A 27-year-old female with borderline personality disorder has been participating in a comprehensive dialectical behavior therapy (DBT) program for nine months, including weekly individual therapy, skills group, phone coaching, and therapist consultation team. Prior to starting DBT, she was presenting to the emergency department approximately twice monthly for suicidal ideation with intent, engaging in self-harm by cutting three to four times weekly, and had two psychiatric hospitalizations in the six months before enrollment. At her nine-month evaluation, her emergency department visits have decreased to once in the past three months for passive suicidal ideation without intent, self-harm episodes have decreased to approximately twice monthly, and she has had no hospitalizations. However, she continues to experience intense emotional reactivity, frequent interpersonal conflicts, and chronic feelings of emptiness. She reports improved use of distress tolerance skills but inconsistent application of interpersonal effectiveness and emotion regulation skills. The PMHNP is evaluating treatment outcomes. Which evaluation is most accurate?