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DBT Session Documentation: A Practitioner Guide

Dialectical Behaviour Therapy session notes have specific structural requirements: target hierarchy, diary card review, behavioural chain analysis, and skills coaching all need to be visible in the record. This guide outlines what each session note should contain.

Last reviewed 7 min read How we review
On this page
  1. DBT target hierarchy
  2. Standard session-note structure
  3. Diary card retention
  4. Phone coaching call documentation
  5. Consultation team
  6. Related reading

Summary

DBT individual therapy sessions follow a structured agenda — target hierarchy review, diary card, chain analysis, skills work. A defensible DBT session note maps onto that agenda. The structure also supports treatment fidelity if the practitioner is in DBT consultation team supervision.

DBT target hierarchy

Linehan's framework prioritises session content as:

  1. Life-threatening behaviours (suicide, self-harm).
  2. Therapy-interfering behaviours (lateness, non-completion of homework, missed sessions).
  3. Quality-of-life-interfering behaviours (substance use, eating issues, employment instability).
  4. Skills acquisition.

A session note should record where in the hierarchy the session focussed and why.

Standard session-note structure

  • Date, duration, mode (individual, telehealth, phone coaching).
  • Diary card review — which target behaviours occurred, frequency, intensity, urges.
  • Target identified for the session — and where it sits in the hierarchy.
  • Behavioural chain analysis (if conducted) — vulnerability factors, prompting event, links (thoughts, feelings, actions, sensations), problem behaviour, consequences. Document the analysis in a structured way; the chain itself is the clinical artefact.
  • Solution analysis — alternative responses identified at each link of the chain.
  • Skills coaching delivered — which skill, why, how the client engaged.
  • Therapy-interfering behaviours noted and addressed.
  • Homework agreed for between sessions.
  • Risk status — current SI/SH urges, safety plan in place.
  • Plan for next session.

Diary card retention

Diary cards are a clinical artefact. Practitioners should retain copies (or digital images) in the file. A session note that references "diary card reviewed" without the card itself in the record cannot be audited later.

Phone coaching call documentation

DBT phone coaching calls are part of treatment and need their own brief notes:

  • Date, time, duration.
  • Crisis or skills-coaching nature.
  • Skills suggested.
  • Outcome.

Consultation team

DBT practitioners working in fidelity programs attend weekly consultation team meetings. Those meetings have their own confidential record but the fact of consultation should appear in the client file.

How we review this guide

Library guides reference original Australian source authorities — not secondary commentary — and are updated when source material changes. Each guide cites the regulator, item descriptor, or governing standard it draws from so you can verify it directly.

Sources checked
  • Original Australian source authorities and peer-reviewed guidance
Review cadence
Reviewed annually and whenever a cited source authority publishes a material change. Last reviewed .
Not advice
Reference content for Australian practitioners and education staff. Not legal, clinical, or billing advice — verify against your governing body and current source documents.

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