Why Do DBT Therapists Use Diary Cards?

Evidence-informed information from SaskADHD and STG Health Services Inc.

Educational notice: This article provides general information and is not a diagnosis, emergency service or substitute for individualized medical, psychological or mental-health care.

QUESTIONS WE HEAR

The short answer: DBT diary cards turn a week of moods, urges, behaviours, vulnerabilities, and skill use into treatment data. They help the therapist and client decide what should be worked on first rather than relying only on memory or whichever event feels most urgent that day.

Diary cards can look deceptively simple. A few ratings. Some boxes. A list of skills. Maybe a short note.

But in DBT, the diary card is not busywork. It is one of the main ways treatment stays connected to what happened outside the therapy room.

Why memory is not enough

When a week has been emotionally intense, memory tends to organize itself around the worst event or the most recent one.

You may arrive in therapy convinced that Tuesday was the whole problem because Tuesday contained the argument. But the diary card may show that urges had been rising since Sunday, sleep had deteriorated for three nights, and skill use had dropped before the argument happened.

That broader pattern can completely change what the session needs to focus on.

STG Health Clinical Perspective

The most useful diary card is not the one with the most detail. It is the one that helps answer: What changed, what happened next, and what should we work on today?

How diary cards shape the session

DBT sessions are not supposed to treat every problem as equally urgent. Standard DBT uses a hierarchy of treatment targets.

Diary-card information helps identify whether the session needs to focus on safety, therapy-interfering behaviour, quality-of-life problems, or skill deficits.

Without some form of tracking, important patterns can disappear between sessions.

What can be tracked?

The exact diary card depends on the treatment plan. Common areas include:

emotional intensity or mood patterns
urges related to specific target behaviours
whether the target behaviour occurred
which DBT skills were used
sleep or other vulnerability factors when clinically relevant
substance use or other behaviours that affect treatment targets
progress toward a specific behaviour the client is trying to increase or decrease

The goal is not to collect every possible data point. Tracking should be clinically useful enough to guide treatment.

Is a diary card a scorecard?

No. A diary card is not supposed to measure whether you were a “good client” that week.

High urges, difficult emotions, or an episode of ineffective behaviour do not make the diary card a failure. In many cases, that is exactly the information therapy needs.

The danger is when tracking becomes perfectionistic: trying to make the card look good, avoiding entries because the week was difficult, or spending so much time documenting that the tracking itself becomes burdensome.

What if I forget to complete it?

That is useful treatment information too.

Maybe the card is too complicated. Maybe the reminder system does not fit your day. Maybe filling it out brings up shame. Maybe you remember only right before therapy. Maybe tracking the behaviour makes you want to avoid the entire treatment.

DBT can treat those barriers as part of the problem-solving process rather than simply labelling the client non-compliant.

The Five-Part Diary Card Check

A good diary-card system should help answer five questions:

What happened? Which target behaviours, urges, or emotional patterns showed up?
When did it happen? Are there patterns across days, times, or situations?
What made it more likely? Sleep, stress, conflict, substances, illness, or other vulnerabilities may matter.
What skills were used? Which strategies were attempted, and at what point in the chain?
What should therapy focus on next? The data should lead to a clinical decision, not simply sit in a chart.

Why digital tracking can help

Paper diary cards work well for many people. Digital tracking can make daily completion easier for others, especially when the system is already on the phone they carry.

DBT Saskatchewan uses the STG Diary Card System to support daily entry and clinician review. The technology is there to make the clinical process more usable—not to replace the therapist.

The usefulness still depends on what is being tracked, how consistently it is used, and whether the clinician actually brings the information back into treatment.

What if my diary card shows I am getting worse?

That is a reason to review the pattern, not hide it.

Sometimes increased tracking makes a problem look worse because it is finally being measured consistently. Other times the behaviour really is increasing. Either way, the treatment plan should respond.

If the data show increasing self-harm risk, suicidal behaviour, substance-related danger, or another serious safety concern, the response needs to go beyond simply continuing to track it.

Questions people also ask

Do I need to complete a diary card every day?

In standard DBT, regular daily tracking is common because it gives the clinician a more accurate picture than completing the card retrospectively once a week. The exact expectation depends on the program.

Can I use an app instead of paper?

Yes, if the app or digital system fits the treatment plan, protects privacy appropriately, and collects the information your clinician actually needs.

Will my therapist judge my numbers?

The purpose is clinical analysis, not judgment. If you find yourself changing entries to look better, that is worth discussing because shame may be interfering with treatment.

Do I still need a diary card if I am doing well?

Often yes, at least for a period. Stability data can show which skills, routines, and conditions are associated with better functioning and help identify early warning signs before a relapse.

What can I do next?

Read about the STG Diary Card System. If you are already in DBT, ask your clinician which variables are most important for your treatment rather than tracking everything you possibly can.

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