Dialectical Behavior Therapy Intensive Outpatient Program

Our Dialectical Behavior Therapy (DBT) Intensive Outpatient (IOP) level of care program is aimed at helping clients who are currently experiencing impairment in functioning in different areas of life (such as work, school, relationships, etc.) due to the severity of their reported symptoms/diagnoses. The DBT IOP typically treats individuals who have tried traditional outpatient therapy and need a higher level of care. The DBT IOP also treats patients who are experiencing more severe symptoms that traditional outpatient therapy may be too slow to address.

Structure and Design

The DBT IOP is located at our Macklind office, where each two-hour group DBT IOP session occurs from 4 – 6 pm Mondays through Thursdays. Each client meets with their primary therapist weekly. In total, the DBT IOP requires a time commitment of nine hours a week. 

Sessions with a psychiatrist are recommended and available through the Institute. These are not included in the DBT IOP and must be scheduled and billed through insurance separately. Depending on the client and their circumstances and issues, family sessions may also be recommended.

All professional appointments need to be scheduled outside of the DBT IOP program hours to avoid missing groups or cause any disruptions in the therapeutic process.

Individual Psychotherapy

DBT IOP clients use individual therapy sessions to apply the skills learned in group to the individual’s life challenges. While participating in the DBT IOP program, clients are expected to work with a DBT IOP therapist at least once a week. With the client’s permission, we will provide treatment updates to outpatient clinicians and collaborate on discharge planning. We can also assist clients in selecting a DBT therapist to work with after discharge. 

Individual DBT therapy follows a hierarchical approach to problems; this may feel different than types of therapy that encourage clients to speak about ‘whatever is on your mind’. Session time, in DBT, is used to address problems in the following order:

  • Tier 1: Life-threatening problems such as suicide ideation, life-threatening behaviors, etc. Also, self-injurious behavior.
  • Tier 2: Therapy-interfering behaviors on the client’s part or the client’s therapist’s part, including urges to quit therapy, willfulness about completing homework assignments, missing sessions, not feeling understood by the therapist, etc.
  • Tier 3: Quality of life-interfering behaviors or conditions, like mood disorders, substance abuse, eating disorders, anxiety disorders, serious interpersonal conflict, etc.
  • Tier 4: Increasing behavioral skills.
  • Tier 5: Creating a life worth living.

The hierarchy serves to guide treatment, prioritize the most pressing problems, and ensure that one problem is focused on long enough to make progress (versus discussing a different crisis each session). Thus, the therapist may conclude that discussing a recent episode of self-injury, for example, is a more pressing use of therapy time than discussing a fight with a significant other, even though the latter may be more distressing to the client.

Diary Cards

A required component of treatment is filling out a diary card daily. This is a form of self-monitoring; self-monitoring helps clients become more mindful of thoughts, emotions, and behaviors which is necessary to change them. Clients are asked to fill out a double-sided diary card on which they track both the emotions and problem behaviors they are trying to change, as well as the skills they are using daily. Diary cards are a way of tracking progress and identifying issues to be addressed in therapy.

After Discharge

Upon completing the DBT IOP, an aftercare plan will be developed with your DBT IOP primary therapist. Additional outpatient treatment is recommended to further develop coping skills and progress further to live the life you really want to be living. 

Outpatient DBT skills groups are available at the Institute. Repeated exposure and practice using them is necessary to maximize their effectiveness in their lives. If it is not feasible for you to attend the Institute’s groups, we will help you identify DBT skills groups in the community that you could attend. 

Individual psychotherapy of some kind is usually recommended. If you have been working with a therapist prior to entering the DBT IOP, we would encourage you to return to them. The Institute has many highly qualified clinicians from a variety of disciplines available work with after discharge.

We’re Only a Phone Call Away

Our Intake Coordinators are always available at 314-289-9411 to schedule a confidential assessment if you, a loved one, or a patient may be experiencing a mental health issue. For additional questions about our programs, you can also use our online contact form.

In the case of a medical emergency or crisis, please dial 911 or go to the nearest emergency room.

Contact Us

New patients please call Intake Coordinators at:


City of St. Louis, Missouri (Macklind)

1129 Macklind Ave, 
St. Louis, MO 63110 
314-534-0200 (returning patients)

Chesterfield, Missouri (West County)

16216 Baxter Rd. Stes 205 and 225,
Chesterfield, MO 63017
636-532-9188 (returning patients)

Belleville, Illinois

521 W. Main St. Ste 201B, 
Belleville, IL 62220
618-825-0051 (returning patients)