Teen DBT vs Adult DBT: What Changes and What Stays the Same

In crisis or thinking about suicide? Call or text 988 now (in Colorado it reaches the 988 Colorado Mental Health Line). If you are in immediate danger, call 911.

Choosing a DBT track for your teen or young adult

If your teen is hurting themselves, talking about wanting to die or you think they are in danger, act first. Call or text 988, or call 911 if there is immediate danger, and tell their current therapist or doctor the same day.

Once things are safe enough to plan, the choice often comes down to which version of DBT fits your family. You may be a parent deciding whether a teen program is worth the time it asks of you. You may be an older teen or young adult wondering whether you belong in a teen group or an adult one. This guide compares the two models. For how to raise therapy with your teen, see how to talk to your teen about therapy.

What stays the same

A Behavioral Tech article on adolescent DBT says it has considerable overlap with standard DBT. The structure is the same comprehensive model. In a large U.S. trial of DBT for teens at high risk of suicide, treatment included weekly individual and group therapy, therapist consultation meetings and parent contact as needed.

The four standard skill areas stay: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. The same article notes that teens can learn complex skills such as radical acceptance and chain analysis, and describes many teens as more willing than adults to try new things and take feedback. Your teen still has their own individual therapist, their own goals and their own diary card.

What changes is mostly who is in the room and what the family learns. Walking the Middle Path names dilemmas that families under stress tend to swing between. One example is the pull between treating ordinary teen behavior as a problem and brushing off behavior that really is a problem. The module teaches ways to find a middle path between the two.

What adolescent DBT adds

DBT for adolescents and their caregivers was developed by Jill Rathus, Alec Miller and Marsha Linehan. Behavioral Tech says it was designed to include caregivers on purpose. The main goal is to make it more likely that teens use their skills and get reinforced for them at home. A second goal is helping the whole family.

• A multi-family skills group. Teens and caregivers learn the skills together. An early study of the adaptation by Rathus and Miller paired individual therapy with a multifamily skills training group.
• Walking the Middle Path. A fifth skills module covering dialectical thinking, common family dilemmas, validation in more depth, and behavior principles such as reinforcement. In a 2015 study, people receiving adolescent DBT rated validation the most beneficial part of skills training.
• Family sessions when needed. Behavioral Tech training covers how and when to bring family members into the teen's DBT sessions.
• Coaching and support for parents. Some programs coach parents on using DBT's behavior principles to shape their teen's behavior and on reducing conflict in family sessions.
• Help with the wider environment. Caregivers may need to arrange other supports, such as testing or school help, when a teen has issues like a suspected learning disability.

What teen DBT asks of parents

In adult DBT, you are the one making the commitment. In teen DBT, caregivers commit too. Behavioral Tech notes that caregivers usually must give consent and often handle transportation and payment. In a multi-family format, a parent or caregiver attends group alongside the teen.

Parents can also slip into what DBT calls therapy-interfering behavior. A Behavioral Tech article gives examples such as undermining skills, not getting the teen to appointments, or belittling the therapist to the teen. It advises clinics to explain their rules to families early and often, including what happens when caregivers miss skills group.

None of this is about blame. It reflects the model's aim of making skills more likely to be used, and rewarded, at home. For the parenting skills themselves, see DBT skills for parents of teens, which covers validation, reinforcement and the rest in detail. For what stays private between your teen and their therapist, see supporting a teen in therapy.

Before you start, it helps to know how a program handles these practical points:

• How caregivers are included: group only, or family sessions as well.
• What parents are asked to commit to, and for how long.
• Whether parents can get coaching, and how it differs from the teen's coaching.
• What happens if a caregiver misses group.
• How the therapist handles what your teen shares in individual sessions.

How long each version tends to run

For adults, the Linehan Institute says the full skills curriculum takes 24 weeks and is often repeated to make a year-long program. Behavioral Tech says individual therapy in the standard model continues weekly for as long as the client is in treatment.

Teen programs in research have often been shorter. The early Rathus and Miller study ran 12 weeks of therapy twice a week. A Norwegian trial used a 19-week version, and the large U.S. trial lasted 6 months. Programs set their own length, so the number you see will depend on the program.

Older teens, young adults, and when neither is the next step

The big trials of teen DBT enrolled young people ages 12 to 18. Programs draw their own age lines, and an 18- or 19-year-old could fit either track. A teen program may fit better when the young person lives at home and family conflict is part of the picture. An adult program may fit better for someone living on their own or in college. Behavioral Tech describes college programs that build treatment around the school term.

Either track asks for months of steady work. To see what full DBT involves week to week, read what comprehensive DBT asks of you. If you are weighing full DBT against a group alone, see comprehensive DBT vs DBT-informed vs a skills group.

If weekly therapy is not enough to keep your teen safe, a higher level of care may come first. See the Denver mental health resources page. When you are ready to talk, Mountainside offers a teen multi-family DBT skills group, an adult DBT skills group and a free 15-minute consultation. See DBT groups in Denver and teen therapy.

Frequently asked questions