Beginning to Envision a Life Worth Living: An Introduction to Pretreatment Sessions in Dialectical Behavior Therapy

The pretreatment phase in dialectical behavior therapy (DBT) sets the critical foundation for working with multiproblem, often highly suicidal clients. Despite the importance of this stage of treatment, very little has been written to aid DBT clinicians in navigating these early sessions most effectively. This article describes the functions and goals of pretreatment in DBT and research relevant to strategies employed in pretreatment. Additionally, a case example of a pretreatment session in DBT is provided, and challenges commonly encountered in pretreatment are discussed, along with recommendations for overcoming those challenges. Clinical Impact Statement Question: What are the functions and goals of the pretreatment phase in dialectical behavior therapy (DBT), and how can therapists navigate pretreatment most effectively? Findings: No novel research findings are presented, but the recommendations and case example provided may prove useful to clinicians working to overcome the challenges of pretreatment in DBT. Meaning: DBT pretreatment strategies appear to promote goal identification and client commitment. Next Steps: More research is needed to determine which strategies in DBT's pretreatment sessions uniquely contribute to positive treatment outcomes.