Clarifying the Core Problem Concept in DBT: A Case Illustration

In her later years of teaching and training, Linehan (personal communication) spoke of an assessment construct that she referred to as a client’s “core problem.” In this paper, we trace the historical roots of this concept, review and clarify its current operationalization, anticipate common therapist questions and challenges to identifying a client’s core problem, and provide a case example to illustrate its utility for Dialectical Behavior Therapy (DBT) case formulation and treatment planning. We propose that conceptualizing a client’s core problem holds great promise for enhancing the therapist’s effective and efficient delivery of DBT.