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The DBT Next Steps Skills Manual, and DBT Next Steps Clinicians Guide are available to order through Guilford Press.
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DBT Next Steps is an expansion and adaptation of Standard DBT featuring a second year of treatment designed to meet the needs of DBT graduates who want to increase self-sufficiency and maintain living wage employment. The goal by the end of the DBT Next Steps year is for clients to have mastered skills and to have created environmental contingencies to provide sufficient momentum that it's close to inevitable that they will achieve their employment, social, and independence goals.
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DBT Next Steps is fundamentally DBT. DBT Next Steps has the same functions as DBT and uses all the principles, assumptions, agreements, and treatment strategies, albeit in the form of a specialized DBT treatment geared towards increasing employment and self-sufficiency.
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History of DBT Next Steps
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Harborview DBT was the first site to implement DBT outside of Dr. Marsha Linehan’s research clinic in 1988, and has since been serving individuals who receive psychiatric disability in the greater Seattle area. DBT Next Steps (in its original form of DBT-ACES) was developed by Dr. Kate Comtois and her colleagues at Harborview DBT to support clients as they overcame systemic issues associated with maintaining living wage employment and self-sufficiency. Comtois and colleagues began to develop a highly structured, contingency-based advanced level of DBT focused on a life worth living outside of the community mental health system. DBT Next Steps has recently been expanded to include clients who are not on psychiatric disability programs but are financially supported by family, friends, or other organizations such as employer disability programs, churches, or nonprofits. To reduce clients’ financial dependency and increase living wage employment, DBT Next Steps focuses on skills to increase self-sufficiency, goal-setting, problem-solving, trouble-shooting, reinforcement of self and others, and dialectics.
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DBT-ACES is a comprehensive treatment with multiple components working in tandem to help graduates of DBT research their social, school, and work goals. DBT Next Steps is the broader use of specific components and treatment strategies without providing the comprehensive treatment.
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Watch Dr. Comtois' presentation on DBT-ACES at the 2011 NEA-BPD conference:
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Watch Dr. Carmel's presentation "Cost-Benefit Analysis of DBT-ACES Across Three Programs"
at the 2021 ISITDBT conference:
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Published evaluations of DBT-ACES:
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Publications on the clinical application of DBT-ACES:
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Carmel, A., & Comtois, K. A. (2023). Integrating Dialectical Behavior Therapy-Accepting the Challenges of Employment and Self-Sufficiency (DBT-ACES) Strategies into Cognitive Behavioral Therapy. Journal of Contemporary Psychotherapy, 53, 217–225.
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Comtois, K.A., Elwood, L., Melman, J.N., Carmel, A. (2020). Dialectical behavior therapy-Accepting the challenges of employment and self-sufficiency (DBT-ACES). In Dimeff, L.A., Rizvi, S., & Koerner, K. (Eds.) Dialectical Behavior Therapy in Clinical Practice, Second Edition: Applications across Disorders and Settings. The Guilford Press.
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Bolden, L. S., Gaona, L., McFarr, L., & Comtois, K. (2020). DBT–ACES in a multicultural community mental health setting: Implications for clinical practice. In The handbook of dialectical behavior therapy (307-324). Academic Press.
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Carmel, A., Comtois, K.A., Harned, M.S., Holler, R., & McFarr, L. (2016). Contingencies create capabilities: Adjunctive treatments in dialectical behavior therapy that reinforce behavior change. Cognitive and Behavioral Practice. 23, 110-120.
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