interfere with the session.
