DBT Next Steps Clinician's Manual

Katherine Anne Comtois, PhD, MPH, is Professor in the Department of Psychiatry and Behavioral Sciences and Adjunct Professor in the Department of Psychology at the University of Washington. She was a research therapist and co-investigator with Marsha M. Linehan on her clinical trials from 1994 to 2006 and Director of the DBT program at Harborview Mental Health and Addiction Services from 1996 to 2019. She now leads the DBT standard and training programs at the University of Washington Medical Center Outpatient Psychiatry Clinic. Dr. Comtois provides training and consultation on DBT Next Steps and the DBT-ACES program through the University of Washington. In addition, Dr. Comtois provides training and consultation in standard DBT internationally as an independent contractor with Treatment Implementation Collaborative LLC.Adam Carmel, PhD, is Clinical Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. He is Codirector of the Annual Comprehensive DBT Training program in the Department of Psychiatry and Behavioral Sciences at the University of Washington. He was previously Director of the Massachusetts Mental Health Center’s DBT program operated by the Massachusetts Department of Mental Health. Dr. Carmel was previously Clinical Assistant Professor in the Department of Psychology at the University of Washington, where he taught DBT in the Behavioral Research and Therapy Clinics under the direction of Marsha Linehan.Marsha M. Linehan, PhD, ABPP, the developer of Dialectical Behavior Therapy (DBT), is Professor Emeritus of Psychology and Director Emeritus of the Behavioral Research and Therapy Clinics at the University of Washington. Before retiring in 2019, she devoted her career to developing and evaluating evidence-based treatments for populations with high suicide risk and multiple, severe mental disorders. Dr. Linehan is the 2025 recipient of the Lifetime Achievement Award from the American Foundation for Suicide Prevention. Her contributions to suicide research and clinical psychology research have also been recognized with the University of Louisville Grawemeyer Award for Psychology, the Career/Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapies, the Gold Medal Award for Life Achievement in the Application of Psychology from the American Psychological Foundation, and the James McKeen Cattell Award from the Association for Psychological Science. In her honor, the American Association of Suicidology created the Marsha Linehan Award for Outstanding Research in the Treatment of Suicidal Behavior. Dr. Linehan was featured in TIME Great Scientists: The Geniuses and Visionaries Who Transformed Our World. She is founder of the Linehan Institute and is a Zen master.

"As a DBT clinician, supervisor, and trainer, I find DBT Next Steps Clinician's Manual to be one of the most immediately applicable treatment manuals I have read in years. There are numerous tools that I can instantly use with my clients. Differentially applying GIVE skills in work and social situations, improving time management on daily tasks, challenging perfectionistic thinking and behaviors, and integrating more positive reinforcement are just a few of the critical components of DBT Next Steps. The manual has clear lesson plans and examples, in-session practice exercises, and assignments to help clients practice and generalize their skills. I will highly recommend this manual and the companion client resource to everyone I train and supervise. Next Steps can be woven into a current DBT program or applied as a freestanding treatment, depending on the client's level of functioning and the skills already acquired."--Alec L. Miller, PsyD, Cofounder, Cognitive and Behavioral Consultants, White Plains and New York City"This is what DBT therapists have been clamoring for! DBT Next Steps Clinician's Manual provides invaluable insights and practical tools for therapists to help clients overcome barriers to building full and satisfying lives once the crises have stopped. Whether you treat psychiatrically and financially disadvantaged persons or those who struggle with other barriers to self-sufficiency, this is the manual for you.”--Kathryn E. Korslund, PhD, ABPP, Director of Clinical Care, Two Chairs"Together, DBT Next Steps Clinician's Manual and DBT Next Steps Skills Handouts are a labor of love that is designed to help build up lives. The beautifully clear, in-depth manual expertly guides clinicians through key teaching points, and includes abundant case examples that bring the teachings to life. The client handouts and assignments break down complicated concepts in a user-friendly style that fosters everyday application of the Next Steps skills."--Janice R. Kuo, PhD, Department of Psychology, Palo Alto University"The focus of DBT Next Steps on getting me out of the mental health system has been a complete success. I pay my own bills, live by myself in my own apartment, and have been for 2 years! I went from not knowing whether I’d see my next birthday to looking forward to every week as an opportunity to connect with people and live a life I’m proud of."--Francis C."DBT Next Steps was revolutionary for me. Although being in DBT helped bring me out of crisis, I knew it was DBT Next Steps that would help me gain the traction I needed to build a life worth living. The program taught me so much about finding and respecting my own limits while also pushing me to live a full and effective life. Years out of the program, I continue to visit the skills from it daily. I am so grateful for the growth and stability DBT Next Steps has brought into my life."--Lou D."I was lucky enough to do a year of Next Steps after a first year of DBT. It helped me refine my ambitions, accomplish the goals that were most important to me, and feel like I was living a worthwhile life. Because of this program I was able to finish grad school after a lengthy medical leave--there's no way I would have had the skills to do that without Next Steps. Several years later, I still refer back to the materials. I recommend DBT Next Steps to anyone who is surviving their life but not thriving yet."--Alice Z.-

• I. Setting the Stage1. What Is Beyond the Crisis?2. Structural Differences between Standard DBT and DBT Next Steps3. Case Examples: Application of DBT Next Steps in Two Different Cases of DisabilityII. DBT Next Step Strategies4. Recovery Goals: Bringing Clarity and Precision to Quality-of-Life Targets5. Skills Training: Learning New Skills and Lots of Practice6. Exposure Strategies: Are Effective Behaviors Blocked by Problematic Shame or Fear?7. Contingency Management: Are Ineffective Behaviors Getting Reinforced?8. Cognitive Modification: When Your Beliefs Interfere with Building a Life Worth Living9. Didactic Strategies: Teaching as Well as Doing10. Smoothing the Process: Validation, Dialectics, and CommitmentIII. Integrating DBT Next Steps into a Comprehensive DBT-ACES Program11. The Structure and Logistics of DBT-ACES12. DBT-ACES Pretreatment13. DBT Next Steps or DBT-ACES: Incorporating the Model in Full or in PartsIV. The DBT-ACES Skills Curriculum14. Overview of DBT Next Steps Skills Format and Strategies15. Module: Perfectionism versus Reinforcement16. Module: Establishing and Re-Evaluating Relationships17. Module: Time Management Skills18. Module: Managing Emotions Effectively19, Module: Succeeding after DBT20. Module: Applications of MindfulnessAppendicesA. Sample Completed DBT Next Steps Skills-Training Class NotesB. Blank Template for DBT Next Steps Skills-Training Class NotesC. DBT Next Steps Pretreatment Materials: Client Application Checklist, Application Materials, and Individual and Group Therapist Performance EvaluationReferencesIndex