The TF-DBT Hierarchy of Priorities


United States Department of Homeland Security

Key Points

1. TDBT provides a hierarchy of treatment priorities:
  • Suicidal thoughts or behaviors.
  • Treatment-interfering behaviors and/or ruptures to the therapeutic alliance.
  • Quality of life behaviors.
  • Skills training and reinforcement.
2. The first three priorities deal with crises, while the final priority deals with skills work.
3. Each COW is an opportunity to practice skills.
4. There are strategies to deal with the crisis.
  • Allocate COW time for the beginning or end of a session.
  • Use a diary card or chain analysis.

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The TF-DBT Hierarchy of Priorities

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