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 450 DBT-LBC certified clinicians globally.

To confirm certification of your 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 Winchester, 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).

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 our DBT for children (DBT-C) program.

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.

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 you can't solve a problem right then, you need to find a way to get through it, so you learn quick skills that will get you through the situation without making things worse.
  • The emotion regulation module helps you learn more about your emotions: how to change your emotions, how to stop your emotions before they start, and what makes you more vulnerable to your emotions.
  • Interpersonal effectiveness teaches you how to be effective with other people, including learning how to figure out and prioritize your goals in interpersonal situations, how to ask for something effectively or say no, how to maintain good relationships, and how to maintain your self-respect.
  • Teens and caregivers in our multi-family DBT skills training group learn an additional skills module: Walking the middle path teaches you how to validate both yours and other’s feelings, and how to think dialectically, or to find a balance between two extremes.

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.

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

• Intense Emotions: If you frequently feel overwhelmed by your emotions, such as anger, sadness, or anxiety, and find it hard to manage them, DBT can help you develop coping strategies.
• Self-Harm or Suicidal Thoughts: If you’ve engaged in self-harm or experienced suicidal thoughts, urges, or actions, DBT provides a structured and supportive environment to address these issues safely.
• Difficulty with Relationships: If you struggle to maintain friendships or have frequent conflicts with friends or family members, DBT focuses on improving communication and relationship skills.
• Impulsivity: If you find yourself making impulsive decisions that lead to negative consequences, DBT teaches skills to help you pause and make more thoughtful choices.
• Desire for Change: If you’re motivated to learn and practice new skills and want to create a more balanced and fulfilling life, DBT 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 when they fully participate in the therapy.  This includes completing weekly skills homework practice assignments and daily diary card monitoring.  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.  Teens and adults engaging in comprehensive DBT will complete a daily DBT diary card, where they will track their emotions, behaviors, urges, and actions, allowing the teen and their therapist to focus on the most important targets in their sessions. 

If you resonate with any of these experiences, DBT may be a beneficial option for you or your teen. It's best to consult with a mental health professional who can help assess your specific needs and determine the most appropriate course of treatment, which is exactly what your therapist will do during your initial intake session at Cincinnati Center for DBT.

This is something best discussed with your individual therapist and family.  Your therapist will discuss your goals, targets, and what’s bringing you to therapy and collaborate with you to decide the best plan for you.  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.  Your therapist will be happy to discuss your treatment needs with you.

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.

You don’t have to do anything, and 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, you 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 your skills trainers teach you skills, help you practice skills, and review how you 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, you get to hear how other teens and caregivers are applying the skills and you 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 you’re going through, when you didn’t even realize that skill could be helpful in your situation.  Other group members may ask questions, make comments, or share examples that further your understanding of the skill.
• You will learn that you’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: your parent has to learn new skills too.
  • A note to teens: Have you ever wished your parent or caregiver would handle things differently? Now’s your chance! In our multi-family skills group, your family member will attend and practice the same skills as you. Just like you, they’re held accountable for showing up and practicing the skills, putting both of you on equal ground. Together, you’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 you when things get tough, making it easier for you to use the skills in real-life situations.
  • A note to parents: Attending multi-family DBT skills group with your teen is an incredible opportunity to learn skills that will not only benefit your teen, but also help you in your own life. You’ll gain tools to manage stress, emotions, and relationships more effectively, while also learning how to reinforce your teen’s skill use. Both you and your teen will walk away more present, balanced, and better equipped to handle life’s challenges—together.
• DBT skills group is cost-effective.  When you participate in group therapy, you are sharing the cost of the session with other group members, instead of paying for the entire session yourself.  That means you 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.

• 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.

When developing DBT, Dr. Marsha Linehan found that it was extremely difficult to try to address a client’s individual problems and goals AND teach them new skills in a single session.  When she tried, she found that either the individual problems or the skills did not get the amount of time or attention needed.  That’s why she decided it was more effective for clients to attend one individual DBT session and one DBT skills training group per week.  In skills training group, clients attend a class focused on learning needed coping skills.  In individual sessions, the client and therapist focus on the client's individualized goals and targets; the therapist helps the client use the skills they learn in group in their specific situations.

DBT is a six-month commitment because it takes six months to get through the DBT skills curriculum.  You will learn the mindfulness skills several times throughout your 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 two 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 to discuss your progress, goals, and options with your individual therapist, skills trainers, and family members when considering graduating or recommitting to DBT skills group.  Our clinicians will review your clinical outcome data with you and discuss your progress so that you can make an informed decision about how long you want to be in DBT.

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, you attend our DBT skills training group and participate in individual therapy with a therapist outside of our practice at least every other week to support you while you're in group. This is a good option if cost is a barrier or you prefer to use insurance for individual therapy.

• Adults: The fee for our two-hour adult DBT skills group is $90 per group.  In order to attend, you 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. DBT Group + Individual Therapy at Cincinnati Center for DBT

In our Group+Therapy Option, you attend our DBT skills training group and participate in individual therapy with one of our therapists at least every other week to support you while you're in group.

• Adults: The fee for our two-hour adult DBT skills group is $90 per group.  In order to attend, you 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 you see and at what frequency, but you can expect to pay between $120-$220 per individual session.  
• 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 you can expect to pay between $120-$220 per individual session.  The teen is required to attend individual therapy at least every other week to support them while they are in group

3. 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.

• Adults: The fee for our two-hour adult DBT skills group is $90 per group.  In order to attend, you 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 you see, but you 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 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 you 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 24/7 parent coaching with their skills trainer.  

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

Some teens and adults would benefit from an alternative approach to our DBT program.  If your or your teen meet(s) any of the following criteria, please let us know and we can work with you 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

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 have any concerns or preferences regarding group placement, we encourage you to share them with our intake coordinator or your individual therapist.

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.