DBT session note template: individual, skills group and a completed example

A DBT session note is the written trace a therapist keeps of each contact in dialectical behaviour therapy. It follows the order of the target hierarchy, starts from the client's diary card and summarises the chain analysis of the behaviour worked on.

Below are two templates to copy (individual session, skills group), short formats for phone coaching and the consultation team, and a completed fictional example, written for therapists in the UK and Ireland.

How a DBT note differs from a CBT note

A CBT session note follows an agenda set with the client. In DBT, Geisser and Rizvi (2014) write, the diary card determines the direction of treatment each session.

• Headings follow the targets, and quality of life comes after life-threatening behaviour.
• Chain analysis is the central tool, a type of detailed functional analysis of one behaviour.
• Acceptance and change both appear. Behavioral Tech explains that DBT adds acceptance strategies, through validation, to the change strategies of CBT.

The four modes of DBT and what each leaves in the file

Behavioral Tech, a DBT training organisation, describes four modes of standard outpatient DBT: individual psychotherapy, skills training, in-the-moment phone coaching and consultation teams for therapists.

• Weekly individual therapy: the full note, by target.
• Skills group (a 24-week curriculum, according to Behavioral Tech): one group note plus one line per member.
• Phone coaching: a short entry per call.
• Consultation team: only decisions that change the care go in the client file.

The target hierarchy, heading by heading

In Stage 1, DBT ranks behaviours to target: life-threatening behaviour first, then treatment-interfering behaviour, then quality-of-life interfering behaviour (Geisser and Rizvi, 2014). Training materials add skills acquisition as a fourth level.

• 1. Life-threatening behaviour. Note what the client reported about the week, what was done in session and what was agreed. Plain: "Reports an urge to self-harm rated 4/5 on Thursday, no action taken by her account. Crisis plan reviewed together." Avoid: "moderate risk" with none of the facts behind the label.
• 2. Therapy-interfering behaviour. Note the client's (lateness, card not filled in, wanting to stop) and the therapist's. Plain: "Card completed 4 days out of 7, agreed a daily reminder." Avoid: "poorly engaged".
• 3. Quality-of-life behaviour. Note the behaviour worked on and the treatment plan goal it links to, in the same words. Plain: "Two nights under 4 hours; PLEASE reviewed." Avoid: "chaotic lifestyle".
• 4. Skills acquisition. Note the module and the exact skill. Plain: "DEAR MAN (interpersonal effectiveness), role play." Avoid: "worked on assertiveness".

What the note says about risk

This note is not a risk assessment: it sets down what was discussed and what was agreed. For a session centred on a crisis, see our crisis session note template. If you gave the client a resource, write it down. In the UK and Ireland, Samaritans can be reached free on 116 123, day or night (Samaritans Ireland lists the same number). In France, the national suicide prevention line is 3114.

NICE guideline CG78 (2009, England and Wales, last reviewed in 2015) suggests considering a comprehensive DBT programme for women with borderline personality disorder for whom reducing recurrent self-harm is a priority, and asks that, after a crisis, crisis plans be updated as soon as possible. If a plan was changed in session, we suggest the note says so.

Diary card: what goes into the note, what stays on the card

The diary card is filled in daily by the client and reviewed at the start of the session. We suggest dating it and filing it with the client's notes, then carrying over only what shaped the session.

• Goes into the note: card completed or not (how many days); any target 1 behaviour, with the day; the strongest urges; the skill used and whether it helped; change since the previous week; the behaviour chosen for the chain.
• Stays on the card: day-by-day emotion ratings, skill boxes not picked up, comments not discussed.

Chain analysis: full version on file, short version in the note

Linehan's chain analysis worksheet walks through a series of headings, summarised here without reproducing the worksheet.

• Problem behaviour: what, when, how often.
• Prompting event in the environment.
• Vulnerabilities in the person and around them.
• Chain of events, link by link.
• Consequences, including any harm caused.
• Skilful replacement behaviours.
• Prevention strategies.
• Repair: repair, correct and overcorrect the harm.

A solution analysis follows the chain: at each weak link, the skill that could have changed what came next. The full chain, often written by the client, goes on file. In the note, five or six lines are enough: behaviour, prompting event, vulnerabilities, key link, replacement skill, repair agreed. A missing-links analysis, from the same worksheets, helps when homework was not done.

Documenting validation and dialectical strategies

Behavioral Tech defines a dialectic as a synthesis or integration of opposites. A note without validation reads like a CBT note.

• Validation: "Anger validated as understandable after two short nights."
• Change: "Worked on the delay before sending an angry message."
• Commitment: what the client agrees to try, in their own words.

DBT individual session note template, ready to copy

• Header: client (initials or ID), date, length, session number, treatment stage; therapist's name, role and signature.
• Diary card: completed or not, number of days, data that shaped the session.
• Target 1, life-threatening behaviour: facts reported, what was done and agreed, resource given, or "none reported".
• Target 2, therapy-interfering behaviour: client side, therapist side.
• Target 3, quality of life: behaviour worked on, treatment plan goal concerned.
• Chain analysis summary: behaviour, prompting event, vulnerabilities, key link, replacement skill, repair.
• Skills: module and name of each skill reviewed or introduced, client's response.
• Validation and strategies: what was validated, change targeted, commitment.
• Phone coaching: number of calls since last session.
• Homework: diary card, skills practice.
• Next session: topics to pick up, date.

Completed example: Chloe, 27 (fictional client)

• Header: C. W., session 9, 03/11/2026, 50 minutes, Stage 1, signature.
• Diary card: completed 6 days out of 7. Self-harm urge 4/5 on Thursday, no action noted, anger 5/5. STOP used on Saturday, "it helped".
• Target 1: Chloe reports an urge to self-harm on Thursday after a conversation with her sister, with no action taken. Crisis plan agreed in session 3 reviewed together. Samaritans number given again. Nothing else reported.
• Target 2: 15 minutes late (bus). Therapist side: mindfulness exercise forgotten last week, done today.
• Target 3: sent her sister an insulting message on Thursday. Treatment plan goal 2, family relationships.
• Chain analysis summary: message sent at 11 pm. Prompting event, sister refused to look after her cat. Vulnerabilities, two short nights, skipped meals. Key link, the thought "she doesn't care about me". Replacement, STOP then wait until morning. Repair, apology drafted in session, Chloe to decide whether to send it.
• Skills: STOP (distress tolerance) reviewed. DEAR MAN (interpersonal effectiveness) introduced for her request to her sister, 10-minute role play.
• Validation and strategies: anger validated; change targeted at the delay before writing. Commitment: "sleep on it before any angry message".
• Phone coaching: one call on Saturday (entry below).
• Homework: diary card; written DEAR MAN; PLEASE, two meals a day.
• Next session: go over the DEAR MAN; return to Thursday's urge if it reappears.

DBT skills group note template

We suggest one group note, then one line in each member's file that never names another member.

• Header: date, length, facilitators, week of the programme, number present.
• Module: mindfulness, distress tolerance, emotion regulation or interpersonal effectiveness.
• Skill taught: exact name (GIVE, FAST, opposite action, wise mind).
• Homework review in general terms.
• Exercises and homework set.
• Line per member: present or absent, homework done or not, participation, anything to pass on to the individual therapist.

Example: "C. W. present, homework done (opposite action, twice). To pass on: finds it hard to stick to her values when refused (FAST)."

Phone coaching call entry

• Date, time, length, who called.
• Reason in one sentence, with distress level at the start and end if the client gives one.
• Skill suggested and module.
• Outcome, and what is held over to session.

Example: "Saturday, 9.10 pm, 6 minutes, call from Chloe. Angry after a message from her sister. STOP, then TIPP (cold water on the face). Says she feels calmer, pick up on Tuesday."

Consultation team: what goes in the client file

According to Behavioral Tech, the consultation team helps therapists monitor their fidelity to the treatment. We suggest putting in the client file only the decision that changes the care ("After team consultation on 05/11, homework review at the start of sessions") and keeping the rest in the team's own notes.

Record keeping in the UK and Ireland

The BACP Good Practice in Action 065 resource on confidentiality and record keeping (updated January 2024) sets out the main points for counsellors and psychotherapists.

• Keeping records that are appropriate, accurate, relevant, lawful and secure is part of the commitment to ethical practice.
• Under data protection law and the BACP Ethical Framework, notes should be adequate, relevant and limited to what is necessary for the service being provided.
• For a counsellor who finds note writing a chore, the guide suggests more factual notes, written close to the time of the session.
• The client is lawfully entitled to seek their disclosure, and amending notes to prevent disclosure is an offence.

BACP is a UK body: in Ireland, we suggest following your own professional body's guidance. For practice in France, Belgium or Switzerland, the same principles are a sound basis; in France, psychologists also refer to their 2021 code of ethics, under which documents are dated and carry the author's name and title. Everywhere, we suggest writing each note as if the client will read it.

Common mistakes in DBT notes

• Copying the whole diary card into the note.
• Writing out the full chain analysis instead of its summary.
• Leaving out therapist-side interference (homework not reviewed, an exercise forgotten).
• "Worked on emotion regulation" without naming the skill.
• Mixing consultation team content into the client file.
• A risk label with no facts, such as "moderate risk".
• Blurring thought, rated urge and action. Say which of the three the client reported.

Checklist before you close the note

• Date, length, name, role and signature present.
• Headings in target order.
• Target 1: facts, what was done and agreed, resource given, or "none reported".
• Interference noted on both sides.
• Chain in six lines at most, full version on file.
• Every skill named with its module.
• Validation and change both visible.
• Phone coaching, homework and next session topics written.

More formats: our clinical document templates and ACT therapy session notes.

Delta and DBT session notes

Delta is the clinical assistant for therapists: it takes your approach into account and keeps the memory of each client, useful when every session builds on the last.

• During the session, Delta transcribes what is said; afterwards, you can dictate your observations.
• It generates the session report, with topics for the next session.
• It updates the client file and the goals being tracked.
• In group sessions, it tells the voices apart.
• Data stays in Europe, in France, on infrastructure certified for health data, and no audio file is kept.

Sources

• Behavioral Tech, What is DBT? (modes, modules, validation; accessed 02/11/2026)
• Geisser S. and Rizvi S. L., The Case of Sonia Through the Lens of Dialectical Behavior Therapy, Pragmatic Case Studies in Psychotherapy, 2014
• BACP, Good Practice in Action 065: Confidentiality and record keeping within the counselling professions, January 2024
• NICE CG78, Borderline personality disorder: recognition and management, 2009
• Samaritans, talk to us on the phone