Providing RO DBT Without 1:1 Therapy: A Skills-Class-Only Model

If you’re planning to offer RO DBT skills training classes without the individual therapy component, it’s essential to ensure that clients are properly oriented and committed to the treatment approach before they attend their first skills class. This step cannot be completed within the class itself—it requires one-on-one time with the client beforehand.

In standard RO DBT individual therapy, this orientation and commitment process typically unfolds over four sessions. However, when offering skills training alone, this can often be completed more efficiently—many programs are able to successfully do this in two hours, typically across two individual sessions.

These pre-class sessions provide a crucial opportunity to explain the focus of RO DBT, assess the client’s readiness to work on overcontrol as a core problem, and secure their commitment to attend and engage in the classes. Ideally, these sessions are led by one of the skills class instructors, though this isn’t strictly required.

What Needs to Happen Before the First Class?

There are two structured sessions recommended prior to a client beginning RO DBT skills training without the individual therapy component. These sessions ensure that the client is fully informed, motivated, and committed to the treatment approach.

Session 1

1. Gain commitment to work on overcontrol (OC) using the self-identification script (required)
2. Orient the client to the purpose and structure of RO DBT Skills Training Classes and gain their commitment to attend (required)
3. Conduct the Preventing Treatment Dropout Protocol (recommended)

Session 2

1. Teach the Biosocial Theory for OC using the official script (required)
2. Teach the Primary Mechanism of Change in RO DBT using the designated script (required)

The primary aim of these orientation and commitment sessions is that, by the end of Session 2:

• The client has clearly self-identified overcontrol as their primary coping style and has made a commitment to work on this as part of treatment.
• The client understands that the main focus of RO DBT will be on addressing maladaptive social signalling, a key target of the therapy.

These foundational steps are essential for setting up clients to succeed in skills classes and engage meaningfully with the material.

You can learn more about these steps in part 6 of our Level 2 training: go to the end of webinar 3 and Dr Lynch explains this in more detail. This is available as part of the RO DBT Practitioner Pathway as well as the RO Skills Instructor Pathway. You can read more about our RO DBT Training Pathways here.

Insights from Dr Nicole Little – one of our Senior Clinicians offering Skills Class only.

“At our eating disorders program, we offer Radically Open Dialectical Behavior Therapy (RO DBT) in a skills class-only format, without concurrent individual therapy. This model has been successfully implemented over the past few years and was approved, in part, based on research supporting the effectiveness of a stand-alone skills class (Keogh et al., 2016).

Clients appropriate for RO DBT are identified at intake by a trained clinician. As the primary RO-trained provider, I personally conduct these assessments to ensure accurate identification of overcontrolled (OC) traits.

If a client appears to be a good fit for the class, I invite them to return for two to three brief orientation sessions before joining the skills group. These sessions are used to lay foundational understanding, covering:

• The biosocial model of overcontrol
• Neuroregulation principles
• Loving-kindness meditation, an essential component of RO DBT

This ensures that all clients—regardless of when they join a class cycle—begin with a shared understanding of the key theoretical underpinnings. Importantly, clients are made aware that social signalling is central to the treatment, and that the class environment provides a rich opportunity to practice this.

We aim to cultivate commitment through relational engagement rather than formal declarations. After the initial assessment, I typically introduce the idea of commitment in an informal, conversational manner—often just while walking the client back to the waiting area. I might say something like:

“If at any point you’re thinking about dropping the class, would you mind chatting with the instructor first?”

In the group setting itself, we avoid direct pressure around commitment. Instead, we let social signalling—a cornerstone of RO DBT—reveal a client’s level of engagement. Consistent attendance, active participation in class, and completion of homework are all signs that the client is “in.”

When a client’s commitment appears to be wavering—such as regularly missing class or not completing homework—we follow the recommended RO DBT guidelines by having a brief, informal conversation (what we call a “chitty chat”) with the client. These conversations typically take place during a break or at the end of class and are used to informally check in on their level of commitment. We use these moments to reflect on what their social singling might be communicating to other class members and to offer an opportunity to realign with their treatment goals.

This approach aligns with the spirit of RO DBT: low-intensity, socially-signalled, and focused on building openness, flexibility, and authentic connection—without needing a full individual therapy component.”