We focus a lot of attention on what clients do that slows down therapy. We spend less time on what we do. That gap is worth closing.
By Karyn Hall, Ph.D. DBT Wise Training
Most conversations about therapy-interfering behavior in DBT focus on the client. The client who skips sessions or who goes silent when you get close to something important and the client who misses sessions or doesn’t fill out the diary card. That focus is important in helping therapy be effective.
But there is another side to this that is just as important. Therapists engage in therapy-interfering behavior too. Yes, we do. Even the most senior clinicians do so at times. Marsha Linehan, in her original treatment manual, put therapist TIB on the same treatment hierarchy as client TIB. Second in priority, right after life-threatening behaviors (Linehan, 1993). We need to look at ourselves.
Acknowledging that we are getting in the way of our own clients’ progress requires a degree of honest self-examination that does not come naturally to most of us. We chose this work because we want to help. The idea that our behavior might be making things harder is uncomfortable. But discomfort is not a good reason to avoid something, and in DBT especially, we know that avoidance tends to make things worse.
The Most Common Therapist TIB: Getting the Balance Wrong
DBT is built on a dialectical tension between acceptance and change. The therapist’s job is to hold both at the same time, validating the client’s current experience while also pushing toward the behaviors and skills that will create a better life. This is key to DBT. It’s the way we help clients who are suffering tolerate the challenges of therapy in order to find that life worth living. That balance is harder to maintain than it sounds, and tipping too far in either direction is one of the most common ways therapists interfere with their own work.
Too much change looks like this: a client walks in having had a terrible week. She had a fight with her partner and is emotionally raw. You want to ease her pain, know what she needs to work on. You’ve been building toward a particular skill practice and today seems like the right moment to push it forward. So you move into problem-solving mode, suggesting skills, reframing cognitions, focused on the agenda you’ve been carrying for the past three sessions. Twenty minutes in, she’s obviously upset with you. She feels like you didn’t hear her at all, because you didn’t.
Therapist: “Hi Angela, how are you doing?”
Client: “I’m sick of this whole thing. You won’t believe my week. It’s the same thing over and over. And I think Jake is going to leave me. I can’t take it.”
Therapist: “Okay, we can do this. We need for you to stay regulated with Jake. Remember how to use DEAR MAN?”
Client: “You always think it’s my fault. You haven’t even heard what happened and you’re blaming me. You think I’m the problem, just like my family.”
Before you problem solve, it’s important that the client is regulated and ready to consider options. Moving too fast to change can lead to the client being dysregulated and unable to problem solve or worse, dropping out of treatment.
Too much acceptance looks different but causes the same problem. You have a client with chronic self-harm who is telling you how awful everything is, and you respond with so much validation that the session becomes a place to vent rather than a place to change. The client feels heard, which is genuinely good. But nothing shifts. The same conversation happens next week. Weeks become months, and the behaviors that brought her in are still there. Validation without movement is its own form of TIB.
Linehan described the balance she was after as a continuous dance, requiring the therapist to move in an ever-changing way with the client, letting go of attachment to a single approach (Linehan, as cited in Psychwire, 2020). When therapists get stuck in one mode, they stop dancing. The client feels it before they can name it.
| What the early DBT research foundWhen Linehan and her team tried applying standard cognitive behavioral therapy to suicidal and self-harming clients in the early development of DBT, clients dropped out, shut down, or became angry. The constant focus on change, without equal attention to validation, felt invalidating rather than helpful. The research team watched their taped sessions and discovered that weaving validation together with change made clients more collaborative and less likely to disengage (Linehan and Wilks, 2015). |
Not Observing Your Own Limits
Linehan was clear that observing limits is not optional in DBT. She wrote that it “is essential to DBT” (Linehan, 1993, as cited in Koons, 2020). And yet failing to observe limits is one of the most common therapist TIBs in practice. Therapists are giving, helping people who are caring. So going above and beyond to help clients is an easy temptation. But when that happens repeatedly the therapist may find themselves in burn-out or dysrregulated with the client.
Here is what that looks like in real life. A client texts you outside of your agreed coaching hours, and you text back. Once is fine. Twice starts a pattern. By the third month, the client is texting at 11 p.m. and you are answering because you worry what happens if you don’t. You have extended your limit so far past where it started that you can no longer find it. The resentment builds. You start feeling dread before sessions. Your clinical judgment is affected because you are managing your own reaction to the relationship more than you are managing the client’s treatment.
Therapist limits in DBT are personal, not arbitrary. They vary from therapist to therapist and can shift over time. What matters is that each therapist takes personal responsibility for identifying, communicating, and maintaining their own limits (Linehan, 1993). Limits that are not communicated clearly are not limits at all. They are unexpressed expectations, and unexpressed expectations create resentment, often for both the client and the therapist.
The solution is not to be rigid or cold. Linehan described five observing-limits procedures: monitoring limits, being honest about them, temporarily extending them when genuinely needed, being consistently firm once a limit is communicated, and combining validation with the limit-setting itself (Linehan, 1993, as cited in Koons, 2020). That last one is worth noting. A client who hears “I care about you and in my practice I don’t respond to texts after 9 p.m.” is in a very different position than one who is simply ignored.
| What observing limits is not Observing limits is not punishing the client. It is not emotional withdrawal. It is not a sign that the therapist does not care. Linehan was explicit that therapists who observe their limits model something important for clients: that it is possible to have and communicate personal limits without the relationship falling apart. For clients who have rarely experienced that, it can be one of the most therapeutic things that happens in treatment (Linehan, 1993). |
What are your limits? How do you communicate these limits clearly to your clients?
Performing Therapy Instead of Doing It
This one is subtler. It shows up as an over-reliance on therapeutic technique at the expense of genuine human contact. The client asks a personal question and you respond with a question back. The client says something important and you reflect it back word for word. You keep your voice steady and measured even when the moment calls for real emotion. You say “I hear you” when what you actually mean is “I am uncomfortable with this and I need to stay behind the glass.”
DBT clients are often exquisitely sensitive to this kind of performance. Many of them have had multiple previous therapists and have learned to spot the gap between what a therapist says and what they mean. One of the most consistent complaints in clinical practice is that previous therapists were too “therapist-y,” meaning they seemed to be performing a role rather than being present (Shaller, 2025). Clients who feel this often stop bringing real material to sessions. The therapy continues. The client is polite and shows up. Nothing actually happens.
The fix is not to abandon structure or professional judgment. It is to bring your actual self into the room alongside those things. Radical genuineness in DBT does not mean oversharing. It means responding as a real person would, including being honest when you don’t know something, acknowledging when you made a mistake, and letting the client see that their situation genuinely matters to you.
Therapist Burnout as a Therapy-Interfering Behavior
When you are dreading a session, you are already in TIB territory. That feeling is information, and it deserves the same nonjudgmental curiosity you would bring to any other clinical data.
The DBT consultation team exists partly for this reason. One of the primary functions of the DBT consultation team is to monitor and reduce therapist burnout (Linehan and Wilks, 2015). This is not a secondary function. It is built into the model because a therapist who is burning out cannot provide effective DBT. The research on DBT outcomes supports this: better adherence to the model, including the team consultation component, produces better client outcomes (Harned et al., 2022, as cited in Shaller, 2025).
Burnout as TIB is often driven by limit violations, by the acceptance-change imbalance described earlier, or by a pattern in the therapeutic relationship that has gone unaddressed for too long. Sometimes it is driven by the client’s behavior. Sometimes it is driven entirely by the therapist’s own history and tendencies. The work is to identify the function, bring it to team, and address it before it compounds.
A therapist who notices they are responding differently to one client than to others is not a bad therapist. That noticing is exactly what the model asks for. What makes it TIB is staying in that pattern without doing anything about it.
| The four-miss rule and therapist accountability. DBT includes a specific rule that clients who miss four consecutive sessions are no longer considered active in the program. This rule is often discussed in terms of client behavior. What is less discussed is the complementary accountability it creates for therapists: if a client is regularly missing sessions, the therapist has an obligation to examine whether something in the treatment, including therapist behavior, is driving that pattern (Linehan, 1993). |
What to Do When You Recognize Your Own TIB
The good news about therapist TIB is that the same principles that apply to client TIB apply here. The behavior is addressed descriptively, nonjudgmentally, and with attention to what function it serves. The fact that the behavior belongs to you does not change the process.
The first step is to notice. This is where personal mindfulness practice matters more than most DBT training discussions acknowledge. A therapist who cannot observe their own emotional reactions in the moment cannot catch their own TIB in real time. Noticing that you have started rushing a client through their chain analysis, or that you are avoiding bringing up a topic because you expect conflict, or that you have given the same vague encouragement three sessions in a row without pushing for change: all of these require the capacity to be a witness to your own behavior while it is happening.
The second step is to bring it to team. A therapist who consults regularly is less likely to stay stuck in a TIB because someone else will see it before it becomes entrenched.
The third step, when a TIB has affected the therapeutic relationship, is to address it directly with the client. This is the step most therapists avoid. It requires saying something like: “I have been noticing that I have been pushing for change faster than where you are, and I don’t think it has been helping. I want to slow down and make sure I’m actually hearing what’s going on for you.” That conversation, done with genuineness rather than excessive self-flagellation, tends to strengthen the relationship rather than damage it. Clients rarely expect their therapists to acknowledge mistakes. When it happens, the trust it builds is significant.
| Three questions to ask yourself between sessions: Am I dreading this client’s next appointment? If so, what specifically is driving that? Have I been leaning more heavily on acceptance or on change in recent sessions? Is that balance intentional or have I drifted? Is there anything this client does or says that I have been avoiding addressing? What am I telling myself about why? |
Frequently Asked Questions
Is therapist TIB addressed in DBT consultation team?
Yes, and it should be a regular part of consultation. The DBT consultation team has two main functions: improving therapist skills and managing therapist burnout (Linehan and Wilks, 2015). Both of those functions include examining therapist TIB. Bringing your own behavior to the team is not optional in well-functioning DBT programs. It is how the model maintains quality and protects against the drift that happens in every therapist’s work over time.
What if I do not have a DBT consultation team?
This is a real challenge for therapists working in solo practice or in settings without a formal DBT program. Regular peer consultation or supervision with someone who understands DBT is the closest substitute. You could also consider a virtual team made up of clinicians who don’t have the option of an in-house team. .
How do I address my own TIB with a client without it becoming the focus of every session?
The key is brevity and specificity. Addressing a therapist TIB does not require a long processing session. It usually takes a few minutes: name what happened, acknowledge the impact on the client, say what you are going to do differently. The client does not need to manage your emotions about it. Once addressed, you return to the client’s treatment. The fact that you brought it up at all, without making it a production, is what matters clinically.Be careful about having it sidetrack the session. “Let’s get back to our work! I can see you practiced GIVE this week–how did it go?”
How is therapist TIB different from countertransference?
The frameworks overlap but are not the same. Countertransference is a psychodynamic concept referring to the therapist’s emotional reactions to the client, particularly those rooted in the therapist’s own history. Therapist TIB in DBT is behavioral and functional: it is defined by its effect on the treatment, not by its emotional origin. A therapist might have a countertransference reaction that never becomes TIB if they manage it effectively. Or a therapist might engage in TIB with no particular emotional charge, simply through habit or oversight. DBT’s interest is in the behavior and its function, not in exploring the therapist’s internal world in depth.
DBT Training and Supervision at DBT Wise
Working through your own TIB is one reason that trained supervision matters as much as initial training. DBT Wise Training offers individual and group supervision in DBT and RO DBT, on-demand CE courses, and comprehensive training for clinicians at all levels of experience. If you are working with a challenging caseload and want support that goes beyond skills training, reach out to learn what is currently available.
| ReferencesKoons, C. (2020). Observing limits during the time of pandemic. Behavioral Tech Institute. behavioraltech.org Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press. Linehan, M. M., and Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy. American Journal of Psychotherapy, 69(2), 97 to 110. Rizvi, S. L., Steffel, L. M., and Carson-Wong, A. (2015). Examining challenging behaviors of clients with borderline personality disorder. PMC. pmc.ncbi.nlm.nih.gov/articles/PMC4690778/ Shaller, E. A. L. (2025). Therapy-interfering behavior in DBT. Guilford Press. |