Introducing DBT-A:

Dialectical Behavioral Therapy for adolescents (DBT-A) is an evidence-based therapeutic approach, with some skills stemming from the well-known Cognitive Behavioral Therapy (CBT) approach. DBT creator, Dr. Marsha Linehan, developed the integrative approach to help clients not only seek out positive change but simultaneously be able to practice acceptance. Today, DBT-A programs globally have been successful in assisting adolescents with severe mental health diagnoses – largely surrounding suicidality, self harm, and strong emotions – begin to “build a life worth living” (Carr, 2025; Rathus et al, 2015). Much of DBT-A’s evidence for success and growing popularity is related to the multiple therapeutic elements used to create a more comprehensive treatment approach. Each DBT-A program is made up of four fundamental components including individual therapy, therapist consultation group, crisis phone coaching and multifamily skills group sessions. 

Multifamily Group Format:

Multifamily skills group sessions remain a core, unique component that DBT-A’s evidence-base from clinical trials is based on. Occurring weekly, these group sessions typically involve two licensed mental health professionals leading all participating families through group-facilitated learning of the DBT-A modules. DBT-A skills training modules include the teaching of mindfulness skills, distress tolerance, walking the middle path (skills for navigating family conflict), emotional regulation skills, and interpersonal effectiveness skills. These structured group sessions create equal opportunity for participants to ask questions, reflect on assigned homework, learn new coping skills and practice implementation of the new skills. Separated adolescent and caregiver group sessions are an example of a modified group therapy format often used when groups are delivered via telehealth. However DBT-A programs remain dedicated to using the multifamily group format due to its suitability to this specific program and overall benefits (Rathus et al, 2015).

What is a Multifamily Group? What does it entail?

The multifamily group format is an evidence-based therapeutic group approach, having undergone extensive research in relation to DBT determining its effectiveness and inherent benefits. Research studies show that participants involved in multi-family group therapy often report positive experiences, referencing several benefits such as shared connection with others, the opportunity for guided learning, and valuable gained experience in practicing core skills (Conroy et al, 2025; Rathus et al, 2015). 

Why chose Multifamily Group for DBT-A program? 

Both caregivers and adolescents not only shared an improved connection with one another but also the other participating families and adolescents (Conroy et al, 2025; Rathus et al, 2015). This improved connectivity with others seems to have been linked to several factors. First, all families and adolescents are learning new skills in tandem with one another, relieving pressure and reducing feelings of loneliness. Secondly, both adolescents and families share that by practicing novel skills with one another through role playing and group activities, there was an improved connection and dynamic within the family that was not only felt during group sessions, but also transferred into their home environment. Lastly, shared perspectives among the families increase feelings of validation and connection with the other participating families. 

 Multifamily group participants also report that the multifamily format’s guided learning is highly beneficial (Rathus et al, 2015). Clinicians will initially lead the group through guided learning of the new weekly concepts, before families and adolescents begin to practice implementing the newly learned material through role playing exercises and group activities. Depending on the type of group therapy, some group formats like adolescent only groups, do not directly incorporate caregivers into sessions. Alternatively, caregivers may be instructed to utilize handouts as their primary resource or are restricted to attending the final twenty minutes of the group session to try to learn the skills that their adolescent will be attempting to practice and improve on at home (Rathus et al, 2015). Participants reflect on the fact that the multifamily group format includes guided learning, directly involving both caregiver and adolescent, throughout the entirety of the session as being very helpful for both building and reinforcing these fundamental skills (Conroy et al, 2025). Additionally, multifamily group’s continued opportunity for participants to engage and practice skills is a considerable benefit. Often after more formal instruction of the new concepts takes place, participants will begin implementation and practice of these skills through role playing exercises and group activities. Attendees have found that hands-on practice allows them the chance to gain proficiency in these skills, receive and give feedback, and more easily transfer what was learned in the group session to a home and community environment.

What are said benefits?

The benefits of the multifamily group format make it best suited for DBT-A programs in comparison to other group therapy formats. For example, adolescent only groups can at times produce interfering and disruptive behaviors that can hinder the therapeutic process (Rathus et al, 2015). The imbalance of adolescents and caregivers can also impair the number of opportunities for both adolescents and families to learn from one another and gain new insight (Rathus et al, 2015). However, multifamily group format isn’t always suitable based on the context of where the therapy takes place and isn’t without its own shortcomings. Research has revealed that participants appreciate that within caregiver or adolescent only groups, the privacy within the space allows participants to feel more comfortable sharing personal details, insights or struggles (Conroy et al, 2025). In relation to this, when initially beginning multifamily group sessions participants, in particular adolescents, can be resistant to group therapy with their own family members. This can serve as an extra barrier to participation and comprehension of the modules, and is something that clinical group leaders must work through (Rathus et al, 2015). 

Concluding Thoughts:

DBT-A is a therapeutic approach to treating an ever growing range of severe diagnoses found within adolescent populations (Carr, 2025). Extensive evidence based research supports the work of DBT-A and continues to explore its effects on treated populations. While the multifamily group therapy format commonly utilized within DBT-A programs may have several weaknesses, many clinicians leading the group are equipped to help participants overcome these barriers. The benefits we find, from improved connection to transferable skill implementation, surpass the drawbacks and support its integration within DBT-A programs helping today’s struggling youth (Carr, 2025; Conroy et al, 2025).

References

Carr, A. (2025). Family therapy and systemic interventions for child-focused problems: The evidence base. Journal of Family Therapy, 47(1). https://doi.org/10.1111/1467-6427.12476 Ivysci

Conroy, K., Kehrer, S. M., Georgiadis, C., Hare, M., Ringle, V. M., & Shaw, A. M. (2025). Learning from adolescents and caregivers to enhance acceptability and engagement within virtual dialectical behavior therapy for adolescents skills groups: A qualitative study. Child Psychiatry & Human Development, 56(5), 1418–1432. https://doi.org/10.1007/s10578-023-01641-7 PubMed

Rathus, J. H., Miller, A. L., & Linehan, M. (2015). DBT-A skills manual for adolescents. Guilford Press.