How We Treat
Dialectical Behavior Therapy for Adolescents (DBT-A)
Clinically reviewed by Brooke Shafer, LCPC/LPC. Brooke was the winner of the Best of Bethesda in Child and Adolescent Counseling for 2024. Brooke has been trained in comprehensive Dialectical Behavior Therapy (DBT) and Dialectical Behavior Therapy for Children (DBT-C) and currently runs a multifamily skills group for middle school-aged adolescents and their families.
It is one of the hardest things a parent can watch: a teenager caught in emotions that feel too big to even name, let alone manage. We believe every adolescent can learn to move through intense emotion instead of being ruled by it. Dialectical Behavior Therapy for Adolescents (DBT-A) is the most structured, evidence-based path we know to help them get there.
What is DBT-A?
Dialectical Behavior Therapy for Adolescents (DBT-A) is an evidence-based therapy for teens who struggle to regulate intense emotions.
Typically, ages range from roughly 13 to 18; although, at the Counseling Center Group, a consultation with our DBT-A trained clinicians will help figure out what is the best model for each family. Thus, some of our DBT-A clinicians work with children as young as 10 or 11. DBT-A teaches mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness through weekly individual therapy, a skills group, phone coaching, and direct caregiver involvement.
Clinicians commonly use DBT-A to support adolescents experiencing anxiety, depression, self-harm behaviors, emotional dysregulation, impulsive behaviors, and interpersonal difficulties.
This structured, skills-based therapy combines behavioral strategies, mindfulness practices, and practical coping tools to help teens manage intense emotions more effectively. At The Counseling Center Group, our DBT-A clinicians are trained specifically in adolescent mental health, family systems, and evidence-based treatment for teens. Every treatment plan is built around your teen’s own goals, not a one-size-fits-all program.
Why Counseling Center Group Uses DBT-A
Counseling Center Group invests deeply in DBT-A because we believe teenagers deserve concrete, accessible, and age-appropriate tools, not just a diagnosis. Diagnoses may give a label to a lived experience, but many teens come in saying that they don’t know what to do next, or that their feelings are deeper and more complicated than just a set of symptoms.
DBT-A closes that gap by pairing every skill with real practice using relevant examples and by involving caregivers directly, so the changes a teen thinks about making in session carries over into their home, their friendships, and their school day. Our DBT-A clinicians train specifically in adolescent development and family systems, because a fifteen-year-old and a thirty-five-year-old don’t need the same version of DBT. CCG delivers DBT adherent to the Linehan model, which means all four components stay intact rather than being offered as a menu. DBT-A also adds a fifth module called Walking the Middle Path, which focuses on balancing acceptance and change and targets evolving independence and control as teens grow older.
Which Teens Is DBT-A Designed For?
DBT-A is designed for adolescents roughly ages 13 to 18 whose emotions escalate fast, take a long time to settle, and spill into school, friendships, and family life. They may be described as “sensitive”, often with a negative connotation. Being sensitive is not a bad thing, though- it just means that they are deeply feeling people who may not have been taught how to deal with their deep feelings. Adapted specifically for teens from Dialectical Behavior Therapy (DBT), it highlights caregiver support and family involvement alongside individual skills training.
Best For:
- Teens whose emotions are intense and fast-changing, escalating quickly and taking a long time to settle. These reactions often leave both the teen and the family around them feeling confused or on edge.
- Adolescents who are experiencing self-harm behaviors or suicidal thoughts. DBT-A was adapted specifically to address these safety concerns while building emotional skills at the same time.
- Teens managing anxiety, depression, or other mood-related concerns, especially when talk therapy alone hasn’t been enough. DBT-A skills answer the often-asked question “I know what I feel and why, but what do I do now?”
- Families navigating ongoing conflict or communication breakdowns, including situations where a teen feels increasingly hard to reach or understand.
- Teens who need concrete skills, not just insight. DBT-A pairs every concept with a practical tool they can put to use the same day.
- Families who want to be part of the process, since DBT-A is built around caregiver involvement rather than individual sessions alone. Evidence supports that parent/caregiver involvement may improve family communication, caregiver well-being, and treatment support.
Not the right fit right now:
DBT-A is not the correct first step for every teen, and we will tell you that at the consultation rather than after intake:
- Teens whose primary need is trauma processing. CCG’s DBT-PE program pairs DBT skills with trauma-focused treatment for adolescents with PTSD.
- Children ages 8 to 12 belong in DBT for Children (DBT-C), which uses a parent training track rather than a teen skills group. For younger children, Parent-Child Interaction Therapy (PCIT) is often the better fit. Note: Counseling Center Group has a flexed model of DBT-C and DBT-A to fit the developmental needs of clients.
- Teens who want general coping skills without committing to a full clinical program. The Emotion Fitness Program teaches DBT skills in a lower-intensity group format. It is not appropriate for teens with active self-harm or suicidal behaviors, who need comprehensive DBT-A instead.
DBT-A is a structured program delivered over 6-12 months, not a single session. If your family is not in a position to commit to that, let us know- we would be happy to figure out a way to meet your family where you’re at and find something that fits.
What Skills Does DBT-A Teach?
DBT-A teaches five skill modules: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness, and walking the middle path. Teens learn named, concrete skills including Wise Mind, TIPP, STOP, Radical Acceptance, Opposite Action, Cope Ahead, DEAR MAN, GIVE, and FAST, practiced in group and reinforced in individual therapy. Skills are taught using frameworks and examples that are specific to teen experiences to increase the likelihood that they will be used and generalized.
- Mindfulness: DBT-A starts with Wise Mind, the balance between emotion mind and reasonable mind. It’s the foundation skill, and it helps teens notice what they’re feeling before they react to it. The concept of mindfulness is woven throughout treatment to help teens notice what they are feeling and what urges may come up before they act.
- Distress Tolerance: Crisis-survival skills such as TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation), the STOP skill, and IMPROVE the Moment help teens get through intense moments without making them worse. Radical Acceptance and Willing Hands round this module out, teaching teens to stop fighting a reality they can’t yet change. Distress tolerance skills are like band aids- they help in the moment and keep you safe until you are in a place where you can do some deeper problem solving.
- Emotion Regulation: Skills such as Opposite Action, Cope Ahead, and the PLEASE skills work on the intensity and frequency of difficult emotions over time, not just in the moment they happen.
- Interpersonal Effectiveness: With DEAR MAN, GIVE, and FAST, teens get concrete scripts for asking for what they need, keeping friendships intact, and talking to parents and teachers without losing their self-respect. Parents and teens have remarked that they are better able to find solutions that work for everyone and feel more validated when using these skills.
- Walking the Middle Path: Many DBT-A programs, CCG’s included, add this fifth module for teens and families. It teaches validation and dialectical thinking to both the adolescent and their caregivers, so the whole family changes the pattern together, not just the teen. (Added by Brooke: This is one of the ways that DBT-A differs from DBT and DBT-C- there is unique need for teens and tweens to understand some of the foundational theories of DBT, and to envision how to use skills specifically when someone old enough to experience their own motivations, core values, and internal goals is still living with their family).
What does DBT-A at CCG include?
A full course of DBT-A at CCG includes five components delivered together: weekly individual therapy, a DBT skills training group, phone coaching between sessions, caregiver and family involvement, and weekly review of your teen’s case by a clinician consultation team. All five are standard, not add-ons.
- Individual Therapy: weekly sessions where your teen applies DBT-A skills directly to their own relationships, school pressures, and emotional patterns.
- DBT Skills Training Group: teens build skills alongside peers across all four core modules, and many sessions involve parents or caregivers directly.
- Phone or Skills Coaching: brief, real-time support between sessions. A teen gets coaching in the moment a crisis happens, not just whenever the next appointment falls. This is one of the key components that gives DBT such great outcomes, as the application of skills in real time is often difficult to reconcile with simply learning and talking about them in sessions.
- Caregiver and Family Involvement: parents and caregivers take part in sessions, family therapy, or skills training, reinforcing a teen’s progress outside of the therapy room and ensuring that everyone speaks the same therapeutic language. Exact treatment models vary by location. Counseling Center Group offers multifamily groups where caregivers and their kids learn skills together and parent- or teen-only groups, in addition to providing skills training during individual or family therapy sessions. For kids in 5th-8th grades, parents attend Multifamily Group with their kids; for 9th-12th grades, parents attend a separate group.
- Therapist Consultation Team: CCG’s DBT-A clinicians meet weekly for peer consultation, so your teen’s care reflects current, adherent DBT-A practice instead of one clinician working alone.
What Does DBT-A Treat?
DBT-A treats emotional dysregulation and the behaviors that follow from it: self-harm, suicidal thoughts, impulsivity and risk-taking, anger, and relationship conflict. It also supports teens managing anxiety, depression, trauma-related symptoms, school stress, and identity concerns when emotion regulation is the underlying difficulty. Teens don’t need a certain diagnosis to benefit from DBT-A.
DBT-A may help adolescents experiencing:
- Emotional dysregulation
- Anxiety disorders
- Depression and mood-related concerns
- Self-harm behaviors
- Suicidal thoughts or behaviors
- Interpersonal relationship difficulties
- Impulsivity and risk-taking behaviors
- Anger and irritability
- Trauma-related symptoms
- Chronic stress and overwhelm
- School-related emotional difficulties
- Identity-related concerns
- Family conflict
- Difficulty managing intense emotions
- Low distress tolerance
- Social and peer-related challenges
What to Expect: How DBT-A Works at CCG
At the Counseling Center Group, DBT-A begins with an intake conversation focused on your teen’s emotional, behavioral, academic, social, and family-related concerns. From there, our intake team matches your family with a clinician experienced in DBT-A and evidence-based treatment for adolescent mental health.
Depending on your teen’s needs and treatment goals, DBT-A treatment may include individual therapy, family or caregiver participation, skills-based group sessions, and phone coaching. Our clinicians teach DBT-A skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, then help your teen put them to use in real situations at home, at school, and with friends.
Sessions typically run 45 to 60 minutes and are available in person or by telehealth, depending on clinician availability and where you’re located. DBT-A is a structured, skills-based program rather than open-ended talk therapy, so your clinician will review progress with you regularly and talk through what a full course of treatment looks like for your teen specifically. CCG’s intake and clinical teams will do their best to create a treatment plan that works for each individual family- if the existing models are not a good fit or not possible, we will still figure out a good way to make DBT-A work for you.
Where DBT-A Is Available
Counseling Center Group provides DBT-A in person and by telehealth across Maryland, Washington DC, Virginia, New York, New Jersey, and Florida. Availability by office depends on clinician schedule and state licensure. Our intake team will match your family with a DBT-A clinician near you, or connect you with a virtual clinician licensed in your state.
DBT-A FAQs
DBT-A is an adolescent-focused adaptation of Dialectical Behavior Therapy that incorporates developmental considerations and greater family involvement. While the core DBT skills remain the same, DBT-A is tailored specifically to the emotional, social, academic, and behavioral needs of teenagers. It specifically emphasizes caregiver involvement to make sure that families are on the same page.
Yes. DBT-A is considered an evidence-based treatment approach for adolescents experiencing emotion dysregulation, self-harm behaviors, suicidal ideation, anxiety, depression, and related concerns. Research supports its effectiveness in improving coping skills, emotional functioning, interpersonal relationships, and overall quality of life.
Neither is universally better. CBT works by restructuring thought patterns and is often the stronger choice for a teen whose main difficulty is anxiety or a specific phobia. DBT-A adds skills training in emotion regulation and distress tolerance, and is the stronger choice for a teen with self-harm behaviors, impulsivity, or emotions that escalate faster than they can manage.
Both DBT and CBT are available at CCG. Our clinicians assess which fits your teen at the consultation, and some teens receive elements of both.
No. While DBT-A is commonly used for adolescents experiencing significant emotional distress, it can also help teens who struggle with emotion regulation, impulsive behaviors, relationship difficulties, stress management, low distress tolerance, or coping with intense emotions.
DBT-A is designed to be a structured, time-bound treatment rather than an open-ended one. Many teens participate in weekly individual therapy and a skills group for months, with progress measured against specific behavioral and emotional-regulation goals rather than an indefinite timeline. Your teen’s clinician will review progress regularly and discuss what a full course of treatment looks like for your family.
Parent or caregiver involvement is a crucial part of DBT-A treatment. Depending on clinical needs, caregivers may participate in sessions, family therapy, or skills-based support to help reinforce progress outside of therapy. Insert data here about outcomes with caregiver involvement?
Yes. Depending on clinician licensure and client location, DBT-A may be offered through secure telehealth sessions in addition to in-person services.
Counseling Center Group is an out-of-network provider, so we don’t bill insurance directly for DBT-A. Many insurance plans reimburse a portion of out-of-network mental health costs. CCG provides a monthly Superbill you can submit to your insurance carrier for reimbursement, and HSA/FSA funds are accepted at every location. We recommend confirming your family’s specific out-of-network mental health benefit before your first session, or contact our team with questions.
DBT-A skills training is organized into mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, often alongside a family-focused Walking the Middle Path module. Teens learn specific, named skills, such as Wise Mind, Opposite Action, Radical Acceptance, and TIPP, that are practiced in groups and reinforced through individual therapy, phone coaching, and caregiver sessions.
Helping Your Teen Build Skills, Not Just Insight
At the Counseling Center Group, we believe intense emotion doesn’t have to define your teen’s adolescence or your family’s daily life. Whether your teen is managing self-harm, anxiety, or relationships that feel impossible to navigate right now, our DBT-A clinicians can help them build the skills to move through it, with you as part of the process every step of the way. If any of this sounds familiar, we’re here.
Clinical Review
About the Reviewer
Brooke Shafer, LCPC/LPC
Winner of the Best of Bethesda in Child and Adolescent Counseling for 2024 Brooke has previously worked in Elementary and Middle Schools and in mental health crisis situations, specializing in ...
Sources and Additional Resources
- Dialectical Behavior Therapy for Adolescents: Theory, Treatment Adaptations, and Empirical Outcomes, Cheavens et al.
- DBT-PE (Trauma-Focused DBT), Counseling Center Group
- Parent-Child Interaction Therapy (PCIT), Counseling Center Group
- Family Therapy, Counseling Center Group
- Anxiety | Depression | Self-Harm & Suicidal Thoughts | Emotional Dysregulation | Trauma, Counseling Center Group
- Locations, Counseling Center Group
- Contact Us, Counseling Center Group
- DBT Linehan Board of Certification
- 988 Suicide & Crisis Lifeline