Background <p>This paper is a narrative review of the implementation trajectories Dialectical Behaviour Therapy in five countries, the UK, Germany Norway, Poland, and the Czech Republic in Europe over the past 30 years. The aim of this comparison is to identify common and divergent systems levels facilitators and hindrances of DBT implementation.</p> Methods <p>DBT experts in each respective country were asked to provide a narrative account of their country’s implementation journey. Histories were then considered in accordance with existing DBT implementation frameworks.</p> Results <p>Common themes emerged such as the importance national guidelines on evidence-based treatment shape implementation, university affiliations promote dissemination, implementation and research activities, national societies help to create standards.</p> Conclusion <p>There are common DBT implementation trajectories that exist across geography and nationally specific mental health care systems. The discussion of the refining of national DBT practices based on emerging literature and the importance of outcomes of implementation such as therapists’ behaviour or client related outcome data adds to existing information.</p>