Topic · AI DBT progress notes

AI DBT progress notes drafted on your Mac — chain-analysis documentation for your consultation team, no PHI uploaded to a vendor

Q: What does a DBT individual therapy progress note include that a generic SOAP note doesn't capture?

A well-formed DBT individual therapy progress note follows a session structure that standard SOAP notes are not built to capture: it begins with diary card review (documenting which target behaviors occurred in the week, the emotional intensity ratings, and the skills the client attempted), proceeds to the session's behavioral target in priority order (life-threatening behavior first, then therapy-interfering behavior, then quality-of-life issues), includes a chain analysis of any target behavior that occurred (the environmental event, vulnerability factors, emotional response, action urge, behavior, and consequences at each link), documents the skills that could have replaced the behavior at each missing-link point, and closes with commitment and homework. A generic SOAP note will compress all of this into a Subjective/Assessment/Plan structure that obscures the DBT model's treatment hierarchy and loses the chain-analysis structure that DBT consultation teams use to review treatment adherence.

Q: Is a DBT-trained therapist required to document in a specific format under Linehan Institute or IDBTA standards?

Neither Marsha Linehan's original training institute nor the International DBT Training Association (IDBTA) mandates a specific progress-note format. DBT consultation teams develop local documentation norms, and insurance payers impose their own documentation requirements on top of those. What matters clinically is that the note demonstrates treatment-hierarchy adherence (life-threatening behavior addressed first), chain analysis for any target behavior, skills work documented, and diary card data reviewed. TherapyDraft's DBT template is organized around these clinical expectations rather than a specific institutional format — giving the clinician a structured draft that meets the standard a DBT consultation team would apply, with room to adapt to local norms.

Dialectical behavior therapy demands a specific documentation structure that no generic AI scribe is built to produce: diary card review at the top, behavioral targets addressed in priority order, chain analysis of any target behavior with missing-links documented, skills introduced and rehearsed, and a session structure that your consultation team can evaluate for treatment-model fidelity. A SOAP-note output that buries all of this in an Assessment paragraph is not DBT documentation — it is a liability in supervision and an audit failure waiting to happen. TherapyDraft is built for modality-specific note drafts, and it runs entirely on your M-series Mac, because DBT session audio contains the kind of detailed crisis content that was never meant to reach a cloud vendor's archive.

TL;DR

TherapyDraft is a local AI note-drafting tool that runs entirely on the clinician's M-series Mac. For DBT sessions, it drafts consultation-team-ready progress notes with diary card review, behavioral-target prioritization, chain analysis of target behaviors, skills documentation, and commitment/homework — without uploading session audio to any cloud, AI subprocessor, or third-party server. The audio, transcript, and draft stay on the device where the session happened. There is a 10-session free trial at no cost; paid plans start at $39 per month.

What DBT individual therapy notes need to document — and why the format matters

Dialectical behavior therapy is one of the most protocol-adherent psychotherapy modalities in practice. Linehan's manual specifies not just the treatment components (individual therapy, skills group, phone coaching, consultation team) but the session structure for individual therapy and the treatment hierarchy that governs which topics a session prioritizes. That structure is not optional for DBT-adherent practitioners — it is the mechanism by which the treatment works, and deviation from the hierarchy is a documentation of treatment adherence (or non-adherence) that consultation teams evaluate explicitly.

A DBT individual therapy progress note documents each stage of that structure:

Diary card review. The session opens with a verbal review of the client's diary card from the prior week. The note documents target behavior frequency and intensity ratings, emotional intensity peaks, skills practiced, and whether any life-threatening behaviors occurred. This is not a brief summary — it is the primary risk-assessment and treatment-target-identification tool in DBT, and its documentation is the foundation of every individual therapy session.
Behavioral target in session (treatment hierarchy). DBT's treatment hierarchy prioritizes life-threatening behaviors (any suicidal or self-harm urges or actions) over therapy-interfering behaviors (missed sessions, late arrivals, treatment dropout risk, in-session avoidance) over quality-of-life targets (the presenting problems that brought the client to treatment). The note documents which level of the hierarchy governed today's session and why — if a quality-of-life target was addressed when there was a life-threatening behavior in the diary card, that deviation from hierarchy is itself a documentation matter.
Chain analysis. For any life-threatening or therapy-interfering behavior that occurred, the note documents the chain analysis: the environmental precipitating event, the vulnerability factors active at the time (sleep, illness, recent stressors, substance use), the emotional response, the action urge, the behavior itself, and the consequences at each link. The missing-link analysis identifies where a DBT skill could have broken the chain — that is the intervention target for the session.
Skills work. Which DBT skills were taught, practiced, or troubleshot in the session? Mindfulness, distress tolerance, emotion regulation, or interpersonal effectiveness — which specific skills were the focus, and what was the client's engagement and ability to use them?
Commitment and homework. What commitment did the client make in session? What homework is assigned for the coming week (diary card practice, skill rehearsal, behavioral experiment)?
Consultation-team note. For consultation-team meetings, the individual therapist needs a summary of the client's status and any adherence questions they are bringing to the team. TherapyDraft's DBT template generates the individual therapy note with a consultation-summary section that can be copied directly to the consultation team meeting format.

Generic AI scribes produce SOAP or DAP notes that compress all of this structure into narrative prose. The chain analysis disappears into the Assessment section. The diary card review disappears into the Subjective section. The treatment hierarchy is nowhere. What remains is a note that records that a therapy session occurred, not a DBT progress note that documents what DBT work was done.

Why DBT session audio is among the most privacy-sensitive content in clinical practice

DBT is the primary evidence-based treatment for borderline personality disorder, chronic suicidality, non-suicidal self-injury (NSSI), and complex emotion dysregulation. The client populations treated with DBT generate session audio that is categorically more sensitive than most therapy audio because the content reflects the actual crises the client experienced in the preceding week in specific detail.

Chain analysis requires the client to walk through a self-harm episode or suicidal crisis event by event, link by link. The environmental precipitating event is described specifically — not "a conflict with a partner" but the specific exchange, the words used, the context of the relationship. The vulnerability factors are disclosed — recent sleep deprivation, alcohol use, a prior trauma activated by the conflict. The internal experience at each link is named — the specific emotion, its intensity, the physical sensation, the urge. The behavior is described as it occurred. That level of specificity is the therapeutic mechanism of chain analysis; it is what makes it effective and what makes the session content so sensitive.

DBT clinicians document the chain analysis in the formal progress note at a clinical summary level — the type of precipitating event (interpersonal conflict), the behavior that occurred (self-harm episode, NSSI), the missing-link skill. They do not transcribe the client's verbatim account of the crisis into the chart, because that level of specificity is neither clinically necessary in the note nor appropriate in a document that can be subpoenaed or disclosed on a signed ROI.

Cloud AI scribes retain the verbatim audio independently of that professional judgment. The audio of a DBT chain-analysis session — containing verbatim accounts of self-harm episodes, specific crisis triggers, substance use details, and relationship content — is stored in the cloud vendor's own infrastructure as a business record. That record is independently subpoenable in any legal proceeding involving the client. For DBT clients involved in custody matters, criminal proceedings, disability determinations, or civil litigation, the gap between "what is in the therapist's chart note" and "what is in the cloud vendor's audio archive" can be the most consequential privacy risk in the clinical relationship.

TherapyDraft eliminates that gap. The chain analysis session is processed on the Mac, the note draft is generated locally, and neither the audio nor the transcript ever reaches a vendor's storage. The vendor-record problem does not arise because there is no vendor record.

The DBT note-drafting workflow on a Mac

Record the session. TherapyDraft captures audio using the Mac's built-in microphone, a USB or Bluetooth external mic, or an audio interface. In-office and telehealth DBT individual sessions are both supported. The recording is stored locally and never transmitted.
Select the DBT template. The format dropdown includes SOAP, DAP, BIRP, GIRP, EMDR, CBT, and DBT. Selecting DBT activates the template with structured sections for diary card review, behavioral target and hierarchy documentation, chain analysis, skills work, and commitment/homework. The clinician configures which fields are required based on their consultation team's documentation standard.
Draft locally. whisper.cpp transcribes the audio on the Mac (under 1.0× real-time factor on M2 or later). The local model — Qwen 2.5 14B-Instruct (4-bit MLX) — processes the transcript against the DBT template and the clinician's own example notes. End-to-end for a standard 50-minute DBT session: 90–150 seconds on M2, 60–100 seconds on M3 or M4. No network socket is open during transcription or inference.
Review the draft. The output is a pre-populated DBT progress note with extracted diary card data, identified target behavior, a structured chain analysis from the session's behavioral work, and documented skills. Chain analysis fields that the clinician did not conduct in session — because the session addressed a quality-of-life target rather than a crisis behavior — will be blank or flagged accordingly. The clinician reviews, edits, and finalizes before signing.
Paste into SimplePractice, TherapyNotes, TheraNest, or your EHR. The DBT output includes a plain-text paste mode sized for standard EHR progress-note fields. You sign the note in your EHR as the author of every field.

DBT consultation team requirements and what documentation supports them

DBT consultation team meetings are a mandatory component of standard DBT. The purpose of the consultation team is not just peer support — it is a formal mechanism for therapist skill development and treatment adherence monitoring. DBT consultation teams review individual therapist cases, assess whether the therapist is adhering to the DBT model, and provide coaching on difficult cases.

For consultation team review to function, the individual therapist needs to present cases in a format that allows the team to assess adherence. That format draws directly on the individual therapy progress note: which target behavior was addressed in session, whether the treatment hierarchy was followed, what the chain analysis showed, what skills were offered as missing links, and whether the session closed with commitment. A progress note that documents this structure is consultation-team-ready by default.

DBT consultation teams also review any life-threatening behaviors from the preceding week. If a client self-harmed or made a suicidal gesture, the team expects to hear a chain analysis of what preceded the behavior and how the individual therapist addressed it. That chain analysis in the progress note is the record that the consultation team uses to assess whether the therapist responded according to DBT protocol — which in turn is the documentation that protects the clinician in the event of a licensing board complaint or malpractice claim involving a high-risk client.

TherapyDraft's DBT template is organized around these consultation-team expectations. The draft it generates provides the structure a consultation team can review without requiring the therapist to re-narrate the session from memory at the team meeting.

Pricing

TherapyDraft is $39 per month or $349 per year for the Solo plan — unlimited DBT note drafts, all format options including the DBT-specific template, all EHR paste presets, the inference attestation log, and one-shot template matching from your own example DBT notes. The 10-session free trial requires no credit card. Full pricing breakdown is on the pricing page.

For comparison: Mentalyc ($19.99+/mo), Upheal ($29+/mo), Freed ($99/mo), Supanote ($39/mo), Blueprint ($0.99/session). None of these run locally — all upload session audio to cloud infrastructure, including the sensitive chain-analysis sessions that DBT caseloads produce. TherapyDraft is the only scribe that drafts DBT-structured notes from session audio processed entirely on the clinician's own Mac.

Related questions

What does a DBT individual therapy progress note include that a generic SOAP note doesn't capture?

A well-formed DBT progress note follows the DBT session structure: diary card review with target behavior frequencies and emotional intensity ratings, behavioral target for the session documented in treatment-hierarchy order (life-threatening first, then therapy-interfering, then quality-of-life), chain analysis of any target behavior with missing-link skill identification, skills work conducted in session, and commitment and homework. A generic SOAP note compresses all of this into a Subjective/Assessment/Plan structure that obscures the DBT model's treatment hierarchy and loses the chain-analysis structure that consultation teams use to evaluate adherence.

Why is DBT session audio particularly sensitive from a privacy standpoint?

DBT sessions for BPD, chronic suicidality, and complex emotion dysregulation routinely contain verbatim accounts of self-harm episodes, suicidal crises, specific precipitating events (relationships, conflicts), substance use details, and behavioral chain content at a level of specificity that the formal progress note appropriately summarizes at a clinical level. Chain analysis requires specific detail by design — that specificity is what makes it therapeutically effective, and also what makes the verbatim audio sensitive. A cloud AI scribe retains that audio as a vendor-owned business record. For DBT clients involved in legal proceedings, the gap between "what is in the therapist's chart" and "what is in the vendor's archive" can be consequential. See the subpoena explainer.

Does TherapyDraft support DBT consultation team documentation as well as individual therapy notes?

TherapyDraft is designed for individual therapy session notes. The individual therapy note it generates is structured for consultation-team review — it documents the behavioral target, chain analysis, skills work, and adherence indicators — which is the input DBT consultation teams need from individual therapists. The consultation team meeting itself and DBT skills group are separate documentation events not currently supported by TherapyDraft.

How does TherapyDraft handle the diary card review section of a DBT note?

TherapyDraft extracts diary card data from the session audio during the review segment of the session. DBT-adherent therapists typically begin individual sessions with a verbal diary card review. TherapyDraft captures that exchange and structures it in the note's diary card summary section: target behavior frequency and intensity, emotional intensity peaks for the week, skills practiced, and any life-threatening behaviors flagged for priority treatment. If the diary card review is conducted using a physical card rather than verbal reporting, the clinician edits the section with the paper data. The note is always a draft the clinician reviews.

Is a DBT-trained therapist required to document in a specific format under Linehan Institute or IDBTA standards?

Neither the Linehan Institute nor IDBTA mandates a specific progress-note format. DBT consultation teams develop local documentation norms, and insurance payers impose their own documentation requirements. What matters clinically is that the note demonstrates treatment-hierarchy adherence, chain analysis for target behaviors, skills work, and diary card data reviewed. TherapyDraft's DBT template is organized around these clinical expectations, with room to adapt to local consultation-team norms. See what a BAA covers for the broader HIPAA context.