Swenson & Linehan (2016) recommend when shifting between acceptance, change, and dialectics in a session, the therapist should:

1

Stay focused

on the primary target which provides the overall agenda and shift to secondary targets (i.e., instrumental targets), as needed in order to accomplish the primary target.

2

Remain alert

for the presence of currently active emotions in the client, especially those emotions that are poorly regulated, emotional dysregulation is the core construct for understanding, and treating clients in DBT.

3

Keep interventions

consistent with guidelines found in: (a) biosocial theory, (b) therapist’s agreements, (c) assumptions about clients, (d) assumptions about therapy, and (e) the current stage of treatment.

4

Use

the structural strategies for structuring the sessions (e.g., beginning a session, targeting, a diary card, etc.).

5

Implement

the suicide crisis protocol if suicidal behavior is increased or imminent.

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