The Multifamily Group Format and Why It Is Helpful


Hey all. This is Desirae with CCDBT. I am one of the clinicians and also one of the skills trainers for our multifamily group. I wanted to take a few minutes to address a question that we often get here at CCDBT: “why is the multifamily group format helpful?” So, the goal is to answer that question in addition to providing a rationale as to why we’ve decided to structure the group in the way that we have and address a couple common questions that we get when people are inquiring about this specific group. 

What Does the Multifamily Group Look Like?

Before I jump into all of that though, I want to give you a very brief overview of what the multifamily group looks like because I think that’s pretty important to know. Our group is for one teen and one parent or caregiver that’s really important to that teen’s life or to that teen in general. The teen and caregiver come together on a weekly basis, attending the two hour skills group for a total of six months. The teen and the parent learn the skills side by side, so the teen and the parent are expected to be active members within the group. Both the teen and the caregiver are participating in any activities that we have going on, they’re participating in the skills homework that is assigned from week to week, and they’re coming in and sharing what that homework was. The format of the group consists of learning skills, which falls very much in line with our adult skills training groups where we cover mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. However, the multifamily group has a fifth module that was specifically designed by the authors of this program and it’s called walking the middle path.

While working through walking the middle path, the parent and the teen are learning how to address any problematic patterns that they’re seeing within their relationship or within the household. They’re learning how to validate one another and how to receive that validation from the other person. And they’re also learning how to increase the flexibility of their thoughts, so very much moving away from “all or none” or “black and white” thinking and being able to consider and see the world through a dialectical perspective.  

Why Involve a caregiver?

Next, I want to provide the rationale for involving a parent or caregiver in the skills group. The first thing that we really believe in is that it’s important for the caregiver to come in and learn the exact same skills that their teen is learning. This provides the parent or caregiver with the ability to have the same language and knowledge, as their teens’ providers and as their teen as well. So if or when a crisis or problem arises, a parent or caregiver is able to provide encouragement and coaching by using the DBT skills. Furthermore, when a caregiver learns the skills and practices them, the caregiver is even more effective when trying to help their teen in those moments. 

Also, believe it or not, parents—you’re human. Just like myself, and your teen and everybody else. And so of course it’s reasonable to expect that you’re going to have your own difficulties, right? Regulating your own emotions, running into interpersonal difficulties, engaging in your own problem behaviors… heck, we all do it. I’m the first to admit it for sure in group. So this can benefit you in your day to day life as well, in addition to supporting your teen through the things that they’ve got going on.

We also hear time and time and time again from parents that one of the most beneficial parts, above and beyond just learning the skills and improving their relationship with their teen, is having this built in support network. So we are hearing parents say how nice it is to know that they, their teen, and their family, are not alone in the struggles that they come and present with. And that they feel very validated and supported, not just by the skills trainers themselves but by the other family members. We see a lot of encouragement and some caregivers saying to other caregivers, “Hey, we too, at the beginning of joining this group had similar issues, blocking points, barriers, and this is how we got through that. Stick with the group skills, and we really believe that things are going to get better for you just as they did for us.” 

Can an additional caregiver join?

Another question that arises is whether an additional parent or caregiver can join the multifamily skills group? And our initial reaction is like “Heck yes!” I love love love to hear when people want to learn skills and by golly it is not only the mission of CCDBT, but a personal mission of mine to get as many skills out there as I possibly can to people. And we have to balance that with what is reasonable and what is going to be effective for the overall group process. So we have really thought about why we are going to cap it at a certain number—which is about 8 to 10 people total for the group. Research really supports that we don’t go over 8 to 10 people because then we’re just not having enough time for people to share their homework, we’re not having enough time to provide feedback for people (kind of corrective learning experiences), or to really highlight, and celebrate the wins that our families and our teens are experiencing when practicing these skills. And we like to answer questions that arise during group, which may not be possible if there are too many people in the group. So, those are some reasons why we limit it to one teen and one parent. 

Another reason is that this provides a rich opportunity for the teen and the parent to pass along the skills to the other parent or caregiver or children in the home, and say, “hey look at this really cool thing that we learned in group, we think this is gonna be really helpful,” or “so far we think this is the thing that is going to be one function of improving our relationship.” And then they can go and teach that to those family members and this process enhances their learning of that skill. Other caregivers mention the option of flip flopping back and forth and attending every other week. Although this is creative problem solving, we want to make sure that a caregiver learns all of the skills to be effective for their teen, rather than fifty percent.  This allows the parent to maximize their effectiveness with their teen. 

To account for the downsides of having only one parent or caregiver join skills group, we encourage everybody to consider another round of skills training. Once somebody can complete or does complete their first six months of DBT training, the parent or caregiver can have a conversation with the skills trainer or individual therapist about having the other parent do a round of skills training with the teen.  This enhances the opportunities for the teen to learn the skills, reinforces the learning that already has happened, and provides opportunities for that person to practice skills that may not have happened in the first six months. 

So that’s what I have for you guys. That was kind of a quick rundown of what is this group, what’s the format, and why is it structured the way that it is. Hopefully, again, it answered a lot of the questions or concerns that you might have. If things are still kind of unanswered, please reach out to us. We are more than happy to answer any additional questions that you might have. As of the time that this was written, we have some openings so we would love to be able to talk to you further and see if joining the multifamily group would be an effective choice for you and your teen. Thanks so much!

About the Author
Desirae Allen (she/her), Psy.D., is a licensed clinical psychologist that specializes in dialectical behavior therapy. Desirae works with teens and adults, creating a compassionate and judgement-free space, where clients can find wellness and recovery. Desirae believes that DBT can make a long-term difference in people’s lives, and she strives to work collaboratively with her clients to provide adherent DBT. Click Here to learn more about Desirae’s experience and therapeutic style.