for Adolescents and Families
Dialectical Behavior Therapy (DBT) is the gold standard treatment for pervasive emotion dysregulation, and professional consensus identifies DBT as the primary treatment for Borderline Personality Disorder (BPD). DBT is thoroughly researched and identified as an evidence-based treatment for adolescents who might experience suicidal behaviors, parasuicidal behaviors (Examples: Self-Injury, cutting, burning), substance use, anxiety, depression, and severe anger.
Comprehensive DBT Structure
Pre-treatment. From the beginning of treatment, adolescents and their families receive a comprehensive diagnostic interview and determine if there is therapeutic match between client and EMH therapist. In addition, the EMH therapist will assess the family’s targeted problems and related treatment goals across five main adolescent-focused topics:
Confusion About Self (Unaware of goals, values, feelings, or related thoughts)
Adolescent and Family Challenges
Individual Therapy. Adolescents meet for weekly individual therapy sessions. A typical individual therapy session is structured and focused on treatment goals. Problems and stressors are analyzed with potential solutions identified.
Multi-Family Skills Group
In DBT-A, adolescents and their caregivers are expected to attend a Multi-Family Skills Group to learn about, practice, and generalize skillful behaviors. The DBT Multi-Family Skills Group assumes a classroom style format, where the main focus of the session is learning new ways of coping.
DBT Multi-Family Skills groups meet once per week for two hours’ time over the course of approximately six months. Typically, a multi-family skills group is comprised of about 3-5 adolescents and their caregivers. Multi-Family Skills Groups occur in addition to the weekly individual therapy service. DBT Multi-Family Skills Groups cover the following skills modules or categories of skills:
In Core Mindfulness, participants will learn how to focus their minds, increase attention, and develop a nonjudgmental stance. Mindfulness is repeatedly reviewed as it is the basis for the remaining DBT Skills modules.
Distress tolerance skills help an individual endure a distressing situation without impulsively reacting with harmful behaviors. In other words, distress tolerance skills help adolescents and families develop coping skills to manage crises and other stressors.
Emotion regulation skills help group members identify various emotions and increase positive experiences. Practice and mastery of emotion regulation skills support group members in decreasing their vulnerabilities to intense emotions.
Interpersonal effectiveness skills help group members improve and sustain their relationships across settings. Group members learn socially effective ways of navigating interpersonal interactions.
Walking the Middle Path
Walking the Middle Path module supports adolescents and families to develop balanced thinking and behavior patterns. Additional skills to be developed include validation and other behavior modification strategies.
Phone coaching is a service offered to adolescents in the comprehensive DBT program. With phone coaching services, an adolescent can call their DBT therapist to support use of skills outside of the therapy hour. Phone coaching sessions are approximately 10-15 minutes in length, and the DBT therapist seeks to reinforce the adolescent’s use of skills and effective choices.
Family therapy sessions are often recommended to support the family’s ability to learn, retain, and use behavioral skills outside the therapy hour. Caregivers and adolescents develop new ways of interacting and communicating, consistent with their values and goals.
At EMH, parent-focused sessions are especially designed to support caregivers in creating a change-ready environment. In other words, helping to create an environment where adolescent behavior change is facilitated by new and helpful communication patterns.
Comprehensive DBT requires clinicians to meet weekly to maintain the treatment’s fidelity. Ultimately, the role of the consultation team is to keep clinicians accountable in providing adolescents and families the best of care.