Starting Dialectical Behavior Therapy (DBT) can feel uncertain—especially if you’re addressing mental health issues, addiction, or emotional dysregulation. DBT differs from traditional talk therapy by offering structured skills training, active therapist guidance, and a balance between acceptance and change.
This post will look into what happens during your first few DBT sessions, how this form of therapy supports co-occurring challenges like substance use and trauma, and what outcomes you can expect.
The Initial Assessment
Your first session typically initiates a multi-week assessment process. During this time, your therapist will gather a wide range of information, including your psychiatric history, any prior diagnoses, and patterns of mental health symptoms like depression, trauma, or personality disorders. You’ll also be asked about your history of substance use or addiction, along with any tendencies toward impulsivity, emotional instability, or self-harming behavior.
This phase is more than just information-gathering; it’s also an opportunity for you and your therapist to build rapport and establish a safe therapeutic space. You’ll work together to explore current emotional struggles, clarify the goals of DBT, and lay the foundation for your treatment journey.
As part of our integrated care for individuals facing emotional dysregulation, addiction, and co-occurring mental health conditions, we provide Dialectical Behavior Therapy in Minneapolis, Minnesota. This comprehensive assessment helps us tailor your treatment plan to address both the emotional and behavioral patterns that may be impacting your recovery.
Setting Goals
A central part of DBT is identifying your vision of a “life worth living”—a concept that helps align treatment with your personal values. That’s why In the early sessions, you and your therapist will begin setting personalized goals for therapy. These might include improving emotional stability, reducing self-destructive behaviors, enhancing relationships, or achieving long-term sobriety.
DBT is a highly structured therapy, typically lasting six to twelve months. It involves weekly individual sessions and group skills training. Your therapist will explain the commitment DBT requires, including the use of diary cards to track emotions and behaviors, regular homework assignments, and active participation. These accountability measures are designed to help you build consistent, lasting change.
Learning the Four Core DBT Modules
Early in your DBT journey, your therapist will also introduce you to the four core skill areas that DBT focuses on:
- Mindfulness – The foundation of DBT. You’ll learn to observe your thoughts and feelings in the present moment without judgment.
- Emotion Regulation – Skills to help you understand, label, and manage intense emotions more effectively.
- Distress Tolerance – Techniques for getting through crisis situations without making things worse.
- Interpersonal Effectiveness – Strategies for improving communication, setting boundaries, and maintaining relationships.
These modules are designed to help you build a “life worth living” by strengthening emotional and behavioral skills in everyday situations. Your therapist will explain how these areas apply to your unique struggles and which ones will be prioritized in treatment.
Understanding the Biosocial Theory
Another key part of your early sessions involves learning about Biosocial Theory, the core framework behind DBT. This theory explains emotional dysregulation as the result of a combination of biological sensitivity and environmental invalidation. In other words, some people are naturally more emotionally reactive, and when they grow up in environments where their feelings are dismissed, criticized, or misunderstood, they may develop unstable emotional and behavioral patterns.
Your therapist will help you understand how your upbringing, relationships, and past experiences may have contributed to your current struggles. The goal is not to assign blame but to give you clarity and insight into why you feel the way you do.
DBT with Addiction & Dual Diagnosis
DBT has been adapted to support individuals with substance use disorders, especially when these are combined with other mental health challenges such as PTSD, depression, or borderline personality disorder. Known as DBT-SUD, this approach integrates traditional DBT skills with relapse prevention strategies, making it especially useful for people with dual diagnoses.
In DBT-SUD, you’ll work on establishing abstinence by setting daily or short-term goals. Therapists use mindfulness and distress tolerance skills to help you manage cravings, avoid relapse, and cope with high-risk situations. Many programs also incorporate behavior chain analysis to explore what leads up to substance use, allowing you to identify and disrupt harmful patterns.
Research shows that DBT-SUD can significantly improve treatment retention, reduce drug and alcohol use, and enhance emotional resilience for those recovering from addiction. If you’ve struggled with repeated relapses or co-occurring disorders, this structured, skill-based therapy may offer the support you need.
What a Typical DBT Session Looks Like
While your first session is focused on assessment, future sessions will follow a more consistent structure. These often include:
- Reviewing your diary card entries
- Analyzing any problematic behaviors that occurred
- Practicing or applying DBT skills to current challenges
- Working through emotional experiences using the balance of acceptance and change
Over time, you’ll develop a toolbox of coping strategies that help you reduce emotional suffering and improve your day-to-day functioning.
Evidence-Based Benefits You Can Expect
DBT is one of the most well-researched forms of therapy for individuals with complex emotional and behavioral difficulties. Clinical studies show that it can reduce self-harming behaviors and suicide attempts by up to 50%. It’s also been found to improve emotion regulation in more than 70% of participants and significantly reduce psychiatric hospitalization and treatment dropout rates.
For individuals with substance use disorders, DBT has been linked to reduced cravings, fewer relapses, and greater long-term abstinence. When delivered through a comprehensive program—combining individual therapy, group skills, and between-session support—DBT offers a reliable, evidence-based pathway toward healing.
Final Thoughts from Northwoods Haven Recovery
Your first DBT session is the beginning of a transformative process. It’s normal to feel nervous, unsure, or even skeptical—but showing up is a courageous first step. Over time, DBT offers not just symptom relief but an opportunity to build emotional resilience, healthier relationships, and a life rooted in self-respect.
At Northwoods Haven Recovery, we offer dialectical behavior therapy (DBT) in Minneapolis, Minnesota, as part of our evidence-based approach to treating substance use disorders and co-occurring mental health challenges. Our compassionate team is here to guide you through each step of the recovery journey with structure, support, and clinically proven tools for lasting change.
