Exploring the Targeting Hierarchy in DBT for Suicidal Behaviors

Robert-Wagner
DBT Centre of Vancouver, Inc.

Key Points

  1. The targeting hierarchy is presented to clients early in treatment to prioritize and methodically address their issues, beginning with life-threatening behaviors.
  2. The therapist is emphatic about addressing therapy-interfering behaviors that can arise from either the client or the therapist to maintain the integrity of the treatment process.
  3. Once the more immediate concerns are managed, the therapeutic focus shifts to the client’s goals, such as improving emotional regulation and reducing symptoms of depression.
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In initial sessions, often within the first four encounters, the concept of a targeting hierarchy is introduced to patients like Sophia. The aim is to establish a structured approach to address the variety of problems they face, acknowledging the impossibility of dealing with all of them at once. This structure helps organize the therapeutic sessions to help clients achieve their goals.

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