DBT Next Steps Clinician's Manual Building a Life Worth Living

Developed over 25 years by preeminent experts, DBT Next Steps is a groundbreaking expansion of standard Dialectical Behavior Therapy (DBT) for clients who have moved beyond crisis behaviors--yet haven't achieved their goals in such areas as employment, school, and relationships. Combining skills training with exposure, contingency management, cognitive modification, and didactic strategies, DBT Next Steps fills a gap by systematically targeting quality-of-life–interfering behavior. In a convenient large-size format, this authoritative clinician's manual provides detailed lesson plans for six brand-new DBT skills modules: Perfectionism versus Reinforcement, Establishing and Reevaluating Relationships, Time Management, Managing Emotions Effectively, Succeeding after DBT, and Applications of Mindfulness. It shows how Next Steps can be incorporated into an existing DBT program or used as a follow-up treatment. Reproducible skills training handouts and assignments are provided in the related client resource, available separately: DBT Next Steps Skills Handouts.

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. Dr. Comtois now leads the DBT standard and training programs  at the University of Washington Medical Center Outpatient Psychiatry Clinic. She is the recipient of the Research Award from the American Foundation for Suicide Prevention and the Distinguished Psychologist Award from the Washington State Psychological Association, among other honors. In addition to leading the development of DBT Next Steps and the DBT-ACES program, she provides training and consultation in DBT internationally. 

Adam Carmel, PhD, is Clinical Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington (UW). Dr. Carmel was previously Clinical Assistant Professor in the Department of Psychology, where he taught DBT in the Behavioral Research and Therapy Clinics under the direction of Marsha M. Linehan. Prior to that, he served as Director of the DBT program at the Massachusetts Mental Health Center and Instructor at Harvard Medical School. Dr. Carmel is a recipient of teaching and mentoring awards from the UW Psychology Internship Program and the Beth Israel Deaconess Medical Center, Department of Psychiatry.

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 magazine's "Great Scientists: The Geniuses and Visionaries Who Transformed Our World." She is founder of the Linehan Institute and a Zen master.

I. Setting the Stage 
1. What Is Beyond the Crisis?
2. Structural Differences between Standard DBT and DBT Next Steps
3. Case Examples: Application of DBT Next Steps in Two Different Cases of Disability
II. DBT Next Step Strategies 
4. Recovery Goals: Bringing Clarity and Precision to Quality-of-Life Targets
5. Skills Training: Learning New Skills and Lots of Practice
6. 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 Living
9. Didactic Strategies: Teaching as Well as Doing
10. Smoothing the Process: Validation, Dialectics, and Commitment
III. Integrating DBT Next Steps into a Comprehensive DBT-ACES Program 
11. The Structure and Logistics of DBT-ACES
12. DBT-ACES Pretreatment
13. DBT Next Steps or DBT-ACES: Incorporating the Model in Full or in Parts
IV. The DBT-ACES Skills Curriculum
14. Overview of DBT Next Steps Skills Format and Strategies
15. Module: Perfectionism versus Reinforcement
16. Module: Establishing and Re-Evaluating Relationships
17. Module: Time Management Skills
18. Module: Managing Emotions Effectively
19, Module: Succeeding after DBT
20. Module: Applications of Mindfulness
Appendices
A. Sample Completed DBT Next Steps Skills-Training Class Notes
B. Blank Template for DBT Next Steps Skills-Training Class Notes
C. DBT Next Steps Pretreatment Materials: Client Application Checklist, Application Materials, and Individual and Group Therapist Performance Evaluation
References
Index