The model starts with DBT skills and pays close attention to the state a teen is in when they try to use them. Family participation connects that work to home.
Every teen who comes to Joshua Tree gets a treatment plan built around their specific situation, strengths, and goals.
The plan draws on two foundational methods, DBT and polyvagal-informed care, with trauma-informed practice as the lens for everything we deliver. ACT, CBT, and family systems work are woven in where clinically indicated.
Clinical foundations
You don't need a clinical background to understand what each one means for your teen. Here's what they are and how we use them.
DBT is the clinical spine of our program. It was developed for people whose emotions can become intense and hard to regulate. In our program, it gives each week a clear structure and gives teens something concrete to practice.
Our groups are built around the four DBT skill sets: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These are concrete tools, practiced in session and used at home, at school, and in relationships.
Threat and shutdown can make it much harder to think, speak, and learn. Polyvagal-informed care asks clinicians to notice that state before pushing ahead with discussion or skills.
We help teens notice what is happening in their body and practice settling enough to stay present. That attention to timing shapes how sessions run.
Trauma-informed care is the lens for the rest of the work. We look for the story behind a behavior. A teen is never required to share more than they are ready to say.
Many teens who arrive with anxiety, depression, or dysregulation are carrying experiences that have not been named yet. We hold that possibility from the first day and pay close attention to safety, trust, and choice.
The four DBT skill sets and what skills practice can look like for adolescents.
Learn more →How Joshua Tree uses nervous-system awareness, including the scientific context and limits of the framework.
Learn more →How family participation connects treatment with communication and support at home.
Learn more →Inside a group day
Each group session follows a three-part arc. Each part builds on the one before it.
Part one
Teens talk about what has been happening with peers and a facilitator in a structured setting. They hear from people their age and learn that they are not carrying everything alone.
Part two
This is the teaching portion. Teens learn and practice DBT skills while building awareness of their own nervous-system state. The skills curriculum is delivered here.
Part three
Teens apply what they just learned through art, music, movement, somatic exercises, and mindfulness. A teen who is not ready to talk yet can still do the work here.
In IOP, teen groups meet Monday, Wednesday, and Thursday, with a morning option (9am–12pm) or an afternoon option (3:30–6:30pm). A parent DBT skills group meets Tuesdays for some families, so IOP runs three to four days a week. Individual and family sessions are scheduled alongside group days.
PHP runs during the day, with more days per week than IOP. Admissions will walk you through the current schedule for either program.
The skills curriculum
The curriculum moves through the four DBT skill sets. Experiential work reinforces the skill being taught at that point in the program.
Phase one
The foundation for everything else. Teens learn to notice what they are experiencing, in thought, emotion, and body, without immediately reacting to it. You can’t use a tool you can’t see yourself reaching for.
Phase two
Getting through a crisis without making it worse. Teens practice concrete tools for overwhelming moments, so the moment can pass without leaving new problems behind it.
Phase three
Understanding how emotions work and learning to influence them. Teens begin to map their own patterns, what sets them off and what settles them, and work on those patterns directly.
Phase four
Handling relationships without losing yourself or damaging the connection. Teens practice asking for what they need, setting limits, and keeping their self-respect with parents, peers, and teachers. The group itself becomes the practice ground.
Phases build across the program. Length of stay is decided with your family and the treatment team, then reviewed throughout care.
The wider toolkit
Beyond the three foundations, the team draws on these in individual sessions and groups. Some — like art, music, movement, and body awareness — give teens a way in before they have the words.
ACT helps teens notice difficult thoughts and feelings without letting them make every decision. The work then turns toward actions that match what the teen values.
CBT works on the connections between thoughts, feelings, and behavior, and helps teens develop patterns that serve them better. It is one of the most established approaches in adolescent mental health, woven into individual therapy and skills groups as clinically indicated.
We understand a teen’s challenges in the context of the family around them, and family therapy is built into treatment. Parents leave sessions with concrete tools to support their teen at home.
Experiential therapy brings the body and the environment into the work. Somatic exercises help teens notice what is happening physically when emotions rise.
This connects directly to our polyvagal-informed approach: noticing body signals can help teens recognize when they are activated and respond with greater choice. Experiential work may also make use of movement, mindfulness, and the outdoor setting near our Apex location.
Expressive therapy uses art, music, and other creative modalities as a way into emotional material that is hard to reach through words alone.
For a teen who is not ready to talk about what happened, this is often where the work begins. Admissions and the clinical team can explain which expressive modalities are part of the current program.
Structural choices
These choices determine what the week feels like and where each kind of work has room to happen.
Family therapy is part of treatment. Parents learn how to recognize and reinforce the skills their teen is practicing, so the language used in session can carry into the kitchen and the car.
Individual therapy runs alongside the group program, so the work that needs privacy has a place of its own. Admissions will explain how individual and family sessions fit into the week.
When a teen already has a psychiatrist, pediatrician, or outside therapist, we coordinate care with those providers as clinically indicated and with your permission. Discharge planning starts well before discharge.
We use standardized measures from intake through discharge. The team reviews the results while care is underway and revisits the plan when progress stalls.
Common questions
Teens practice specific skills together. A session might involve a distress tolerance exercise, role-playing a hard conversation, or working through an emotion regulation tool with a partner. Skills get practiced where a therapist can coach them, so they are ready to use outside the room.
IOP offers more clinical contact than weekly outpatient therapy, with structured group practice and family involvement. We also pay attention to the state a teen is in when skills are introduced. A teen who is overwhelmed or shut down may need help settling before they can use what they are learning.
Most teens start with some resistance. Willingness tends to develop in the room, often faster than families expect. The structure and the peer connection do a lot of the early work.
Trauma-informed care and trauma processing are different things. We do not process trauma in a group setting. Trauma-informed means we approach the work assuming a history we may not know yet, move at each teen’s pace, and put felt safety before skill-building. Deeper processing happens in individual therapy, when clinically indicated.
Family therapy is built into treatment, and parents practice the same skills their teen is learning, so home and treatment speak the same language. Admissions will explain what family participation currently looks like.
Small steps. Strong roots. You belong here.
Tell us what has been happening. We’ll help you understand whether this level of care fits.
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