Dialectical Behavior Therapy: Assessment and Case Conceptualization

Dialectical behavior therapy (DBT) is built on a rich foundation of behavior therapy traditions and, through its innovative blend of dialectical philosophy, Zen Buddhism, and radical behaviorism, extends and enriches these traditions. Ultimately, DBT is a therapy that rests heavily on precise case formulation and the treatment plans that follow from it. Such case formulations are developed through the rigorous assessment procedures that were developed by radical behaviorists throughout the history of behavioral therapy. Similarly, many of the interventions that follow from these formulations have been developed and refined by many behavioral predecessors of DBT. For DBT clinicians, it is behavioral precision, devotion to assessing rather than inferring, and a commitment to precisely targeting controlling variables, paired with acceptance principles espoused by Zen Buddhism, that helps clients build lives worth living. Although DBT may differ from other behavioral therapies in its integration of acceptance-based philosophies, principles over protocols, and a range of assumptions that are central to the treatment, the underpinning emphasis on precision in formulating and targeting behaviors is a shared feature that lives in the “DNA” of DBT, along with its behavioral therapy family members.