When programs went remote in 2020, DBT clinicians had a specific worry, and it wasn’t the one you would guess. Nobody was especially concerned about individual therapy over video; talk therapy had been delivering fine that way for years. The worry was the group. A DBT skills group is a class with homework review, and half of what makes it work is the pressure and warmth of other people in the room who are also struggling and also didn’t do the homework. It seemed like exactly the thing a grid of faces would ruin.
It mostly didn’t. Studies of remote and hybrid DBT delivery since then have found outcomes broadly comparable to in-person programs across the measures that matter most: reductions in self-harm, drops in emergency-room use, skill acquisition, and program completion. The evidence base is younger and thinner than the decades of in-person trials, and anyone who tells you it’s settled is overselling. But the direction is consistent and the effect sizes are close enough that most established programs kept a remote or hybrid track after they no longer had to.
What got better
Three things, and they aren’t small. The first is attendance. A full program asks for individual therapy plus a two-hour group every week for a year, and in-person that means somewhere between four and eight hours of your week once travel is counted. Remove the commute and the dropout math changes. Programs consistently report better attendance remotely, and in a treatment where four consecutive misses can end your cycle, attendance isn’t a side issue — it’s the treatment.
The second is access. Adherent DBT programs are scarce and clustered in cities. Video makes every program licensed in your state reachable, which for people outside a metro area is the difference between adherent DBT and whatever is within driving distance. Someone in a rural county who would once have had DBT-informed weekly therapy as their ceiling can now join a real program.
The third is subtler. A skills group asks you to talk about your week in front of eight strangers, and for people whose emotions run hot that room can be genuinely overwhelming. On video you’ve a degree of control over your own exposure — you can turn your body away, you can be in your own space, you can regulate without everyone watching you do it. Several clinicians will tell you that socially anxious clients who would have quit an in-person group stayed in a remote one.
What got harder
Phone coaching was always the component that lived outside the room, so it transferred without a scratch. The individual therapy transferred well. The group is where the real losses are, and they’re worth naming honestly.
Group cohesion builds more slowly on video. The five minutes before and after a session, when people actually talk to each other, mostly doesn’t happen on a call that starts and ends at the hour. Skilled leaders build that back in deliberately with breakout rooms and early opens, and where they don’t, the group stays a lecture. Practising a skill in the room — actually rehearsing a DEAR MAN out loud with someone playing your boss — is clunkier over video and often gets quietly skipped, which is a real loss because that rehearsal is where skills stop being theoretical.
And there’s a group of people for whom remote is a poor fit regardless of the evidence: those without a private space to take a call, those whose living situation is part of what they’re working on, and those in a level of crisis where a physical room and a physical person matter. A good program will assess for this rather than default everyone to video.
What to ask a remote program
The questions that separate a program that adapted from one that simply moved to Zoom.How do you run skills practice in group? You want breakout rooms and role-play, not a slide deck. Is there any time before or after group for people to talk? The answer reveals whether anyone thought about cohesion. What happens if I am in crisis during a session? A remote program must have a location-and-emergency-contact protocol, and should tell you about it before you need it. Are you licensed in my state? Therapy is regulated where you sit, not where they sit.
If you’re still deciding between a full program and individual work, that decision matters more than the delivery method — adherent DBT vs DBT-informed takes it apart.