Introduction

Dialectical Behavior Therapy (DBT) was initially developed to treat chronically suicidal individuals diagnosed with borderline personality disorder. Grounded in the biosocial theory of emotion dysregulation, DBT posits that heightened emotional sensitivity when combined with invalidating environments contributes to the development of maladaptive coping strategies. The treatment integrates behavioral change techniques with mindfulness and dialectical philosophy aiming to enhance emotion regulation, distress tolerance, and interpersonal effectiveness, while maintaining a balance between acceptance and change (Feigenbaum et al., 2012; Linehan, 1993; Lynch et al., 2006). This dialectical framework positions DBT not only as a symptom-focused intervention but as a systemic model that recognizes the interaction between individuals and their relational environments.

Standard DBT is delivered through four interrelated modes of treatment: individual therapy, group skills training, telephone coaching, and therapist consultation team support. Individual therapy targets motivation and application of skills to personal challenges, while group skills training provides structured instruction in emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness. Telephone coaching supports generalization of skills to real-life situations. The therapist consultation team helps to maintain adherence and sustainability. Together, these modes create an integrated system aiming to reduce life-threatening and therapy-interfering behaviors while addressing the environmental factors that maintain emotional dysregulation (Linehan, 1993).

DBT has since been adapted for diverse clinical populations, including those with eating disorders (Donkin et al., 2025), post-traumatic stress disorder (PTSD) and complex trauma (Bohus et al., 2020; Choi-Kain et al., 2021; Schaug et al., 2025), and attention-deficit/hyperactivity disorder (ADHD) (William et al., 2024). Among these adaptations, the development of DBT for adolescents represents a particularly important shift, as it extends the model beyond the individual to explicitly include caregivers (Linehan & Wilks, 2015).

A major development is the adaptation of DBT for adolescents and their caregivers Dialectical Behavior Therapy for Adolescents (DBT-A). While retaining the four treatment modes of standard DBT, DBT-A expands the model by positioning parents or caregivers as active participants in the therapeutic process. In DBT-A, the group skills training is delivered in a multifamily format, in which adolescents and caregivers learn and practice DBT skills together. The multifamily group serves as a central mechanism for skills generalization and systemic change, fostering a shared emotional vocabulary, reducing patterns of invalidation, and improving communication within the family context (Rathus & Miller, 2014). The adolescent adaptation, therefore, represents a shift from an individually focused intervention toward a relationally embedded model in which family participation is integral to therapeutic change.

In the adolescent adaptation, DBT-A consists of weekly skills training group sessions, where adolescents and caregivers learn and practise DBT skills together. Each session is combined with structured homework to encourage the generalization of newly acquired skills to real-life contexts. Skills are taught through a combination of teaching, modeling by therapists, guided group discussions, and role-plays (Miller et al., 2017). Randomized controlled trials demonstrate that DBT-A reduces self-harming behaviors and suicidal ideation compared with treatment-as-usual (McCauley et al., 2018; Mehlum et al., 2014). These improvements are maintained at long-term follow-up and are mediated by reductions in hopelessness and enhanced emotion regulation (Asarnow et al., 2021; Mehlum et al., 2019). Collectively, these findings indicate that DBT-A provides adolescents and their families with lasting coping strategies that promote clinical stability and skill generalization beyond the active treatment period.

Within the program, skills are organized into five modules: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness, and walking the middle path. Mindfulness focuses on present-moment awareness and non-judgmental observation of internal experiences. Distress tolerance provides strategies to manage emotional crises without engaging in maladaptive behaviors. Emotion regulation supports understanding and modulating emotional responses, while interpersonal effectiveness develops assertive communication and relationship skills. The “walking the middle path” module is specific to the adolescent adaptation and aims to reduce parent–child conflict by promoting validation, dialectical thinking, and balance between acceptance and change within family dynamics (Lynch et al., 2006; Miller et al., 2017; Smith et al., 2023).

Within the DBT-A framework, the modules are designed to address both intrapersonal and interpersonal functioning. “Walking the middle path” is a unique adolescent-family module promoting validation and dialectical understanding between parents and children (Rathus & Miller, 2014). By embedding parent and adolescent participation within the group skills training mode, DBT-A situates family engagement at the core of the treatment model rather than as an additional component, thereby aligning parental involvement with the broader dialectical and behavioral principles of DBT.

Mhaoláin and MacNeela (2021) found that DBT-A resulted in improved emotional regulation among adolescents aged 16–18 years, reporting that group involvement reduced feelings of isolation and fostered interpersonal connections. However, Hardiman (2016) also suggested that borderline traits and improvements in emotional functioning were reported post-completion of the treatment. Similarly, Poon et al. (2022) observed reductions in emotional dysregulation and depressive symptoms across diverse groups, suggesting DBT-A may be beneficial across different populations. Nonetheless, the extent to which these changes are sustained over time remains underexplored.

DBT also incorporates telephone coaching to support skill generalization between sessions. Although not a central focus of the present study, phone coaching forms part of the broader DBT framework and has been associated with improved continuity of care and reduced dropout when implemented with appropriate structure and consultation support (Ramzan et al., 2025; Ruork et al., 2021; van Leeuwen et al., 2021).

Research exploring parents’ perspectives indicates that parents value the opportunity to share experiences within a group context (Bosworth et al., 2023; Smith et al., 2023). Smith et al. (2023) examined whether separate skills groups for parents and adolescents might be preferable but concluded that further research is needed to determine the optimal format. On the contrary, Bosworth et al. (2023) argue that multifamily groups created the opportunity to develop a common language. This study uses a multifamily format because it allows adolescents and parents to practice skills together, promotes shared understanding, and enables families to see how other families manage similar challenges. Such interaction may enhance collaborative problem-solving, emotional validation, and communication across the family system—benefits that are less easily achieved when skills are taught in separate groups. Bosworth et al. (2023) employed a qualitative design, while Smith et al. (2023) adopted a mixed-methods approach relying on self-report outcome measures collected from adolescents as part of routine service evaluation.

Research emphasizes that parents play a central role in shaping adolescents’ emotional development and reinforcing skill use at home. Parents have reported applying DBT skills beyond the family context, including in school and healthcare advocacy (Martin et al., 2017), suggesting potential wider relational effects. However, little research has explored how participation in DBT-A influences parents’ broader social and professional relationships. The present study addresses this gap by exploring the experiences of parents who completed a 24-week multifamily DBT-A program at a therapeutic center in Prague, Czech Republic.

Methods

Design

We employed a qualitative design to explore parental experiences with DBT-A, as this approach enables an in-depth understanding of personal perspectives. It allowed themes to emerge organically, offering rich insights and generating potential avenues for future research. To collect data, we conducted face-to-face semi-structured interviews, which provided a flexible framework to explore participants’ unique experiences while ensuring consistency across interviews. This methodological choice was informed by previous work that used qualitative methods to investigate the benefits of DBT-A (Bosworth et al., 2023).

Participants

We used criterion-based purposive sampling to select participants aligned with the research aims (Campbell et al., 2020; Guarte & Barrios, 2006) recruiting them from a database of former clients at a Therapy Center in Prague, Czech Republic. Completion of the program constituted the primary sampling criterion, as these parents were uniquely positioned to reflect on its perceived impact. All 52 former clients who met this criterion were invited to participate, and 15 parents contacted the researcher expressing interest and were subsequently screened for eligibility. Of these, two were excluded based on the predefined criteria (see Table 2). All eligible individuals agreed to participate and signed an informed consent form. To increase diversity within the sample, we applied a stratified sampling approach regarding gender identity, age, and occupation. Participants were not related and did not have the same child. Two participants attended the same skills group. However, most did not. The DBT-A program was delivered using a standardized manual within an established clinical service. Therapists had between 2 and 9 years of clinical experience and were trained in DBT-A within the organization, although not all had completed formal DBT certification. Adherence to the model was supported through weekly supervision and consultation team meetings. Attendance requirements (minimum 20 of 24 sessions) and the structured nature of the program helped ensure that participants received a broadly consistent intervention despite variation in facilitators. To meet the criteria of the DBT-A program, participants were required to attend at least 20 of the 24 sessions.

Thirteen parents (3 males, 10 females), aged between 41 and 59 years, took part in the interviews. Participants represented three different nationalities and a range of occupational backgrounds and marital statuses, as detailed in Table 1. While formal fidelity measurements were not collected for the purposes of this study, the structured nature of the program ensured consistency. Participants attended all group sessions with their child. Four participants reported prior experience with various types of therapy, predominantly Eye Movement Desensitization and Reprocessing (EMDR) and unspecified forms of individual therapy. Participants were recruited based on referral to the service due to significant emotional and behavioral dysregulation in their children. However, the present study focused on parental experiences rather than quantifying symptom severity in the young person. The sample size was informed by previous qualitative studies and the scope of the project, aiming to ensure both the feasibility and generation of rich, in-depth data (Brocki & Wearden, 2006; MacMahon et al., 2015; Pearson et al., 2021).

The inclusion and exclusion criteria are presented in Table 2 and were designed to minimize potential stress for participants. Parents were excluded if they had a prior relationship or conflict of interest with the researcher (ES), or had a previous diagnosis of depression, bipolar disorder, anxiety disorder, or schizophrenia, or a history of suicidal behavior. These criteria were applied to reduce potential emotional burden and ensure that participation in the interviews would not negatively impact individuals with current or past vulnerabilities.

While these exclusion criteria were applied to minimize potential distress and protect participant well-being, they also resulted in a relatively psychologically stable sample. It is possible that including parents with lived experience of mental health difficulties may have yielded more pronounced or qualitatively different insights into processes of personal and relational change. This should be considered when interpreting the findings and may limit the transferability of the results to more clinically complex populations. Future research could usefully include more diverse clinical samples to further explore these processes.

Materials

Demographic data were collected via a self-report questionnaire based on Allen (2018) and Syversen (2024). It included age, sex, gender, ethnicity, nationality, marital status, employment, household income, region in Czechia, prior therapy, and the family problem prompting DBT-A participation. A semi-structured interview schedule was developed using clinical experience, supervisor input, and dominant literature themes like emotional regulation, family dynamics, communication, and interpersonal relationships to explore DBT-A’s impact (Appendix A). This format enabled focused yet flexible discussions with consistency across interviews (Baumbusch, 2010). One-on-one interviews encouraged openness on sensitive topics, allowing rapport and emotional responsiveness (Brocki & Wearden, 2006). Participants were asked about changes in their relationship with their child, interactions within the family, experiences with colleagues, and engagement with the wider community. These prompts encouraged reflection on personal and relational changes following the program, while allowing participants the freedom to introduce additional topics they considered meaningful. We acknowledge that some prompts may have encouraged reflection on positive outcomes. However, the semi-structured format allowed participants to discuss both positive and negative experiences. During analysis, challenges and limitations were specifically attended to, minimizing potential positivity bias in line with IPA methodology. The themes presented in the findings, such as shifts in perception, changes in relationships inside and outside the family, and wishes for future implementation, were not predetermined categories but emerged inductively from participants’ responses. Although these areas were not queried through single, explicit questions, they naturally arose from the broader prompts about communication, interpersonal relationships, and the impact of skills learned in the program. The semi-structured format enabled participants to elaborate on aspects most salient to them, providing rich accounts that informed the emergent themes.

Procedures and data collection

We obtained permission from the Therapy Center before participant recruitment and the supervisor reviewed the proposal to ensure that it aligned with the organization’s policies and ethical standards. Participants were approached through an invitation email by a member of gatekeeper’s administration team. Previous clients who took part in the DBT-A program from 2021 to 2024 were contacted. Those who were interested received an information sheet. The procedure can be seen in the attached flowchart, as shown in Figure 1. All interviews were conducted by the first author, who completed postgraduate-level training in qualitative research methods. This training included 3-h workshops focused on semi-structured interviewing, qualitative data collection, and reflexive practice. As part of this training, the first author conducted pilot interviews, participated in mock interviews, and undertook practice qualitative analysis exercises. Interviewing and analytic procedures were further supported through ongoing supervision and feedback from a senior expert in qualitative research (ML) throughout the study. Interviews lasted 40–60 min, were conducted in Czech via Microsoft Teams, and were transcribed and translated using Microsoft Word and subsequently checked by a human interpreter. Confidentiality was maintained throughout the data-handling process. Although interviews were conducted via Microsoft Teams and transcripts were translated using Microsoft Word, no identifiable information was included in the recordings, transcripts, or translation files. All data were stored on secure, password-protected institutional servers, and access was restricted to the research team. The human interpreter who checked translations signed a confidentiality agreement. It is important to note that translation may have influenced the nuance of participants’ expressions. Therefore, quotes presented in this article are framed to retain meaning while acknowledging possible subtle shifts in interpretation. Providing this context helps situate the quotations and supports the interpretation of findings, ensuring that conclusions drawn from participants’ statements are understood within the translation and interview framework. Participants received a £10 shopping voucher after completing the interview, as recognition for their time and effort.

Ethical considerations

The study received university ethical approval (project number 46276) and followed the British Psychological Society (BPS) Code of Human Research Ethics (2021). Participants gave informed electronic consent and could withdraw their data at any time before or during the interview, and up to one month after data collection. Support resources were provided after the interviews. Confidentiality was maintained, as participants contacted the researcher directly and no identifying data was shared with the gatekeeper.

Data analysis

All interviews were audio- and video-recorded via Microsoft Teams. Transcripts were auto-generated, manually checked for accuracy, translated into English, and amended as needed. Analysis used Interpretative Phenomenological Analysis (IPA), chosen for its focus on how individuals make sense of lived experiences (Hardiman, 2016). IPA allowed interpretation of both explicit content and underlying meaning, fitting mental health research (Mhaoláin & MacNeela, 2021). It suited the study’s aim by identifying challenges, positive experiences, and participants’ suggestions. IPA provided an interpretative, idiographic account, attending to unique individual perspectives while recognizing patterns across participants (Wagstaff et al., 2014).

Each transcript was analyzed individually to preserve IPA’s idiographic focus. Following repeated readings, detailed exploratory comments were made on content, language, and meaning. These informed the development of emergent themes for each case, capturing key elements of participants’ lived experiences and supported by verbatim quotations. The analysis was iterative and inductive: initial codes were generated through close engagement with the transcripts, grouped into preliminary categories, and gradually refined into themes and subthemes through ongoing comparison within and across interviews. Both authors independently coded the transcripts. Intercoder agreement on this subset was high (90% agreement), and any discrepancies were discussed to reach a shared understanding of the codes. Coding was conducted independently and concurrently by the two coders using the same coding framework. The second coder (ML) is a licensed psychotherapist and a senior expert in qualitative research, with extensive experience in qualitative methodology and clinical research. ML contributed to the development and refinement of the coding framework, independently coded a subset of the data, and provided ongoing methodological oversight throughout the analytic process. This dual-coder approach enhanced analytic rigor and reliability by integrating methodological and clinical expertise while minimizing individual interpretive bias. Because both coders were involved from the outset of the study, no additional bias was introduced by the timing of the second coder’s work. Following coding, both authors collaboratively reviewed the full code set to identify patterns, cluster related codes, and develop preliminary themes. Themes and subthemes were refined through iterative discussion until full consensus was reached. This process ensured not only consistency in coding but also cross-coder agreement in the final thematic structure.

A cross-case analysis was then conducted to explore patterns of both convergence and divergence. Emergent themes were clustered into superordinate themes that reflected shared meanings while also attending to the distinctiveness of individual experiences. Throughout the process, the analysis remained iterative and reflexive. The number of statements for each sub-theme is detailed in Appendix B.

Reflexivity

As a researcher with experience in DBT-A (ES), I was aware that my background could influence the interpretation of the data. To reduce bias, none of the participants were current or former clients. While I expected parents to report relational changes, I remained open to other emerging themes. Reflexivity was maintained through ongoing supervision and peer discussions during the analytic process, which helped to identify and challenge potential assumptions. Coding and theme development were reviewed collaboratively to ensure they accurately reflected participants’ accounts rather than the researcher expectations. The first author monitored potential biases throughout data collection and analysis and identified a tendency to focus on positive experiences. To counteract this, negative or challenging experiences were specifically sought during coding by highlighting all instances where participants described difficulties, tensions, or unmet expectations. Themes were cross-checked against the full dataset to ensure these perspectives were represented in the analysis, and peer discussions were used to question overly positive interpretations and suggest alternative readings of the data. This approach resulted in a more balanced interpretation. We recognize that participants’ recollections may be influenced by the time that has passed since treatment, which for some was up to four years ago. While retrospective accounts can be affected by natural memory decay, they can still provide valuable insights into the aspects of treatment that were most meaningful or impactful to participants. Several factors may also contribute to a positivity bias. Parents who perceived treatment as helpful may be more motivated to participate in research, and reflections over time may become shaped by gratitude, relief, or a sense of distance from distress. We acknowledge these potential influences as part of the interpretative nature of qualitative research and discuss them as limitations while emphasizing that the aim of the study was to explore perceived meaning and long-term reflections rather than to reconstruct events exactly as they occurred.

Results

During the interviews, participants reflected on changes in their perception, relationships, within and beyond the family, and in some cases, their views on future use of DBT-A. Three overarching themes and seven sub-themes were established through IPA. Rather than representing discrete categories, these themes reflect overlapping processes of personal and relational change. The themes are presented in Table 3.

Theme 1: Reframing self and relationships through DBT-A

Parents stated that DBT-A was a transformative experience that influenced how they viewed themselves, their children, and their relationships. Central to this theme is a sense of self-perception and relational understanding.

These changes were noticeable in how they communicated, interpreted emotional experiences, and viewed their relationships. This theme comprises three interconnected sub-themes: From Blame to Acceptance, Self-Perception and Emotional Competence, and Redefining Relational Values and Boundaries. Together, these sub-themes capture how parents developed greater self-compassion, emotional understanding, and redefined their understanding of relationships.

Sub-theme 1: From blame to acceptance

Participants mentioned gradually coming to accept both the past and the present. Acceptance is a crucial part of DBT as it underpins the dialectical balance between change and validation. This encourages individuals to acknowledge reality while reducing emotional suffering that comes from resistance. For parents, acceptance meant creating emotional space to process what had happened without being overwhelmed by guilt or regret. Participants described the program as providing both space and safety to process and accept the challenges over time. There was a clear shift from self-blame toward self-compassion. For example, one parent reflected “I could have done it differently” (T), which reflects an initial stance of regret and self-criticism. In contrast, another participant stated, “now, you’re actually doing as much as you can” (J), indicating a movement toward acceptance. This reflects a redefinition of parental responsibility, where parents began to recognize the limits of their control while maintaining a commitment to change.

Acceptance also extended to how parents responded to their child’s distress. One parent shared “… I can just …, just look at her with. With those cut hands, and it’s not something that was kind of winding me up me…” (M). Here, the participant refers to a reduction in previously overwhelming emotional reactions. Rather than responding with distress, the parent demonstrates a more regulated and accepting stance, enabling more supportive engagement. This reflects DBT’s emphasis on reducing reactivity and fostering mindful presence in relationships.

Together, these accounts illustrate how acceptance functioned not only as an internal shift but as a relational process that enabled parents to respond more effectively to their child’s emotional needs.

Sub-theme 2: Self-perception and emotional competence

Building on this shift in acceptance, parents also described changes in how they perceived themselves and their emotional capacities. Increased self-awareness was central to this process. For instance, one participant noted, “…I’m feeling like I have something to pass on as myself” (H), highlighting how personal growth was experienced as relationally meaningful.

Parents described becoming more aware of their emotions and more intentional in their communication. One participant reflected, “I don’t feel that the others have changed… I actually feel different, because I perceive their behavior a little differently” (B). illustrating how internal change shaped interpersonal perception. Similarly, another stated, “I perceive it in my relationship with myself” (M), indicating that improved self-awareness underpinned broader relational changes.

These internal shifts translated into more effective communication. For example, one parent described using DBT skills directly: “I think I’m more assertive and that sometimes I use like the Dear Man just like that. Describe the situation…” (T). This reflects the application of learned skills in real-life interactions.

The changes in communication were noticeable. Parents talked about being able to communicate in a more confident way. In addition, they validated others’ feelings, suggesting a deeper connection with others’ emotional experiences “I feel that I’m much more confident in it, I’m much calmer in it” (H).

Together, these accounts suggest that increased self-awareness functioned as a foundation for improved emotional regulation and more effective interpersonal communication, linking internal change with relational outcomes.

Sub-theme 3: Redefining relational values and boundaries

Participants described a profound change in how they viewed relationships after DBT-A. For some, this change was in letting go. A participant spoke about experiencing relief after realization that they do not have to stay in a friendship “I was terribly worried that I had few friends, but I stopped… I realized that I don’t have to keep in touch at all costs” (A). This suggests a sense of freedom and autonomy from social expectations, reflecting integration of DBT skills such as self-validation and acceptance. Participants began to prioritize emotional balance and authenticity in their connections. Moreover, there was a deeper understanding of relational dynamics “As a whole, my view of relationships… I think I went more deep… the relationship is about two” (E). This shows recognition of mutual responsibility and illustrates a movement from self-focused distress toward recognition of reciprocity and shared responsibility. Through this, parents redefined what a “balanced” definition of relationship entails.

It was also mentioned that relationships were used as a protection from loneliness. “We just shouldn’t go into the relationship just because we don’t want to be alone” (J). This suggests acknowledging past motivations and reflects personal growth, showing how DBT’s emphasis on mindfulness and emotional regulation enabled participants to make more intentional relational choices.

The awareness was also highlighted in dysfunctional patterns. “It was also normal to be rude… because it was just some norm for me” (T). Participants spoke not only about recognizing the pathology in past relationships, but also about redefining what is tolerable in the future. This is linked with increased self-awareness and setting stronger and healthier boundaries, indicating internalization of interpersonal effectiveness skills.

Relationships were viewed as fragile and worth preserving. “I feel gratitude and responsibility for it… I mustn’t mess it up” (V). This reflects a sense of relational accountability and maturity, suggesting that increased self-awareness translated into a more deliberate and caring approach toward others. Collectively, these narratives illustrate how DBT-A supported parents in redefining their relational values—moving from obligation and reactivity toward autonomy, reciprocity, and mindfulness in relationships.

Theme 2: The shift in relation patterns

Parents described changes not only in their relationships with their children but also with partners, family members, friends, and colleagues. DBT-A skills were experienced as practical tools for fostering connection, reducing emotional reactivity, and enhancing communication across contexts. This theme reflects how changes initiated within the family extended into broader relational domains.

Sub-theme 1: Transforming family dynamics

Parents described a significant deepening of family relationships following DBT-A. Attending the program together deepened connection and trust. Shared sessions allowed open dialogue “Now we just have conversations that we couldn’t have had before in our lives” (D). A shared “communication language” (E) was given to name emotions and experiences. “Things that have always been here at once, can be named” (E).

This reframed the dynamic from control to collaboration. “You are simply like a partner for the child, and not just like the annoying mother” (B). Parents felt more confident, emotionally connected, and children opened up more often.

Besides, parents described using DBT-A skills with siblings, other children, and even their own parents, which highlighted intergenerational patterns of emotional invalidation or authoritarianism. “My dad… just explodes and curses…” (J). Several participants felt that DBT-A helped to break the cycle and establish healthier boundaries. However, not all changes were easy, as some older family members resisted change and struggled to adjust. “I explain to her, Mom, I can solve this on my own… it helped me by calming me down” (P). Some older family members resisted by maintaining established roles or dismissing the child’s growing autonomy. While the participant found asserting independence helpful, it highlighted how difficult it was for older relatives to adjust to new communication and boundaries.

Changes in romantic relationships were also mentioned. Parents described becoming more mindful, reflective, and less reactive. “I realized… he could see it with completely different eyes… I’m just trying to understand it” (A). The dialectical view helped participants tolerate differing views. Some noted challenges when partner was not involved in the program: “My husband noticed… and he is not completely excited” (E). Despite challenges DBT-A appeared to promote emotional awareness and empathy.

Sub-theme 2: Fostering emotional connectedness beyond family

Several participants described how DBT-A reshaped their broader social and professional lives. Through mindfulness and validation, parents became less reactive and more open to others’ perspectives. For example, one participant stated, “Yes, so I’m over it… I have my own private life. I won’t deal here if they want this, then they don’t” (A), reflecting increased acceptance and respect for interpersonal boundaries.

Mindfulness was repeatedly described as transformative. Initially unfamiliar, participants came to see it as central to managing interactions. “I can observe the person for a while… just actually observing them and noticing some things” (H). Parents reported listening more attentively and responding with calmness rather than impulsivity. Validation was described as particularly impactful. One parent noted, “They actually suddenly told me something they had never said to anyone” (H) illustrating how acknowledging others’ emotions created trust and emotional safety.

Skills used professional settings supported participants’ confidence and empathy. “I work as a teaching assistant… I very much use the validation for those children” (T).

Others noticed that people around recognized their growth. “She said that she actually sees that I’m really behaving completely now … it really changes a person a bit.” (L). Participant V shared feedback from colleagues: “Kindness, calm… maybe even a little bit like admiration.” These reflections suggest a personal transformation that extended the family context.

Finally, participants spoke about ability to set boundaries in order to protect their own wellbeing, “I’m not going to give it the energy to think about it or analyse it somehow” (B). This suggests an increased balance in interpersonal relationships.

These accounts suggest that DBT-A skills supported a broader transformation in relational functioning, extending beyond the family into social and professional contexts.

Theme 3: Reflections on future use and accessibility of DBT-A

Some participants reflected on the potential future use and accessibility of DBT-A. Although this was not discussed by all participants, those who did raise expressed both a sense of missed opportunity and hope for broader application. For these participants, DBT-A was experienced not only as a therapeutic intervention for their child but as an unexpectedly meaningful resource for themselves.

Sub-theme 1: Desire for early integration of DBT skills in schools

Several participants expressed a wish to see DBT skills implemented within the school system. Many expressed frustration that the skills were not introduced earlier. “Jesus Christ yes yes and from the age of twelve, eleven…” (A).

They emphasized that emotional education should be prioritized alongside academic subjects: “This should be applied to kindergartens… dividing by a two-digit number is supposed to defeat you” (D). Another added, “Why is history taught and not this?” (E).

Parents emphasized the importance of earlier access to DBT skills. One parent reflected on their child’s earlier difficulties, stating that “She had no idea what was happening to her.” (A), referring to the adolescent’s lack of understanding of their own emotional experiences. This highlights the perceived importance of introducing emotional education earlier, as parents believed DBT could provide young people with tools to recognize and manage internal states.

Subtheme 2: Seeking ongoing support and wider access

Seven parents mentioned a need for ongoing support. There was a suggestion of a self-help group for parents. “I would really appreciate a self-help group. on which the parent could simply write hey, my child did this, this is normal…” (A). This comment reflects need for validation, reassurance, and guidance beyond therapy.

Parent wished that the skills would be more known “I think it’s applicable to anyone” (H), suggesting that the principles of DBT are not only relevant for crisis setting but may be valuable across the population. Others mentioned retrospective stance, reflection on how earlier access could have altered the family trajectories “If we had encountered that as part of some kind of family therapy… it might have saved our family and marriage” (V). These quotes portray DBT-A not only as an intervention for crisis management but as a life-enhancing framework. Parents viewed it as both reparative and preventive—something that could support emotional health and communication across the lifespan.

Discussion

This study explored parents’ experiences of a 24-week DBT-A program, highlighting perceived changes in self-understanding, reflective capacity, and relational functioning. Parents described increased mindfulness, emotional awareness, and ability to adopt alternative perspectives, which they applied not only within the family but also in broader social and professional contexts. These findings are consistent with prior research showing that DBT interventions enhance emotional regulation, interpersonal effectiveness, and mindfulness (Bosworth et al., 2023; Flynn et al., 2023; Smith et al., 2023). Extending this work, the present study suggests that skills acquired in DBT-A may generalize across multiple relational domains, including partnerships, extended family, friendships, and workplace interactions. This discussion first situates the findings within existing DBT-A literature, then examines the transferability of skills across relational domains, and finally considers intergenerational and sociocultural implications.

Within the family, parents described strengthened connections with their adolescent children, noting reciprocal improvements in communication and deeper, more collaborative interactions. Many described a shift in their parenting role—from that of an authority figure to a more supportive, collaborative partner. Beyond the immediate family, parents perceived themselves applying DBT skills with relatives, including siblings and their own parents, and some expressed a desire to share or recommend these skills to other relatives, highlighting the perceived value and wider applicability of the approach.

Participants also identified limitations of the program, noting that DBT-A sometimes created uncomfortable dynamics within the family. Parents reflected on patterns inherited from their own upbringing, often describing experiences of emotional invalidation, authoritarian parenting, or emotional suppression. While not all participants explicitly related these dynamics to broader socio-political factors, it is possible to situate them within a wider historical and cultural context. For example, historical political conditions in the Czech Republic may have shaped parenting norms emphasizing obedience, conformity, and emotional restraint (Javakhishvili, 2018). Such legacies may have contributed to the persistence of hierarchical and emotionally restrictive parenting styles across generations. Javakhishvili (2018) similarly describes how historical trauma and socio-political oppression can shape parenting practices across generations, especially in post-totalitarian societies. From a theoretical perspective, DBT-A’s emphasis on validation, collaboration, and dialectical thinking contrasts with more authoritarian parenting models. Although this study did not directly assess these influences, the introduction of DBT-A may encourage parents to adopt more empathetic and emotionally attuned approaches illustrating how therapeutic models can respond and potentially challenge broader contextual and cultural factors in parenting. These interpretations are intended as contextual framing rather than empirical conclusions, as the study did not directly assess sociopolitical influences.

It is important to note that the study was conducted in the Czech Republic, where sociocultural factors may have shaped participants’ experiences and reflections. Parenting norms in this context may be influenced by historical legacies, including periods of political control and social expectations around conformity, emotional restraint, and hierarchical family structures (Javakhishvili, 2018). These cultural and historical influences could have affected both parents’ perceptions of DBT-A and how they applied the skills within their families. While these influences were not directly assessed, they provide important context for interpreting the findings, highlighting that some relational patterns or responses may be specific to the Czech sociocultural environment. Therefore, caution is warranted when considering the transferability of these results to other cultural settings, as parenting, family interactions, and societal expectations may differ.

Additionally, parents reported using DBT-A skills in relationships with partners who were often the first to notice changes. They also reflected on how their interactions with their partner influenced their child. Over time, parents described perceiving DBT-A skills as relevant in broader social context, including friendships and professional relationships. They reported being more willing to adopt different perspectives while maintaining assertiveness and using mindfulness to engage more effectively with others. Participants noted that these changes were observed by people in their social and professional circles and some mentioned sharing the skills with colleagues or friends. These accounts suggest that DBT-A skills were not confined to parenting contexts but became integrated into participants’ broader relational functioning. These findings align with previous research. Martin et al. (2017) found that mothers who participated in DBT skills training reported greater emotional awareness, improved interpersonal effectiveness, and increased confidence in both parenting and other relationships. Similarly, Everett et al. (2024) documented that parents used DBT strategies to manage interactions more reflectively and were recognized by others for their behavioral and emotional growth. Khoury et al. (2023) further support this, suggesting that mindfulness enhances self-awareness, emotional regulation, and perspective-taking, which collectively improve interpersonal functioning. Overall, these findings indicate that the interpersonal and emotional changes fostered through DBT-A are both personally meaningful and perceived by participants as transferable across multiple relational domains.

Influence on family dynamics was also observed. Consistent with previous research, parents in this study frequently described the development of a “shared language” that facilitated more effective conversations (Bosworth et al., 2023; Smith et al., 2023), highlighting benefits for both parents and children. Bosworth et al. (2023) and Flynn et al. (2023) add that the program enhanced mutual empathy within families. Our study also found that parents applied DBT-A skills more broadly across the family system, including with siblings and extended family members, reflecting findings by Bosworth et al. (2023), who reported that skills learned in DBT-A often transferred beyond the therapeutic setting and positively affected family dynamics.

An important extension of these findings concerns intergenerational processes. Parents reflected on their own upbringing and described efforts to disrupt previously unhelpful patterns, striving instead to implement more child-centered and emotionally aware approaches. This intergenerational perspective has been less emphasized in prior research, which has predominantly focused on symptom reduction in adolescents (Mehlum et al., 2014; Steil et al., 2018) or immediate family functioning (Bosworth et al., 2023). However, studies examining intergenerational transmission of emotion regulation strategies (Kim et al., 2009; Li et al., 2025; Morris et al., 2007) underscore the importance of addressing these patterns. Similarly, Lobban et al. (2013) found that 60% of family interventions improved at least one outcome for relatives, highlighting the value of systemic approaches. Pham (2021) further supports this perspective, demonstrating that emotionally responsive parenting, such as maternal control aligned with a child’s desire for support, promotes emotion regulation and positive affect across cultural groups.

Javakhishvili (2018) further reinforce this need, demonstrating how parental trauma affects emotion regulation, parenting sensitivity, and intergenerational attachment patterns, and how group-based systemic interventions like multifamily therapy may buffer these risks. Similarly, Mooren et al. (2023) highlight that trauma-focused multifamily therapy can enhance parental mentalisation and emotional regulation, while fostering resilience within a supportive group context. These findings suggest that DBT-A, particularly in its multifamily format, may hold broader systemic value beyond individual symptom change. Moreover, DBT-informed skills have been adapted for couple and family-based interventions, with brief, skills-focused programs showing promise in increasing emotional resilience and interpersonal functioning (Kirby & Baucom, 2007). This raises the possibility that shorter or adapted DBT-based formats could be explored in future research. Longitudinal studies examining families more than one year post-intervention would also help determine whether the reported relational changes are sustained over time.

The present findings also highlight the need for future quantitative research to build on the themes identified in this study. Systematic investigation of the prevalence and strength of these themes across larger samples would allow for greater generalizability and help determine which aspects of parental change are most strongly associated with DBT-A participation. Quantitative designs could also examine relationships between specific skills use and relational outcomes, providing a complementary perspective to the in-depth insights generated through qualitative analysis. Such approaches would be particularly valuable in more clinically diverse samples, including parents with their own mental health difficulties, to better understand variability in treatment outcomes.

Strengths and limitations

This study has several strengths. It produced rich, detailed data capturing multiple perspectives on interpersonal relationships. Unlike most prior research focusing on adolescents, it centered on parents’ personal growth. Participants also shared how they applied DBT skills beyond therapy, providing insight into the program’s real-world impact.

However, there are limitations. Participants completed DBT-A at different times, with some interviews over a year later, possibly affecting recall accuracy. Interviews were conducted in Czech and translated into English, which may have caused loss or distortion of nuances. The sample lacked ethnic diversity, reflecting the Czech Republic’s largely white population (Czech Statistical Office, 2021), limiting generalizability. In addition, the exclusion criteria resulted in a relatively high-functioning parent sample, which may be atypical of families with adolescents experiencing more severe and/or complex difficulties. Excluding parents with their own mental health diagnoses may have limited the depth and range of experiences captured, particularly as such parents may engage differently with DBT-A skills or experience more pronounced personal and relational changes. Future research should consider including a more clinically diverse parent sample to better understand the full scope of DBT-A’s impact. This limits the generalizability of the findings to parents with greater mental health burden or more complex family contexts. Voluntary participation may have introduced positive bias, as those with favorable experiences were more likely to join. In addition, some interview questions were framed in a way that may have invited reflection on positive changes. For example, participants were asked: “Can you describe how, if at all, your ability to maintain or strengthen relationships has changed?” and “How, if at all, do you feel more confident in building or maintaining relationships?” (Appendix A). Similarly, questions such as “Are there situations in your community or social life where you feel the program has been particularly helpful?” implicitly direct attention to beneficial outcomes. Although the semi-structured format allowed space for discussing challenges, this question framing may have contributed to positivity bias.

The first author also monitored potential analytic biases, noting a tendency to privilege positive accounts and actively ensuring that difficult or negative experiences were equally attended to. Participants’ recollections may have been influenced by the time elapsed since treatment, where natural memory decay or emotional distance may shape how experiences are reconstructed. These influences are acknowledged as part of IPA’s interpretative nature; while retrospective accounts may not capture events precisely as they occurred, they still offer valuable insight into what parents perceived as most meaningful and enduring. The relatively small sample size may limit the breadth of perspectives captured and reduce the generalizability of the findings. Although the study explored interpersonal functioning, data were derived from a single reporter per family. As such, the findings reflect parents’ subjective perceptions of change and do not indicate whether other family members, peers, or individuals outside the family observed similar changes. This limitation restricts the extent to which multiple perspectives on interpersonal functioning could be captured within the study. Finally, only parents’ perspectives were explored, so it is unclear if children or other family members experienced the reported relational changes similarly.

Conclusion

The results of the study suggested that DBT-A has a great influence on parents’ relationships and perspectives in multiple fields. Firstly, participants highlighted changes in perception and awareness. They accepted their past and moved from self-blame to self-compassion. Secondly, the program influenced relationships. Parents reflected on re-evaluation of relationships and setting boundaries. Additionally, they mentioned changes in relationships with the child as well as relationships within family. Parents spoke about differences in healthier communication, family dynamics, and understanding. The skills were used in broader family and revealed differences between generations. Moreover, participants noted using the skills at work or in relationships with colleagues. They also discussed using skills such as mindfulness or validation to increase their awareness and engagement in interactions with others; therefore, the interactions were more reflective and open. At the same time, parents acknowledged that applying DBT-A skills sometimes led to uncomfortable situations within the family. These included arguments, emotional tension, or conflict with partners or other family members, particularly when parents began setting clearer boundaries, communicating more directly, or responding differently than before. Such tensions were described as challenging but also as part of an adjustment process, as established family interaction patterns were disrupted. Clinically, this highlights that while DBT-A skills may promote healthier long-term functioning, they can initially intensify relational strain as families adapt to new ways of interacting. The last theme expressed a desire for earlier access to DBT. Parents highlighted the need for DBT in schools. Ongoing support through peer groups was also mentioned as a wish for future implementation. Participants also believed that DBT could be used as a prevention of relational challenges.