What is Dialectical Behavior Therapy?
The Child Study Center’s Dialectical Behavior Therapy (DBT) program is an evidenced-based psychotherapeutic treatment program designed to treat teens with difficulty regulating their emotions and behaviors. DBT strategically blends the change techniques from traditional cognitive behavioral therapy with acceptance-based strategies from Zen mindfulness practice. Developed by Dr. Marsha Linehan, DBT was originally created to treat adult women who were chronically suicidal, self-injuring and exhibiting symptoms of Borderline Personality Disorder. DBT has since been adapted for teens and their families. The ultimate goal of this treatment is to help the teen build the skills necessary to both envision and create a meaningful life that feels worth living. DBT may be an effective therapeutic option for teens that commonly experience:
- Suicidal thoughts or actions
- Self-injurious behaviors such as cutting or scratching
- Other risky behaviors, such as abusing substances or school truancy
- Difficulty regulating emotions (including depression, extreme mood fluctuations, seemingly unpredictable emotional reactivity, and/or difficulties managing anger)
- Frequent and intense conflict with peers, adults, and/or other family members
- An unclear sense of who they are or life direction
In the important initial phase of treatment, DBT works with the teen and parent(s) to target the following behaviorally-oriented goals:
- Eliminating life-threatening and self-injurious behaviors
- Increasing the teen’s commitment to the therapy process
- Decreasing behaviors that are causing other problems with family, school, and/or peers
- Increasing coping skills, such as learning to deal with conflict, learning to cope with painful emotions, and improving self-care
What Does DBT Treatment Consist of and What Services Can I Expect?
The teen and their parent(s) will have a comprehensive psychiatric evaluation with a member of our DBT service team. The diagnostic evaluation will also consist of an additional component to help determine whether or not our DBT program is an appropriate therapeutic fit for the teen. Typically, adolescents ages 13-17 are appropriate referrals to the DBT program. However, exceptions are made on a case by case basis.
The initial evaluation is followed by a separate feedback session with parents and/or the teen to review treatment recommendations. If DBT is not the recommended treatment other treatment options will be suggested.
The initial 20-week phase of the adolescent DBT program includes the following therapeutic program components:
Weekly Individual Therapy Each teen in the program works individually with a therapist who is an active member of our DBT team. Our expert clinicians tailor change and acceptance techniques to identify and maintain focus on the primary problems to be addressed for each individual teen and their family. Clinicians help the teen stay motivated in the program, and develop and utilize effective coping and problem-solving skills.
Weekly Multifamily Skills GroupThe weekly multifamily skills group (MFSG) is a highly structured 20-week skills-oriented group for both teens and their parents. The teen and their parents learn DBT skills together in a group format alongside other families. The MFSG is more “class-like” as compared to traditional group therapy. There are handouts, homework exercises and experiential activities practiced weekly, but there is no expectation that group members must reveal or share any information that is either uncomfortable for themselves or their teen. DBT skills taught include:
- Core Mindfulness: Helping teens and their parents become more fully aware of their emotions, thoughts, impulses and behavior
- Distress Tolerance: Helping teens and their parents learn ways to get through difficult moments without making impulsive decisions they may regret
- Emotion Regulation: Helping teens and their parents learn cognitive and behavioral techniques for reducing vulnerability to, and enhancing the ability to cope with, overwhelming emotions
- Interpersonal Effectiveness: Helping teens and their parents learn how to maintain healthy relationships, manage conflict, and maintain self-respect
Walking the Middle Path: Helping teens and their parents learn to live a more balanced life and avoid the emotional and behavioral extremes that frequently lead to stress
Additionally, parents learn to understand and respond to their teen’s behaviors, encourage the use of skills at home and receive support from one another within a DBT framework. Past experience has shown that the inclusion of parents has made the treatment more effective because parents learn to serve as coaches for their child as well as benefit from learning the skills themselves.
Telephone coaching is a tool used by clinicians to help teenagers become comfortable and skilled at using their new and adaptive coping responses in the real world. Teens are encouraged to call their individual therapist when they have urges to engage in problem behaviors or feel “stuck” and unsure of what to do. The clinician’s role is to help the teen problem solve in real time and identify DBT specific coping skill to practice in the moment. DBT clinicians are on-call to their patients both during and after normal business hours for telephone coaching.
Other Program Components
Teen and Parent Graduate Groups
In addition to the program components above, our DBT program includes “Graduate Groups” for both teens and parents who:
- Completed the initial 20-week MFSG
- Interested in participating
- Considered by the DBT clinical team to be appropriate for inclusion in the group
In contrast to the MFSG, the graduate groups are separated into teen-only and parent-only groups. The goals of the DBT Graduate Groups are:
- Maintain behavioral gains by reinforcing and supporting progress from the first phase of treatment
- Help teens and parents strengthen and generalize their behavioral skills to various settings and relationships
- Help the teens and their parents increase behaviors that improve their overall quality of life
For more information or to schedule an appointment please contact our intake department at 646-754-5000 or e-mail us at firstname.lastname@example.org.
Our team of seasoned clinicians and Cognitive Behavioral Therapists has received intensive training in Dialectical Behavior Therapy.
Amy Donovan, LMSW