Author: Alexandra Meija, LMHC, C-PD
Tracking symptoms and behaviors can be very time consuming, and often challenging for our clients. Often clients are frustrated with the process due to poor time management, forgetfulness, or inconvenience. It can be a painful process for them to look over their day and remember what happened, especially if it was one of those terrible, horrible, no good very bad days. Additionally, many clinicians aren’t aware of what symptom and behavioral tracking is and the benefits this process can bring to the therapeutic process. So why should anyone bother with symptom and behavior tracking? And, as clinicians, how do we keep our clients motivated to maintain their daily tracking habits?
What is a DBT Diary Card?
Marsha Linehan, the brilliant mind behind Dialectical Behavioral Therapy (DBT), created DBT Diary cards for the purpose of tracking her clients symptoms and behaviors because of their complexity in the Borderline population she was working with.
A DBT Diary Card includes symptoms such as depression, anxiety, anger, mood changes, impulsive behaviors such as substance use, sexual experiences, self-injury and other important indicators such as sleep and appetite that clients log daily, at the end of each day. Additionally, tracking can include positive psychology items such as reflecting on gratitude, positive experiences and skills practice on a daily basis which helps clients to think about the good stuff every day.
How can DBT Diary Cards help clients?
One of the major reasons we want our clients to track their symptoms and behaviors daily is for them to find insight into the changes they experience and how these changes relate to their mental health. For instance, if a client with a Bipolar diagnosis charts daily and notices a change in their sleep patterns, they might also see this as a change in their mood episodes. These kinds of insight over time can become more habitual, and eventually no longer require tracking for this kind of recognition.
How can DBT Diary Cards help clinicians?
As clinicians, we also want to see our client's symptoms and behaviors over the weeks to have a clear understanding of the challenges they faced over the week. When we are able to see our client's tracking we already know if they self injured, have had conflicts, or suicidal thougths over that week and can target these things in our next session with them. Over time, we can also see trends in our clients: we can see cycles in mood episodes, trends of symptoms and behaviors escalating or getting better over periods of time. These clinical insights can help us see whether our interventions are helpful and effective or if we might need to change strategies.
What are some challenges of DBT tracking?
Getting our clients to see these benefits and stay motivated in tracking their symptoms and behaviors is an obstacle, especially since Covid-19 hit. Giving handouts or sharing digital copies of diary sheets can be challenging. Figuring out ways to keep the diary cards confidential and neat while still getting all of the information we want out of them can be frustrating and time consuming. We might find ourselves reminding our clients, session after session, why tracking is important without seeing much improvement.
Two solutions for more effective tracking:
Create your own digital diary card: Add all of the information you want your clients to track and share this virtually with your clients utilizing whatever HIPAA compliant software you already use to keep your clients information confidential. You can ask your clients to set their own reminders on their phones to complete daily tracking in the evenings. This solution may not be very efficient or dependable in the long run.
Use a tracker specially designed to help: There is a solution designed for clinicians to gather all the information they feel will benefit their clients’ treatment and save time and energy spent motivating and reminding clients to log daily. Waverider.io allows clinicians to see their clients’ tracking in real-time, as clients save tracking daily, and allows us to modify and tailor each diary card to each specific client’s needs easily.
Waverider sends reminders to clients so they don’t forget to log and makes the process easy and fun so it doesn’t feel so much of a chore. Additionally, Waverider does what no other worksheet can: it lets us as providers see progress over time clearly and shows waves of symptoms rising and falling on screen so it is easier to predict slumps and plan ahead for them.
Whatever the situation, all clinicians and clients can benefit from tracking symptoms and behaviors that they want to treat in therapy. There are now many different options in how to approach this kind of tracking: print outs, digital sharing, or utilizing Waverider. Try out symptom and behavior tracking with your clients and see how it can benefit your practice and improve your session time with clients.
About the author:
Alexandra is a licensed mental health counselor specializing in trauma, personality, mood, and anxiety disorders. She utilizes evidence-based treatment modalities such as CBT, DBT, RO-DBT, Mindfulness, and Exposure therapy. Alexandra joined Waverider early on and has been an instrumental voice advising the team. Her passion and commitment to helping her clients work towards behavioral development goals through self-awareness and consistent work, inside and outside of therapy sessions, has informed our thinking behind our behavioral tracker.