The purpose of this study was to examine how therapists conduct Dialectical Behavior Therapy (DBT) individual psychotherapy with clients, focusing on clinical factors that could account for decisions regarding modifications of DBT (e.g., client diagnosis, therapist theoretical orientation, and intensity of DBT training). Additionally, the study investigated how therapists integrate DBT into their primary approach to therapy. Greater adherence to the DBT protocol was reported by therapists who described using DBT with a client with a diagnosis of borderline personality disorder. More frequent use of DBT components (i.e., group skills training, consultation teams, and telephone consultation) was reported by therapists who viewed their therapy as being guided by an applied behavior analysis/radical behavioral theoretical orientation and by therapists who had received intensive DBT training. Most therapists reported using DBT skills in their non-DBT work, with non-cognitive-behavioral therapists more likely to introduce mindfulness skills. (Contains 2 tables.)