First therapeutic interview in complex cases

The first interview in Conductual Dialectical Therapy is not simply a moment of initial assessment, but rather a decisive clinical instance in which the treatment, in fact, begins. Based on the model proposed by Marsha Linehan, the initial interview allows organizing the complexity of the case based on a functional logic, prioritizing behaviors according to their severity and impact on the patient's life. This implies that, from the first meeting, the therapist not only collects information, but also begins to actively intervene: it validates, structures, guides and establishes a clear framework that will serve as the basis for the entire subsequent therapeutic process.

In this sense, the first interview plays a central role in the construction of an initial clinical formulation based on the DBT hierarchy of targets. Identifying behaviors that threaten life, that interfere with treatment or that harm quality of life allows treatment to be organized from the beginning, avoiding diffuse or non-strategic approaches. This early ordering not only increases the effectiveness of treatment, but also offers the patient an experience of clarity, direction and containment, especially relevant in contexts of high emotional dysregulation or impulsivity.

At the same time, this first meeting is essential for establishing the therapeutic alliance and commitment to treatment. Through the strategic use of validation and the dialectic between acceptance and change, the therapist begins to build a relationship that is not only empathetic, but also active and goal-oriented. In DBT, engaging the patient from the beginning is not a secondary step, but an intervention in itself: it involves negotiating goals, explaining expectations and working on possible interferences, thus establishing the basis for adherence and continuity of the therapeutic process.

Finally, the first interview allows you to anticipate difficulties and plan interventions adjusted to the characteristics of the case, integrating assessment and action from the beginning. Far from being a passive space, it is a moment in which the therapist begins to model skills, introduce behavioral language and establish a coherent framework for the treatment. In this way, the initial interview in DBT not only organizes what will come, but is, in itself, a therapeutic intervention that guides, contains and sets in motion the process of change.

Methodology

Continuous integration between theory and practice

Role playing at different moments of the course

Focus on clinical decision making from the first interview