What is the correct order of targets for an individual DBT session with a Stage 1 client?

• A. Decrease life-threatening behavior, decrease therapy-interfering behavior, decrease quality-of-life interfering behavior, increase behavioral skills
• B. Increase behavioral skills, decrease life-threatening behavior, decrease therapy-interfering behavior, decrease quality-of-life interfering behavior
• C. Decrease quality-of-life interfering behavior, increase behavioral skills, decrease life-threatening behavior, decrease therapy-interfering behavior
• D. Decrease therapy-interfering behavior, decrease quality-of-life interfering behavior, increase behavioral skills, decrease life-threatening behavior

Answer: (A)

In DBT, the sequence for Stage 1 targets starts with safety: first reduce life-threatening behaviors to remove imminent risk. Next, address therapy-interfering behaviors that disrupt treatment and the therapeutic relationship. After those are under control, focus on decreasing quality-of-life interfering behaviors that impair daily functioning. Only then do we prioritize increasing behavioral skills to sustain change. This is why the best order lists decreasing life-threatening behavior first, followed by decreasing therapy-interfering behavior, then decreasing quality-of-life interfering behavior, and finally increasing behavioral skills.