El Grupo is loosely based on the dialectical behavioral therapy approach to group psychotherapy, using ideas from the Skills Training Manual for Treating Borderline Personality Disorder, by Marsha M. Linehan. The group teaches skills from this manual to help the patients target issues in their daily lives. To give structure to El Grupo, the leaders designed a six-month cycle consisting of four modules. Each module is focused on teaching essential psychosocial skills outlined in the manual: mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. The manual was translated from English to Spanish by the primary leader of El Grupo, to accommodate the language spoken by the participants and to make the handouts more relevant for the group's members. The hour-long group sessions are held weekly. Each group starts with a mindfulness exercise, followed by sharing the experience of the exercise, reviewing homework, and openly discussing a new skills set for that week. Tools utilized, aside from the milieu itself, include role-playing exercises, chain analyses, skills handouts, and behavior modeling.