Therapists’ Therapy Interfering Behaviour Chain & Solution Analysis
The analysis must be of a single episode of one of your own therapy-interfering behaviours.
You should present their chain and solution analysis in the form of a schematic diagram or
table. Narrative may be used to elucidate more complex points of the analysis. Please also
evaluate the effectiveness of the different solutions that you used and any difficulties in
implementation of those solutions.
Treatment of Therapists’ Therapy Interfering Behaviour
 The narrative and schematic diagram together should illustrate a clear DBT
conceptualisation of the target behaviour
 The behavioural analysis should be of one episode of the therapy-interfering
behaviour
 Vulnerability factors must be clearly distinguished from the Prompting Event
 Links in the chain are described with clarity with affect distinguished from cognition
 Dysfunctional links are highlighted and correctly specified e.g. as an emotion,
cognition or secondary target
 Consequences of the behaviour are identified and functional consequences specified
correctly as reinforcers or punishers of the target behaviour
 Controlling variables and functions of the behaviour should be specified
 The solution analysis should be comprehensive i.e. solutions for all dysfunctional
links identified (there is no expectation that all solutions would have been
implemented in a single session however) and should demonstrate the use of all four
DBT change procedures (skills training, cognitive modification, exposure and
contingency management) where appropriate. A balance of change and acceptance
based solutions should be evident.
Therapy Interfering Behaviour Analysis
Write out a chain and solution analysis of one of your own therapy-interfering behaviours.
As with clients behaviours remember to specify behaviourally exactly what you did or failed
to do. For example; did not confront client’s dysfunctional behaviour, did not conduct chain
analysis of self-harm behaviour, did not get client to rehearse solution, late for consultation
team, refused to do chain analysis on consultation team. Write out the chain and solution
analysis for a specific example of the therapy-interfering behaviour (see example below).
Describe which of the solutions were most effective in helping you resolve the situation.
Example:
Vulnerability factors
Late for session
Poor sleep night before
Prompting event
Client responding in
monosyllables, frowning
and looking at floor
Put reminder on
computer to leave 5
minutes earlier for
session
Implement sleep hygiene
routine
Emotion
Anxious (1/5)
Cognition: Interpretation
‘She doesn’t want to do
this chain analysis, she
said last week she hated
it’
Emotion
Behaviour
Anxious (2/5)
I said ‘Shall we start with
this self-harm then’
Emotion
Client says ‘No – don’t
want to do it’ in angry
tone of voice
Anxious (3/5)
Judgmental cognition –
also an assumption that
the client does not want
to do the chain
I said “We’ve agreed to
do it”
‘What do I do now – I
don’t think its worth
making clients do what
they don’t want to do’
Emotion
Anger (2/5)
Mindfulness: notice the
tension in my stomach
rise and fall
Cognitive Restructuring
“Last week she told me
she disliked chain
analyses. I wonder if she
is not keen this week?’
Generate alternative
interpretations: ‘Maybe
she’s had a row with her
partner / receptionist’,
‘Perhaps she’s tired
today’
Take a mindful breath
Interpersonal
effectiveness: Speak
more confidently, ask
client about which
episode would be most
useful to focus on (if
more than one)
Notice change in body
posture – have moved
forward in the chair, I’m
frowning too now. Sit
back in the chair, relax
facial muscles – act
opposite
Cognitive Restructuring
‘In this moment I’m not
sure what strategies to
use to move forward
with the client’
Cheerleading ‘Its hard
helping clients to do this
difficult treatment’
Interpersonal
Effectiveness: Ask
Consultation Team to
help me work out what
to do in situations like
this.
Act opposite: let go of
tension in the body, think
compassionate thoughts
about myself, the client
and the treatment
Emotion
Cognition
Target Behaviour: Not
conducting a chain
analysis
Immediate negative
reinforcement
Distal Consequences
Positive Punishers
Further TIB…
Clients says “No I didn’t,
you forced me – you can’t
make me. I refuse”
glaring at me
Anxious (4/5)
Tense and relax a couple
of muscles groups (neck
& shoulders)
‘I think she might get
Mindfulness “I’m noticing
really aggressive if I
worry thoughts that she
insist and I’m not willing may becomes aggressive
to get into a battle about if I don’t back off”
this’
Cognitive Restructuring
“I don’t want to reinforce
my clients avoidance –
this is a big problem in
her life’
Says to client ‘What
Review ‘cons’ of backing
would you find most
off – could do this aloud
helpful to do today’
with client. We both
need to practice
overcoming avoidance!
Role play on consultation
team how to initiate
chain analysis when
client refuses
Anger (0/5)
Anxiety (0/5)
‘I shouldn’t have given
in’
‘I should know how to
handle that’
Shame (2/5)
Avoided asking for help
in consult team