Skills Class 22 - Don’t Let It Slide: Targeting Therapy Interfering Behaviors in DBT

Dialectical Behavior Therapy (DBT) explicitly prioritizes therapy-interfering behaviors (TIBs), ranking them second only to suicidal and self-harm behaviors within the DBT treatment hierarchy. DBT assumes that effective treatment cannot occur when attendance, collaboration, or the therapeutic relationship are compromised, and therefore treats these behaviors as direct targets of intervention rather than secondary obstacles.
This clinical demonstration focuses on how DBT therapists identify and address therapy-interfering behaviors as they arise in real time. Using a live, role-played clinical interaction, the presenters will demonstrate DBT-consistent strategies for responding to behaviors such as missed or late sessions, noncollaboration, avoidance of therapeutic tasks, excessive contact, and behaviors that strain the therapeutic relationship. The demonstration highlights how therapists balance validation and change while aligned with the treatment hierarchy, clarity, precision and compassion.
Attention will be given to therapist decision-making in challenging moments, including the use of chain analysis, contingency management, and dialectical strategies to reduce reinforcement of therapy-interfering patterns. The presenters will also address therapist-interfering behaviors and the emotional responses that commonly arise when working with complex, high-risk clients.
Participants will observe interventions that can be applied across CBT-oriented treatments to improve engagement, maintain structure, and keep therapy moving forward. This demonstration is intended for clinicians seeking practical strategies for addressing behaviors that interfere with effective treatment delivery.