Dialectical behavior therapy (DBT) is an evidence-based treatment for individuals with severe emotion regulation difficulties and borderline personality disorder (BPD). The treatment comprises four stages that are structured based on the client’s level of disorder (e.g., severity, complexity), and each stage includes both primary and secondary treatment targets. In Stage 1, the primary treatment target is severe behavioral dyscontrol (e.g., suicidality, self-injury), and the associated treatment goal is behavioral control. In Stage 2, which often requires treatment for trauma and PTSD, the primary treatment target is emotional avoidance and the associated goal is non-anguished emotional experiencing. Across both stages, clinicians use chain analyses to identify a client’s secondary treatment targets (e.g., emotional vulnerability, apparent competence, inhibited grieving), or the underlying dialectical dilemmas and behavioral patterns that are related to problem behaviors.

Thus, effective therapeutic work with multi-diagnostic clients relies on careful case conceptualizations and chain analyses. This workshop will help DBT clinicians improve their ability to assess primary and secondary treatment targets and create case formulations to address what is most relevant in multi-diagnostic clients – particularly those in need of treatment for PTSD. In addition, clinicians will be given an overview of the DBT-Prolonged Exposure (DBT-PE) protocol for the treatment of comorbid BPD and PTSD.

This workshop is an intermediate to advanced workshop for clinicians with knowledge of DBT.


lorie PicLorie Ritschel, Ph.D., is Clinical Assistant Professor of Psychiatry at the University of North Carolina School of Medicine and is a licensed psychologist with a private practice in Durham, NC. She is a certified DBT therapist and an expert trainer of DBT through Behavioral Tech, LLC. Dr. Ritschel specializes in the treatment of depression, anxiety, and emotion dysregulation in adolescents and adults using Cognitive Behavior Therapy, Dialectical Behavior Therapy, and Behavioral Activation.





  • 8:30-9:00 – registration and sign-in    
  • 9:00- 10:15 –DBT as a transdiagnostic treatment; treatment targets based on stage of treatment
  • 10:15 – 10:30 – break
  • 10:30 – 12:00 – Primary and secondary targets in Stage 1 treatment
  • 12:00-1:00 – lunch
  • 1:00 – 2:30 – Targets in Stage 2: the DBT-PE protocol
  • 2:30 – 2:45 – break
  • 2:45 – 4:30 – Chain analyses and case conceptualizations

Learning Objectives: 

At the completion of this program, participants will be able to

  • Classify primary treatment targets according to stage of treatment
  • Identify secondary treatment targets
  • Create a case conceptualization that includes both primary and secondary treatment targets by stage of treatment
  • Understand how to conduct nuanced chain analyses to address treatment targets
  • Describe the DBT-PE protocol for the treatment of comorbid BPD and PTSD
  • Harned, M. S., Korslund, K. E., Foa, E. B., & Linehan, M. M. (2012). Treating PTSD in suicidal and self-injuring women with borderline personality disorder: Development and preliminary evaluation of a dialectical behavior therapy prolonged exposure protocol. Behaviour research and therapy, 50(6), 381-386.
  • Koerner, K. (2011). Doing Dialectical Behavior Therapy: A Practical Guide. New York, US: The Guilford Press.
  • Koerner, K., & Linehan, M. M. (1997). Case formulation in dialectical behavior therapy for borderline personality disorder. Handbook of psychotherapy case formulation, 340-367.
  • Wagner, A. W., Rizvi, S. L., & Harned, M. S. (2007). Applications of dialectical behavior therapy to the treatment of complex trauma‐related problems: When one case formulation does not fit all. Journal of Traumatic Stress,20(4), 391-400.

Clinical Institute at the University of North Carolina at Chapel Hill School of Social Work

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