Program Overview

Our early teen program adapts standard DBT for the developmental needs of early teens. The middle school years are a challenging period in child development for most children, for those who struggle with emotional sensitivity, difficulty regulating emotions, and self-destructive behaviors, DBT can provide the skills and support needed to thrive during this period. Note, if school relationships might interfere with therapy, we can place your child in a group without their direct peers.

The goal of our program is to help early teens increase their ability to cope with intense emotions, be more effective in their interactions with family, friends, and teachers, and to assist families in their own practice of the skills necessary to help their adolescents grow and develop as they progress into adulthood.

Program Details

This program is designed to meet the needs of both the child and their family. It includes individual weekly therapy sessions, weekly skills groups (with a parent), and periodic family sessions, and phone coaching. Here’s how the program works:

Assessment (1 session)

Before starting our program you’ll have a 60-minute assessment session with one of our therapists so that we can better understand the issues that you’re experiencing and determine if DBT, and our center, are a good fit for your family. During this session, we’ll discuss the prevalence of:

• Impulsive behaviors

• Difficulty regulating emotions

• Family Interpersonal challenges 

After this session, we’ll follow up with a recommendation as to whether or not our program is appropriate. If it’s not, we’ll provide input on alternative programs that might be a better fit for your family. 

Pre-Treatment (1-3 sessions)

Before we can begin our treatment program we require that participants commit to completing the program and making behavioral changes. We do this because evidence has shown that setting clear expectations upfront increases the likelihood of positive outcomes. Many participants will experience frustration during the program and a desire to quit—but evidence shows that those who stick with it are likely to get a positive outcome! 

Your therapist will lead a 50-minute session at which they will explain all aspects of our program and what “commitment” to the program entails. This will include a discussion of common therapy interfering behaviors such as missing sessions, staying silent in sessions, feelings of discouragement, etc. After this discussion, both the child and the parents (or guardians) will be asked to sign a commitment letter. 

The use of commitment strategies is often crucial for teens as many would not “choose” to be in therapy if given the option. For this reason, our therapist spends time during the early phases of treatment using commitment strategies that aim to help the teen understand the triggers of his/her behaviors, the consequences, both positive and negative, of behaviors, and the implications for behavior change.

Treatment (24 - 36 individual sessions / 28 group sessions)

There are two required components to our program and two optional components described below: 

Individual Therapy (weekly)

Individual therapy starts as soon as possible after the child commits to the program. The initial sessions will include additional assessment after which a treatment plan will be provided to the parent or guardian. 

The goal of individual therapy is to work on the primary issues that have been identified in the treatment plan, to maintain the child's motivation and commitment to the treatment, and to provide individual support for skills use. 

Skills Group (weekly)

Once the assessment process is complete and a basic foundation has been laid during individual therapy, the child and a parent or guardian can begin a multi-family skills group. This is a small psychoeducational learning group that meets for 90 to 120 minutes (depending on whether a break is needed) weekly. Groups typically include 3-5 children and their parents or guardians. Each family learns skills and receives support from each other within a DBT framework. Parents also learn to understand and respond to certain adolescent behaviors and to encourage the use of the skills at home. The skills group continues for approximately seven months and is led by a therapist and an associate. Sessions combine lecture, discussion, role-playing, and practice exercises in order to teach the following skill modules:

• Mindfulness: teaches participants how to focus the mind, direct attention, and how to non-judgmentally observe and describe what they are feeling and thinking in the moment. These skills can help teens develop a more stable sense of who they are, and can help reduce reactivity to painful thoughts and emotions.

• Distress tolerance: targets impulsivity by teaching how to effectively distract and soothe themselves while considering the pros and cons of their actions. These skills typically replace problem behaviors such as emotional outbursts, cutting classes, self-inflicted cutting, physical fights, and using alcohol or drugs.

• Emotion regulation: addresses extreme emotional sensitivity, rapid mood changes, and other unregulated moods such as chronic depression, anxiety, or hostility. Examples of specific skills include learning to identify and label emotions, learning how to increase positive moods, and learning how to make yourself less vulnerable to negative moods.

• Interpersonal Effectiveness: addresses difficulties in maintaining consistent and rewarding relationships by teaching skills such as how to ask for what you want, how to say no in a gentle yet effective manner, and how to maintain your sense of self-respect and independence in the face of peer pressure.

• Walking the Middle Path: targets extreme, rigid, or non-balanced thinking and behaviors among teens and their caregivers. These skills involve learning about common areas of conflict in relationships and reducing the conflict by learning methods of behavior change as well as methods of validation and acceptance.

Family Sessions (as needed)

Family therapy is available on an as-needed basis to increase behavioral skill use within the family system, improve communication between family members, and reduce family interactions that interfere with the child’s or their family’s quality of life.  

Parents may also benefit from additional sessions with a parenting coach (typically one of the multi-family skills group leaders). The coach offers specialized parenting strategies to assist parents in reaching their goals in a planful and proactive manner rather than relying on a reactive crisis-oriented approach.

Phone Coaching (required for Comprehensive DBT)

On-demand skills coaching, or what DBT calls “phone coaching” is a requirement for comprehensive DBT and may be included in your treatment plan. Phone coaching is designed to promote skills use where it matters most–in the real world. When clients feel “stuck” and unsure what to do, they are encouraged to contact their individual therapist for help in applying their newly learned DBT skills in “real-time.” In addition, parents are able to contact one of the skills trainers for coaching in how to apply skills with their children.

Recommended Reaching

Here’s what DBT looks like in practice for a teen.