Understanding DBT Diary Cards
When processing behavioral incidents, particularly those involving intense emotions, use tools such as diary cards. Let’s take the example of Lisa, who had an argument with her boyfriend that escalated to feelings of suicidality.
A DBT diary card is not a traditional diary but a structured tool for client self-reporting. Lisa can mark yes/no on content agreed with her therapist, or rate feelings and urges from 0 to 5. Such assessments enable therapists to quickly identify areas and patterns of concern. For instance, if Lisa marks a “3” under suicidal urges on a Tuesday, while the rest of the week it’s at zero, that indicates a significant issue or incident that needs to be addressed.
In analyzing the diary card, the therapist can link emotional incidents like an argument to Lisa’s suicidal urges. This sparks a focused discussion, even if Lisa is reluctant to talk about the incident. The therapist’s role is to create a supportive environment, stressing the importance of addressing such issues whilst also respecting Lisa’s pace.
Tracking Actions and Urges
The therapist and Lisa created a customized diary card during their initial sessions. A client may choose to track specific behaviors or incidents, perhaps using personalized or humorous labels. In this way, essential components – in Lisa’s case, the tracking of suicidal urges and actions – are tailored to client needs and preferences.
Lisa’s goal was to reach a point where she experiences high urges but takes no harmful actions. This is also an indicator of progress, showing her enhanced ability to withstand intense emotions and urges without engaging in destructive behavior. The therapist guides Lisa in using various DBT skills to manage such feelings in the moment.
There is no one-size-fits-all DBT skill for every situation. Clients learn a variety of skills, akin to tools in a toolbox, for managing different challenges. The key is to choose the most appropriate skill for each situation.
Adopting the Right Therapeutic Stance
Achieving a Balance
Being an effective DBT therapist requires a balance between seriousness and approachability. The therapist must avoid being overly formal or patronizing. Adopting a conversational and genuine demeanor is key, even when discussing serious topics like suicidal urges. The therapist’s stance should reflect an appreciation of the gravity of the situation while being relatable and grounded.
Personalizing the Approach
DBT is a structured, manualized treatment, but it’s crucial for therapists to personalize their approach. Rigidly adhering to the manual can make relationships feel forced and unnatural. Therapists should develop and display their unique style, but in alignment with DBT principles, ensuring authenticity within effective interactions.
Looking for practical everyday tools? This print-friendly handout is just what you need. Click on the following link to download the PDF:
Implementing DBT Diary Cards in Therapy
This handout presents an overview of dialectical behavior therapy (DBT) diary cards in therapeutic settings, a crucial tool for understanding and managing clients’ intense emotional responses and behaviors. It focuses on the structured application of diary cards for client self-reporting, highlighting their role in identifying patterns of concern and facilitating targeted therapeutic discussions. The guide emphasizes the importance of collaboration between therapist and client in customizing diary cards, ensuring they accurately reflect and address individual needs and preferences. Additionally, it discusses the implementation of various DBT skills to manage challenging emotions and behaviors, underscoring the need for therapists to choose the most appropriate skill for each unique situation. The handout also touches upon the essential balance in the therapeutic stance, blending seriousness with approachability, and the importance of personalizing therapy while adhering to DBT principles.
Instructions
After you familiarize yourself with the use of DBT diary cards, you may Incorporate them in your therapeutic practice to track and understand client behaviors and emotional patterns. Initiate by working collaboratively with clients to create customized diary cards, ensuring they accurately reflect the individual’s needs and behavioral goals. Use these cards for clients to self-report feelings, urges, and behaviors and the gathered information can help identify patterns or spikes in emotional responses that require attention. Facilitate discussions based on diary card entries, mainly focusing on incidents or thoughts that trigger problematic behaviors. Guide clients in applying suitable DBT skills for managing intense emotions, emphasizing choosing the most effective skill for each situation. Throughout the process, maintain a balanced therapeutic stance that combines seriousness and approachability, personalizing your approach to align with DBT principles while fostering an authentic therapeutic relationship.