Deliberate Practice in Dialectical Behavior Therapy

Deliberate practice exercises allow students and trainees to rehearse foundational dialectical behavior therapy (DBT) skills and strategies to respond effectively and flexibly to diverse, complex clinical presentations and situations.

Each book in the Essentials of Deliberate Practice series contains customized role-playing exercises in which two trainees act as a client and a therapist, switching back and forth under a supervisor's guidance. The trainee playing the therapist improvises appropriate and authentic responses to client statements organized into three difficulty levels—beginner, intermediate, and advanced—reflecting common issues encountered by DBT practitioners.

The first 12 exercises each focus on a single skill, such as validating clients, encouraging commitment to therapeutic goals, teaching problem-solving skills, and working with clients in crisis or expressing suicidal ideation. Following these are two comprehensive exercises—an annotated transcript and free-form mock therapy sessions—in which trainees integrate essential skills into a single DBT session.

Step-by-step instructions guide participants through the exercises, identify criteria for mastering each skill, and explain how to monitor and adjust difficulty. Guidelines to help trainers and trainees get the most out of training are also provided.

To demonstrate how deliberate practiceopens in new window can be fully integrated into a professional curriculum, this series features exercises developed and refined within the clinical training curriculum at the Sentio online marriage and family therapy (MFT) therapist training programopens in new window in California, which is where we started developing this series. These exercises, which have been tested at clinical training sites around the world, are used to enhance clinical outcomes within the firsthybrid MFT program approved by the California Board of Behavioral Sciencesopens in new window (BBS) to fully integrate deliberate practice into its entire curriculum. By integrating these models into its hybrid MFT program in California, Sentio University demonstrates that therapist training graduate programs can use deliberate practice to bridge the gap between theory and clinical mastery through repetitive, feedback-informed practice to support the development of modern, outcome-focused clinicians.

Series Preface
Tony Rousmaniere and Alexandre Vaz

Acknowledgments

Part I. Overview and Instructions

• Chapter 1. Introduction and Overview of Deliberate Practice and Dialectical Behavior Therapy
• Chapter 2. Instructions for the Dialectical Behavior Therapy Deliberate Practice Exercises

Part II. Deliberate Practice Exercises for Dialectical Behavior Therapy Skills

Exercises for Beginner Dialectical Behavior Therapy Skills

• Exercise 1. Establishing a Session Agenda
• Exercise 2. Validation
• Exercise 3. Reinforcing Adaptive Behaviors
• Exercise 4. Problem Assessment

Exercises for Intermediate Dialectical Behavior Therapy Skills

• Exercise 5. Eliciting a Commitment
• Exercise 6. Inviting the Client to Engage in Problem Solving
• Exercise 7. Skills Training
• Exercise 8. Modifying Cognitions
• Exercise 9. Informal Exposure to Emotions

Exercises for Advanced Dialectical Behavior Therapy Skills

• Exercise 10. Coaching Clients in Distress
• Exercise 11. Promoting Dialectical Thinking Through Both–And Statements
• Exercise 12. Responding to Suicidal Ideation

Comprehensive Exercises

• Exercise 13. Annotated Dialectical Behavior Therapy Practice Session Transcript
• Exercise 14. Mock Dialectical Behavior Therapy Sessions

Part III. Strategies for Enhancing the Deliberate Practice Exercises

• Chapter 3. How to Get the Most Out of Deliberate Practice: Additional Guidance for Trainers and Trainees

Appendix A. Difficulty Assessments and Adjustments

Appendix B. Deliberate Practice Diary Form

Appendix C. Sample Dialectical Behavior Therapy Syllabus With Embedded Deliberate Practice Exercises

References

Index

About the Authors

Tali Boritz, PhD, CPsych, is an assistant professor in the Clinical Psychology Program in the department of psychology at York University and a collaborator scientist in the Borderline Personality Disorder (BPD) Clinic at the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. She specializes in the treatment of BPD and complex trauma. Her research at York University and CAMH focus on psychotherapy process and outcome and psychotherapy training in BPD treatments.

Shelley McMain, PhD, CPsych, is an associate professor in the department of psychiatry at University of Toronto, head of the Borderline Personality Disorder Clinic and a Clinician Scientist at the Centre for Addiction and Mental Health (CAMH), and cofounder of the Centre for MindBody Health in Toronto. She currently serves on the DBT Strategic Planning Committee and on the Scientific Advisory Board of the Linehan Institute. Recognized as a leader in dialectical behavior therapy in Canada and internationally, Dr. McMain conducts research in DBT, personality disorders, emotion regulation, suicide and self-harm, substance abuse, and psychotherapy process and outcomes.

Alexandre Vaz, PhD, is chief academic officer of Sentio University marriage and family therapy (MFT) program in Californiaopens in new window. This innovative online/hybrid MFT programopens in new window was the first approved by the California Board of Behavioral Science for MFT licensure to fully integrate deliberate practiceopens in new window into its curriculum to ensure superior clinical outcomes. He is also director of clinical training for the Sentio Counseling Centeropens in new window which is Sentio MFT program’s guaranteed practicumopens in new window site where students provide low-cost online couples therapy in Californiaopens in new window. Dr. Vaz is the author/coeditor of many books on deliberate practice and psychotherapy training.

Tony Rousmaniere, PsyD, is president of Sentio University marriage and family therapy (MFT) program in Californiaopens in new window. He led the development of online/hybrid MFT programopens in new window, which is the first MFT therapist training program approved by the California Board of Behavioral Science for MFT licensure that fully integrates deliberate practiceopens in new window. Dr. Rousmaniere is the author/coeditor of many books on psychotherapy training. He is also the executive director of the Sentio Counseling Centeropens in new window, which is Sentio MFT program’s guaranteed practicumopens in new window site where students provide sliding-scale online therapy in Californiaopens in new window, and past president of the APA’s Division 29.

Trainee therapists and their supervisors will find an absolute treasure trove within this short volume. Boritz and colleagues have used their considerable expertise to develop a detailed set of deliberate practice exercises, of different levels of difficulty, to support therapists as they learn and shape their dialectical behavior therapy practice. This unique volume provides behaviorally specific instructions, enabling all therapists, regardless of their prior experience, to benefit from engaging with the exercises. For those new to deliberate practice, the authors clearly describe all the necessary steps to maximize learning.
—Michaela A. Swales, PhD, Professor of Clinical Psychology, North Wales Clinical Psychology Programme, Bangor University, Bangor, Gwynedd, North Wales, and Director of Training, British Isles DBT Training, Wrexham, England, United Kingdom

This book is part of the Essentials of Deliberate Practice series by Tony Rousmaniere and Alexandre Vaz. The materials on this page include a Deliberate Practice Reaction Form and a Deliberate Practice Diary Form that can be used with every book in this series, as well as volume-specific content.

These documents are offered for your personal use in clinical training or teaching courses. If you reprint or adapt them for publication, permission is required from the publisher.

Deliberate Practice Reaction Form

The Deliberate Practice Reaction Form can be used with any of the deliberate practice exercises throughout the series to measure how challenging it was for the trainees and to adjust the difficulty as needed. Appendix A includes a black-and-white version of the form with instructions for assessing and modifying an exercise’s difficulty. A color version of the Deliberate Practice Reaction Form is also available for individual download.

• Appendix A: Difficulty Assessments and Adjustmentsopens in new window (PDF)
• Deliberate Practice Reaction Formopens in new window (PDF)

Deliberate Practice Diary Form

The Deliberate Practice Diary Form is an optional form that trainees can complete during a training session’s final evaluation or between sessions to process their experiences with the activity, including what was and was not helpful and what they learned. Appendix B, which is the same across all books in the series, presents this form.

• Appendix B: Deliberate Practice Diary Formopens in new window (PDF)

Volume-specific materials

The following content is unique to Deliberate Practice in Dialectical Behavior Therapy and includes a sample syllabus that integrates the deliberate practice exercises into a standard clinical course.

• Appendix C: Sample Dialectical Behavior Therapy Syllabus With Embedded Deliberate Practice Exercises (PDFopens in new window | Wordopens in new window)

Video demonstration

A YouTube series (Practice Time! with Amy DeSmidt and Jamie Manseropens in new window) highlights authentic deliberate practice sessions featuring exercises from this book and other releases in the Essentials of Deliberate Practice series.

Additional resources

Deliberate Practice in Dialectical Behavior Therapy APA Books Webinaropens in new window

Supplemental resources for therapist training

Designed for faculty at graduate institutions, these supplemental resources provide a framework and clear examples for implementing deliberate practice within existing therapist training curricula. Sentio University is where we started to develop what would become the APA Essentials of Deliberate Practice series. We provide a comprehensive suite of free psychotherapy training resources based on the deliberate practice methodologyopens in new window. These materials are designed to supplement modern hybrid and online therapist training curricula and are used extensively within our own clinical programs.

• California MFT program integration: These materials are a core component of the Sentio hybrid MFT program in Californiaopens in new window, the first in the state to fully integrate DP into its entire curriculum and receive California Board of Behavioral Sciences approval for licensure.
• Free deliberate practice exercises: Access our library of therapist skill-building worksheetsopens in new window used to enhance the online California MFT degree through repetitive, feedback-informed practice.
• Deliberate practice video demonstrations: Visit our YouTube channel for free therapist training videosopens in new window to view clinical demonstrations from the APA Essentials of Deliberate Practice book series. These videos illustrate key skills used to enhance the online California MFT degree through repetitive, feedback-informed practice.
• AI and emerging therapy resources: Learn how deliberate practice can be used to safely and ethically integrate AI for therapist trainingopens in new window. Review our AI research programopens in new window and our clinical guidelines on using AIopens in new window to prepare for the modern landscape of digital mental health.