Frequently Asked Questions:

FAQs About Dialectical Behavior Therapy for Adolescents (DBT-A)

• What is DBT-A?
• Is DBT a suicide-prevention treatment?
• Do I need to have hope to be in DBT?
• Can DBT work for me even if nothing else has worked?
• I've had family, friends and even therapists tell me that I don't want to get better and/or that I am "lazy." Will I hear those things in DBT?
• How fast does DBT work?
• Are there rules in DBT?
• I'm not willing to stop my self-harm or suicidal behaviors. Should I come to DBT?
• My family members want me to go to DBT, but I don't want to. Should I come to DBT?
• Am I going to have to be in DBT treatment forever?
• Is DBT only for people with Borderline Personality Disorder (BPD)?
• Will I be encouraged to talk about my past/childhood in DBT?
• Do I have to talk in a group? 
• Both my parents/caregivers want to come to my skills group, but one of them can't come all the time. Is that okay?
• As a parent/caregiver, can I know what you talk about in sessions with my child/teenager?
• How much work do I have to put in outside of my sessions?
• What happens after I complete the treatment cycle?

What is DBT-A?
DBT teaches life skills to help people cope with difficult feelings, manage troubling moods, and avoid high-risk and dangerous behavior. DBT for adolescents and caregivers includes the caregiver(s) and the adolescent.

DBT-A skills involve five skills modules:

Is DBT a suicide prevention treatment?
No. While the majority of individuals who come to DBT have chronic thoughts about committing suicide and may have attempted suicide on multiple occasions, the goal of DBT is not to prevent suicide. The goal is to help a person "build a life worth living" by learning skills, accepting who they are, and changing what they can so that they will no longer want to kill themselves.

Do I need to have hope to be in DBT?
No. Many people who come to DBT have very little, if any, hope that their suffering can be lessened. We know that it's only with time that your experiences with DBT will help to increase hope. We ask that participants in our DBT program "act opposite" to their limited hope by showing up regularly to sessions, practicing their skills, and allowing the treatment to work.

Can DBT work for me even if nothing else has worked?
Definitely. Many people who come to DBT have had limited success in other therapies. This is usually because the other therapies didn't effectively treat the skills deficits that lead to their difficulties. DBT believes that gaining insight into the reasons for difficulties/behaviors doesn't solve the issue. Instead it may be the first step to changing the behaviors. However, insight isn't necessarily required to make changes.

I've had family, friends and even therapists tell me that I don't want to get better and/or that I am "lazy." Will I hear those things in DBT?
Absolutely not. In multi-family DBT we have the following beliefs/assumptions about everyone who attends the program:

• You're doing the best you can
• You want to improve
• You need to do better, try harder, and be more motivated to change
• You may not have caused all of your own problems but you have to solve them anyway
• The lives of suicidal individuals are unbearable as they are currently being lived
• You must learn new behaviors in all relevant contexts
• You can't fail in therapy

How fast does DBT work?
DBT is a marathon, not a sprint. Changing behaviors takes time and patience. In some ways, we're "re-wiring" the connections in the brain by teaching people to act and think in different ways, which then leads to different outcomes. As DBT therapists, we don't expect to see major, if any, changes, until closer to the end of the treatment cycle. Some individuals and families need two cycles of comprehensive DBT to see changes, which is understandable given that adult DBT programs are generally a year-long commitment!

Are there rules in DBT?
Only one. The only real "rule" in DBT is that if you miss three consecutive individual sessions, three consecutive DBT skills group sessions, or five sessions (group + individual) all together within the 24-week period, you'll be discharged from the program. This is based on the idea that DBT can only work if a person is coming to treatment. There are no "excused" absences for things like being in the hospital, going on vacation or being sick. Ultimately, if you miss a full month of treatment for any reason, it's clear that the timing just isn't right for you to be in DBT.

I'm not willing to stop my self-harm or suicidal behaviors. Should I come to DBT?
Probably not. DBT sees both suicidal and self-harm behaviors as problem solving strategies that are effective in the moment to deal with distress, yet don't help a person in the long-term, and have many consequences that actually lead a person to suffer more and feel worse. If you're not willing to work on replacing these strategies with more effective long-term strategies, DBT sessions would be filled with endless battles because of differing goals. Both you and the therapist would quickly burn out, making it difficult for therapy to continue.

My family members want me to go to DBT, but I don't want to. Should I come to DBT?
Unless you want to be in DBT treatment, it's unlikely to work. Just showing up isn't enough. You'll be asked to practice skills outside of sessions and if you don't have a little bit of motivation or interest in doing the work, nothing will change. All DBT sessions would then have to focus on why you weren't doing the work, which would lead to battles because of differing goals. Both you and the therapist would quickly burn out, making it difficult for therapy to continue.

Am I going to have to be in DBT treatment forever?
No! DBT is a recovery-based model. This means that we'll try our hardest to work with you on building a life that doesn't require you to be in DBT or any other treatment forever. Most people who graduate from our program go on to live very meaningful lives with much reduced suffering. 

Is DBT only for people with Borderline Personality Disorder (BPD)?
No. While DBT was originally created for individuals with BPD who were chronically suicidal and self-harming, it's now used to treat individuals with multiple diagnoses who have difficulties with emotional dysregulation, distress tolerance, interpersonal relationships and impulsivity.

Will I be encouraged to talk about my past/childhood in DBT?
It depends. While early childhood experiences are helpful in the beginning of therapy to fully understand how the biosocial theory applies to you (e.g., invalidating/ineffective environment, biological irregularities), DBT primarily focuses on the present and future.

Do I have to talk in a group? 
The DBT group is structured like a class. Because our time in the group is limited, we try to stay structured to keep focused on learning the skills. The group starts each week with a homework review. We typically limit each person to a maximum of two minutes to report on skills practice from the previous week. Individuals can “skip” if they don't want to report on homework that day. We also discuss skills that we're learning in the group, but your participation is optional.

Both my parents/caregivers want to come to my skills group, but one of them can't come all the time. Is that okay?
Yes! To participate in the Adolescent DBT program, at least one parent/caregiver must attend skills group with their teen on a consistent basis. If another parent/caregiver cannot come every week, that's okay, as long as the attending family members keep them updated on what's missed.

As a parent/caregiver, can I know what you talk about in sessions with my child/teenager?
In Adolescent DBT, we ask that parents/caregivers observe rules of confidentiality by not asking us to provide specific information learned in individual sessions. You, however, are welcome to provide us with information about your child/teenager. Confidentiality will be broken, as by law, if your child/teenager is at imminent risk to themself or others, or reports feeling threatened, so that their safety or the safety of others is maintained.

How much work do I have to put in outside of my sessions?
Each week, you'll be expected to complete an assignment for the DBT skills group. This usually involves practicing a skill and filling out a short worksheet. Participants complete a daily diary card that they bring to both the DBT skills group and individual sessions. At times, homework may also be assigned by your individual therapist if you or they believe it will be helpful in reaching your goals. While not required, individuals who review what was taught in the skills group during the week tend to have more success in DBT.

What happens after I complete the treatment cycle?
Once the cycle is completed, there are a number of treatment options depending on the needs of the individual, their family and treatment recommendations of the team:

• Contracting for another cycle of comprehensive DBT
• Stepping down to a 16-week graduate group and continuing individual/family therapy
  • ​​​​​Graduate group is a teen-only group, designed to help teens generalize their skills into their lives, support them while they do trauma work, and get them closer to their long term goals. The graduate group allows teens who have already learned the skills to practice them in a session with other members, process and discuss current struggles, and solidify their understanding of how to integrate DBT in their lives. Teens are allowed to join the graduate group only if they've shown progress, have the skills necessary to be in a less structured/processing group and are actively working towards long term goals.
• More intensive DBT-informed family therapy
• Trauma-focused therapy using evidence-based treatments, such as trauma-focused cognitive-behavioral therapy, and/or prolonged exposure.

When individuals, families, and therapists have agreed that their DBT goals have reached,  they will graduate from therapy. Some join other therapeutic groups in the community or get support from their environment only.