Determining if DBT group is right for your teen or adult client involves reflecting on their emotional experiences and challenges. Here are some signs that DBT group might be a good fit:

• Intense Emotions: If they frequently feel overwhelmed by their emotions, such as anger, sadness, or anxiety, and find it hard to manage them, DBT can help them develop coping strategies.
• Self-Harm or Suicidal Thoughts: If they've engaged in self-harm or experienced suicidal thoughts, urges, or actions, DBT group provides a structured and supportive environment to address these issues safely.
• Difficulty with Relationships: If they struggle to maintain friendships or have frequent conflicts with partners, friends, or family members, DBT group focuses on improving communication and relationship skills.
• Impulsivity: If they find themselves making impulsive decisions that lead to negative consequences, DBT group teaches skills to help them pause and make more thoughtful choices.
• Desire for Change: If they’re motivated to learn and practice new skills and want to create a more balanced and fulfilling life, DBT group offers practical tools to facilitate that change.
• Willingness to monitor and practice behaviors outside of session: DBT is a “doing” therapy, so teens and adults get the best outcomes from DBT group when they fully participate in the therapy.  This includes completing weekly skills homework practice assignments. Participants will be expected to practice the skills they learn in group each week in their lives and come back and report on how their practice went.  

Not at all! Many clients attend DBT group while continuing individual therapy with their current provider. We ask that the client see you at least biweekly for the duration of their 24 weeks in group so that their individual needs are supported. We’re happy to coordinate care and will ask you and your client to complete a group agreement and safety plan prior to their start in group.

Nope! Our DBT groups are skills-focused and designed for anyone struggling with emotional, behavioral, or interpersonal dysregulation.

Some teens and adults would benefit from an alternative approach to our DBT program.  If your client meets any of the following criteria, please let us know and we can work with you and them to find an alternative treatment plan that will be a better fit.

• Active psychosis that impairs their ability to function and engage appropriately
• Severe learning disability
• Severe cognitive impairment
• Unwillingness/disinterest in attending group and/or completing skills homework
• Teen does not have consistent caregiver to attend with them (or teen is unwilling to attend with parent)
• Inability to meet treatment/attendance requirements due to:
  • Severe medical issues
  • Insufficient finances to pay for sessions
  • Transportation difficulties

During the DBT group intake and orientation session at Cincinnati Center for DBT, we begin by reviewing the forms and self-assessment measures your client completed prior to the appointment. This helps us understand their presenting concerns, treatment history, and what they’re hoping to gain from participating in group. We also conduct a suicide risk assessment to ensure safety and clinical fit.

If your client is a good match for DBT group, we move into the orientation and commitment process. This includes:

• Educating your client about what to expect in group
• Clarifying the structure, expectations, and goals
• Using commitment strategies to increase readiness and motivation

If your client is willing and able to make the full commitment, we schedule them for their group start date.

In our DBT skills training groups for teens and adults, group members learn the four DBT skills modules:

• • Mindfulness, where people learn how to take more control of their minds and be more present.  For anyone in the world, not just people with severe emotional dysregulation, we're often either thinking of the past or focused on the future, and we're not actually here now.  Mindfulness helps us to be more aware and present because we can handle just this one moment. When we're thinking about all the stuff that can happen in the future, that causes more suffering.  We can handle right now and when we have a good grasp on mindfulness, we can actually use the skills better.
  • The distress tolerance module is all about how to tolerate the moment.  If they can't solve a problem right then, they need to find a way to get through it, so clients learn quick skills that will get them through the situation without making things worse.
  • The emotion regulation module helps them learn more about their emotions: how to change their emotions, how to stop their emotions before they start, and what makes them more vulnerable to your emotions.
  • Interpersonal effectiveness teaches them how to be effective with other people, including learning how to figure out and prioritize their goals in interpersonal situations, how to ask for something effectively or say no, how to maintain good relationships, and how to maintain their self-respect.
  • Teens and caregivers in our multi-family DBT skills training group learn an additional skills module: Walking the middle path teaches them how to validate both their and other’s feelings, and how to think dialectically, or to find a balance between two extremes.

DBT skills training groups are very different from traditional psychotherapy or interpersonal process groups.

While traditional therapy groups often focus on sharing personal experiences, emotions, and gaining insight through group discussion, DBT skills groups are structured more like a class. The primary focus is on teaching and practicing specific behavioral skills that help participants manage emotions, tolerate distress, and improve relationships.

In DBT group:

• Members are not expected to share personal stories in depth
• Disclosure is limited to how they applied the skills during the previous week
• Participation is focused on learning, not emotional processing

Group members are encouraged to reflect on and share how they used that week’s assigned skill in real-life situations. Any additional personal information shared is entirely at the client’s discretion.

This format makes DBT skills group accessible, practical, and safe, especially for clients who may feel overwhelmed in traditional group therapy settings. It also complements ongoing individual therapy, rather than replacing it.

There are a lot of benefits to participating in a DBT skills training group as opposed to learning the skills in individual therapy:

• DBT skills training is more like a class than a psychotherapy group.  In the past, clients may have participated in a psychotherapy group or seen psychotherapy or support groups in TV shows or movies.  Oftentimes, when people think of group therapy, they think of a bunch of people sitting around sharing intimate details about themselves and crying a bunch.  That is NOT skills training!  DBT skills training is structured like a class where the skills trainers teach clients skills, help them practice skills, and review how they practiced skills between classes.  The format is highly structured and there isn’t much room for discussion outside of learning and practicing skills.  We’ve had many clients feel apprehensive about starting DBT skills training due to preconceived notions about group therapy, but once they started group and experienced the structure of it, they were glad they joined.
• DBT skills groups allow for exponentially more learning than when skills are delivered one-on-one.  In DBT class, participants get to hear how other group members are applying the skills and they get to learn from the feedback the skills trainers provide to the other group members.  Oftentimes, another group member may apply a skill in a situation similar to what they’re going through, when the client didn’t even realize that skill could be helpful in their situation.  Other group members may ask questions, make comments, or share examples that further your client's understanding of the skill.
• Your client will learn that they’re not alone.  When people are suffering, they often think that they are alone in their pain and that others couldn’t understand it.  They might feel afraid of or uncomfortable sharing their emotional pain, concerned that people will judge them.  Sometimes they’ve even had the experience of others invalidating, judging, or making fun of them for how they feel.  Clients who participate in DBT skills group learn that they are not alone and learn that group is a safe place to take off the mask and practice using skills to solve problems.  Although not everyone in group is dealing with the same problems or diagnoses, everyone in group is there to learn how to manage their emotions and relationships better.
• Teens: Their parents have to learn new skills too.
  • A note to providers with teen clients: Have you ever wished your client's parent or caregiver would handle things differently? Now’s your chance! In our multi-family skills group, the teen's family member will attend and practice the same skills as the teen. Just like the teen, they’re held accountable for showing up and practicing the skills, putting both the teen and the caregiver on equal ground. Together, they’ll both become more skillful, which means better communication, less conflict, and a stronger relationship. Plus, since they’ll be learning the same skills, they’ll be able to support and remind the teen when things get tough, making it easier for the teen to use the skills in real-life situations.
  • A note to providers with parent/caregiver clients: Attending multi-family DBT skills group with their teen is an incredible opportunity to learn skills that will not only benefit their teen, but also help the caregiver in their own life. They’ll gain tools to manage stress, emotions, and relationships more effectively, while also learning how to reinforce their teen’s skill use. Both the caregiver and their teen will walk away more present, balanced, and better equipped to handle life’s challenges - together.
• DBT skills group is cost-effective.  When your client participates in group therapy, they are sharing the cost of the session with other group members, instead of paying for the entire session themselves.  That means they pay less per session and have longer skills sessions when participating in group compared to learning the skills in one-on-one therapy.  For example, our multi-family DBT skills training groups cost $180 per two-hour session with two facilitators, vs. our individual therapy sessions cost $120-$220 per 45-60-minute session with one therapist.

The cost of DBT at Cincinnati Center for DBT depends on the level of care you receive.

1. DBT "Group Only" Option

In our "Group Only" option, your client attends our DBT skills training group and participates in individual therapy with you at least every other week to support them while they're in group.

• Adults: The fee for our two-hour adult DBT skills group is $90 per group.  In order to attend, your client must commit to attending group for 24-weeks (the length of time required to cover all of the critical skills).
• Teens: The fee for our two-hour multi-family DBT skills group is $180 per group, which allows the teen and one caregiver to attend.  In order to attend, the teen and caregiver must commit to attending group for 24-weeks (the length of time required to cover all of the critical skills). The same caregiver must attend all 24 weeks.

2. Comprehensive DBT

Comprehensive DBT is our most intensive therapy service and usually best for higher-risk teens and adults.  In Comprehensive DBT,  the client receives four modes of DBT treatment: DBT skills training group, structured individual DBT therapy, skills phone coaching, and a consultation team for the therapist.  You can learn more about our Comprehensive DBT program here.  If your client enrolls in our comprehensive DBT program, they will typically pause individual sessions with you during their time with us, unless there’s a specific therapeutic need that your work would support as an adjunct to the DBT treatment.

• Adults: The fee for our two-hour adult DBT skills group is $90 per group.  In order to attend, your client must commit to attending group for 24-weeks (the length of time required to cover all of the critical skills).  The cost of individual therapy would depend on which therapist they see, but the client can expect to pay between $120-$220 per individual session each week. Adults who participate in our comprehensive DBT program have access to 24/7 phone coaching with their DBT therapist completely free of charge.  
• Teens: The fee for our two-hour multi-family DBT skills group is $180 per group, which allows the teen and one caregiver to attend.  In order to attend, the teen and caregiver must commit to attending group for 24-weeks (the length of time required to cover all of the critical skills). The same caregiver must attend all 24 weeks. For individual therapy, cost varies depending on the therapist, but your client can expect to pay between $120-$220 per individual session each week.  Teens who participate in our comprehensive DBT program have access to 24/7 phone coaching with their therapist completely free of charge.  Their parents also have free access to parent coaching with their skills trainer.  

For more information on fees and insurance, please see our Fees page.

We accept Lyra Health.  Otherwise, we are considered out-of-network.  What that means is that your client would pay for group at the time of the session and seek potential reimbursement from their insurance. We are happy to provide the documentation needed (i.e., a "superbill") to support their efforts for reimbursement. It’s important for them to look at their benefits if they will be seeking reimbursement. We’ve had clients who receive significant reimbursement and some who have no benefits. Your client can always use a HSA or FSA card for services. Also, most people have higher deductibles, so unless they have a major surgery planned, they may not hit their deductible. If they have to pay 100% up to their deductible, that means that they'll pay out of pocket for in-network and out-of-network.

We encourage your client to investigate all options regarding insurance and arrive at an informed decision regarding their mental health care.  There are many advantages to not using insurance for therapy, including confidentiality, having access to specialists, and more control over their treatment in general.

Great question!  We want to make this as easy as possible for you and your client, so please feel free to download this sheet and give it to your client to use to talk to their insurance about their out-of-network benefits: Tips for using Out-of-Network Benefits

You or your client can use this tool to see if they qualify for out-of-network reimbursement for our services:

Although every teen and adult could benefit from learning DBT skills, some clients will benefit most from engaging in comprehensive DBT, which includes individual DBT therapy and phone coaching, in addition to the DBT skills group.  Teens and adults who are good candidates for comprehensive DBT are those who: self-harm or have frequent urges to engage in self-harm or suicide attempts; experience problems with substance use or addiction; have an eating disorder; have been diagnosed with borderline personality disorder (BPD); have difficulty staying in mental health treatment; experience significant impulsivity and problems in relationships; find that their symptoms interfere with their ability to have a reasonable quality of life (e.g., maintain a job, housing, financial stability, or relationships; attend or do well in school; get along with friends or others, or have relationships with their family).

Anyone who participates in a DBT skills training group is required to engage in individual therapy at least every other week to support them while they are in group.  However, not everyone requires comprehensive DBT.  Our staff would be happy to consult with you regarding the best option for your client.

Our DBT skills training groups meet weekly for two hours for a total of 24 weeks.  It is important to attend each session in order to learn all of the critical skills.

For individual therapy, teens and adults should meet with their individual therapist at least every other week to support them while they’re in group.  If they are participating in comprehensive DBT, we recommend weekly individual sessions.

The multi-family DBT skills group for teens and their parents/caregivers is a highly effective, evidence-based treatment designed to help young people manage intense emotions and improve their relationships. It teaches practical skills to handle difficult feelings like anxiety, depression, anger, and hopelessness, which can often lead to self-harm or suicidal thoughts.  Each teen and one of their parents/caregivers attends group with other teens and parents/caregivers.

The multi-family DBT skills group for teens focuses on five core areas: emotion regulation, distress tolerance, interpersonal effectiveness, mindfulness, and walking the middle path. 

Through DBT, teens gain the tools to manage overwhelming emotions, communicate more effectively, and create a life they want to live. It’s a structured, supportive approach that helps teens find peace, control, and balance in their lives.

Our multi-family DBT skills group for teens accommodates teens ages 14-18.  For children younger than 14, we can provide individual skills training to the teen, the teen and one parent/caregiver, or the teen and both parents/caregivers. For children ages 6-12, we recommend they consider participating in a  DBT for children (DBT-C) program.

DBT Graduates Group is designed for clients who have completed one year of DBT skills training and who would like help strengthening their DBT skills and generalizing their use of DBT skills to more contexts in their environment.  Clients who have completed one, six-month round of DBT skills training are considered on a case-by-case basis.  To be eligible for DBT graduates group, clients must have a strong understanding of the DBT skills to the point that they would not need to learn the DBT skills again.

DBT Graduates Group puts more emphasis on the group members holding themselves accountable to strengthening their DBT skills.  Usually, there is not much teaching of the DBT skills and there is no homework review.  Instead, DBT graduates group members use the time to discuss their struggles and successes with the DBT skills.  DBT graduates group members will help each other problem-solve how to overcome obstacles with using the DBT skills.  Additionally, DBT graduates group members will take turns leading the mindfulness practice at the beginning of group in order to strengthen their mindfulness practice and understanding.

Many of our DBT graduates group members have shared that they appreciate the accountability the group provides, as it can be hard to continue to remember and practice DBT skills when not attending a weekly DBT group.  DBT graduates group is only one-hour long and group members are asked to commit one module at a time (e.g., mindfulness + emotion regulation, interpersonal effectiveness, or distress tolerance), although most group members participate in at least one full round of DBT graduates group.  If your client is interested in registering, you can contact us at 513-268-8306 or support@cincinnaticenterfordbt.com.

DBT, or Dialectical Behavior Therapy, is an evidence-based treatment developed by Marsha Linehan, Ph.D.  DBT is the gold-standard treatment for teens and adults who experience chronic emotion dysregulation or who are chronically suicidal.  Originally published as a treatment for borderline personality disorder (BPD), DBT has since proven effective in treating multiple disorders, including mood, depression, alcohol and drug use, and eating disorders.

DBT is based on Marsha Linehan’s biosocial theory, which states that chronic emotion dysregulation stems from a transaction between emotional vulnerability and an environment that invalidates or trivializes the person’s experience.  DBT is designed to help teach teens and adults how to reduce emotional vulnerability and learn to interact effectively with the environment.

A core piece of DBT is the skills training group.  This is typically a 6-12-month commitment during which clients learn skills to help them be present in the moment, regulate their emotions, tolerate distress, and interact effectively with others.  Clients are expected to attend a weekly group and apply the skills they learn in their lives.  In this respect, the saying “It works if you work it” is very true for DBT - if you want to do something different, you gotta do something different.

Additional pieces of DBT include structured individual DBT therapy, skills phone coaching, and a consultation team for the therapist.  Although many people benefit from all four modes of DBT, it is important to discuss this with your therapist and determine what modes of treatment will help you best meet your goals.

The highest standard in assessment of DBT delivery is the DBT-Linehan Board of Certification™ (DBT-LBC).  DBT-LBC is the only DBT certification endorsed by Dr. Marsha Linehan, the treatment developer.  Clinicians who are certified by DBT-LBC have passed rigorous assessment of their DBT knowledge and skill and have been deemed to provide DBT adherently.  Currently, there are only approximately 500 DBT-LBC certified clinicians globally.

To confirm certification of a DBT provider or program by the DBT-Linehan Board of Certification™, please visit the DBT-LBC website, https://dbt-lbc.org then click consumers, and then click “Find a Certified Clinician” or “Find a Certified Program.”

The Founder & CEO of Cincinnati Center for DBT, Dr. Nikki Vail, is a DBT-Linehan Board of Certification, Certified Clinician™, and oversees the work of all DBT clinicians at Cincinnati Center for DBT.  All of our DBT therapists participate in extensive DBT training throughout their careers with us, including 42 hours of intensive DBT training upon hire, weekly core didactic training with a DBT expert and former student of Dr. Marsha Linehan's for the first year of their tenure with us, and weekly advanced didactic training to continue to hone their DBT skillset for the remainder of their career with us.  Additionally, each clinician participates in review of session recordings in accordance with our commitment to the community to provide DBT with fidelity to the evidence-based model.  Several of our clinicians are in the process of meeting the requirements for certification through the DBT-Linehan Board of Certification™ (DBT-LBC).

DBT is a structured program that uses a combination of four key treatment modes to help teens and adults manage emotions, improve relationships, and build coping skills. Here’s how it works:

1.     Individual DBT Therapy
   Teens and adults meet one-on-one with a DBT therapist to work through their specific emotional struggles, such as intense sadness, anxiety, or anger. They also learn how to apply DBT skills to real-life situations.
2.     DBT Skills Training Group
   In this group, teens and adults learn essential DBT skills, like emotion regulation and effective communication.   Group members practice the skills they learn in group outside of session to solidify their learning and share how it went at the next group session. In our Teen program, teens and their parents or caregivers attend sessions together in our multi-family group; this helps families work through conflicts and strengthen their relationships while learning alongside other families.
3.     24/7 Phone Coaching with the Therapist
   When teens and adults in our comprehensive DBT program need immediate support between therapy sessions, they can call their therapist for real-time coaching. This helps them use DBT skills in the moment during a crisis or emotional challenge.  Additionally, parents of teens in our comprehensive Teen DBT program get 24/7 access to parent coaching with one of our skills trainers.  This allows them to get help applying DBT skills to their teens from skills trainers in real-time.
4.     DBT Therapist Consultation Team
   Behind the scenes, the client's therapist is part of a team of DBT professionals who meet regularly to ensure they’re providing the highest quality of care. This helps ensure that our teen and adult clients are receiving well-rounded, expert support.

Together, these four components provide a comprehensive approach to help teens and adults manage their emotions, build healthier relationships, and create lasting change in their lives.

DBT is often needed when a teen or adult is struggling with intense emotions that feel overwhelming or out of control. It’s especially helpful for teens or adults who:

• Experience frequent mood swings, anxiety, or depression
• Seem to be in persistent crisis
• Struggle with self-harm or suicidal thoughts/urges/actions
• Have difficulty managing anger or frustration
• Experience unstable and roller coaster relationships with family, friends, and/or others
• Have trouble communicating effectively or resolving conflict
• Feel emotionally disconnected, misunderstood, or trapped in emotional turmoil
• Engage in harmful impulsive behaviors such as substance use or disordered eating
• Experience dissociative symptoms or have a history of trauma

DBT is designed to help teens and adults who feel stuck in patterns of extreme emotional distress. If a client's emotional struggles are interfering with their daily life, relationships, or mental health, DBT can provide the skills and support needed to regain balance and move toward a more stable, fulfilling life.  DBT is most helpful when participants have the general willingness and capacity to attend a two-hour skills group that is held weekly for 24 weeks.

• To allow for more families to join. We want to keep the group total around 8-10 (4-5 family pairs).
• The parent and teen in the group have the opportunity to teach the other parent (and other kids or family members in the home) these skills.
• Just as we want our adult clients to come every week so they learn and practice all the skills, we want the same for our parents. If they rotate in and out then they don't get that chance.
• Sometimes we will encourage the teen to do another round of skills training to enhance their knowledge and provide additional opportunities to practice and receive feedback from the skills trainers. If the teen commits to another six months, we encourage another adult/caregiver to join.

DBT is a six-month commitment because it takes six months to get through the DBT skills curriculum.  Your client will learn the mindfulness skills several times throughout their group commitment because these are the core skills needed to effectively use the other DBT skills!  We also spend 6-8 weeks in each of the distress tolerance, emotion regulation, and interpersonal effectiveness modules (and middle path module for teens and parents in the multi-family DBT skills group).

DBT was originally designed as a one-year treatment, during which clients went through the full six-month commitment of skills two times.  However, research has shown that not all clients need to go through the skills twice.  As of this writing, research has not determined who exactly needs a full year of skills versus six months.  We encourage you and your client to discuss their progress, goals, and options when considering graduating or recommitting to DBT skills group.  Our clinicians will review your client's clinical outcome data with them and discuss their progress so that they can make an informed decision about how long they want to be in DBT group.

Yes!

We strive to create a welcoming and supportive environment for everyone in our practice and groups. Two of the core principles of DBT - nonjudgmentalness and radical genuineness - help foster the sense of safety that many of our clients feel in our groups. We regularly work with LGBTQIA+ and neurodivergent teens and adults, and if you or your client have/has any concerns or preferences regarding group placement, we encourage you or the client to share them with our intake coordinator.

While we don't currently see many BIPOC teens or adults in our groups, we deeply value inclusivity. Our clinicians and staff continue to engage in ongoing anti-racism and diversity training to do our best to ensure that everyone feels safe and respected. We are committed to fostering a space where BIPOC clients feel comfortable and supported, and we look forward to welcoming more BIPOC members into our groups in the future.