Dialectical Behavior
Therapy

for Children
(DBT-C)

Dialectical Behavior Therapy for Children (DBT-C) is a treatment intervention that targets children (ages 6 – 12) with chronic emotion dysregulation. DBT-C was developed by Francheska Perepletchikova, PhD. Dr. Perepletchikova personally trained, mentored, and provided consultation to EMH therapists. DBT-C maintains the theoretical orientation, principles, and strategies of adult-focused DBT, but the treatment is delivered through a developmentally appropriate framework. Most notably, DBT-C emphasizes the critical role of partnership between the child’s caregivers and the treating therapist. In the beginning of treatment, caregivers develop effective ways of helping their children emotionally regulate and manage unwanted feelings. For those who wish to learn more about DBT-C, please visit: Dialectical Behavior Therapy (DBT) for Children and Preadolescents (childmind.org). 

Pre-Adolescents Who Benefit from DBT-C

DBT-C may benefit children who exhibit frequent and intense temper outbursts, have poor frustration tolerance, become upset easily, and exhibit a slow return to emotional baseline/neutrality. Children who present with this set of problems might meet diagnostic criteria for Disruptive Mood Dysregulation Disorder (DMDD).

Unfortunately, some children have learned to regulate their intense emotions in harmful ways including suicidal behaviors, non-suicidal self-injurious behaviors, extreme tantrums, and physical/verbal aggression. DBT-C therapists refer to these children as “Supersensors,” highlighting the superpower-like ability of these emotionally sensitive children to uniquely experience and regulate their feelings.

Parenting Supersensors: Addressing the Joys and Challenges

Parenting Supersensors can be both a joy and a challenge. In the course of trying to cope with strong urges, Supersensors may engage in impulsive or harmful behaviors. When this happens repeatedly, it can unwittingly place stress on the environment (i.e. parents, teachers, coaches) causing unhelpful responses (i.e. invalidation, over emphasis on punishment, parental loss of temper). Often times, a Supersensor’s problem behaviors are accidentally reinforced by the environment, therefore increasing the chances of continued problem behaviors.

 

For many parents, their traditional parenting strategies for other children appear ineffective with Supersensors. As such, when parents are unable to effectively meet the Supersensors behavioral needs, there is a “poorness of fit” between the Supersensor’s mental health needs and the environment’s capacity to support the Supersensor.

 

In DBT-C, treatment focuses on effective ways that the environment can support the child’s unique needs, while simultaneously helping the child to learn individual ways of coping. Neither party is absolutely to blame for conflict, while at the same, both parties require acceptance and change for resolution.

Goals of DBT-C

  • Strong collaboration between parents/caregivers and the primary therapist Ultimately, the primary therapist helps parents prioritize the creation of a “change ready environment,” or a new environment that is validating and supports the Supersensor’s behavioral skill development.
     

  • Teach emotion regulation skills to both parents and Supersensors.
     

  • Strengthen the parent-child relationship by supporting parents in safeguarding the Supersensor’s sense of self-love, safety, and belonging.

Hierarchy of Treatment Targets

Similar to traditional DBT, DBT-C uses a hierarchy of treatment targets to organize and prioritize various topics to be addressed in therapy. As such, the parents’ functioning and ability to adaptively structure the environment is required in the beginning of treatment.

  1. Decrease current severe psychopathology and risk of psychopathology in the future

  2. Decrease life threatening behaviors of the child

  3. Decrease therapy destroying behaviors of the child

  4. Decrease therapy interfering behaviors of the parents

  5. Improve parental emotion regulation

  6. Teach effective parenting techniques

  7. Target the parent-child relationship

  8. Improve the parent-child relationship

  9. Target the child’s presenting quality-of life and therapy interfering behaviors

  10. Decrease risky, unsafe, and aggressive behaviors

  11. Decrease quality-of-life interfering behaviors

  12. Provide skills training

  13. Decrease therapy-interfering behavior of a child

Treatment

In the beginning phase of DBT-C, Supersensors and caregivers can expect to participate in a fully comprehensive diagnostic interview. Parents and caregivers will meet frequently with the primary therapist.

 

Following the initial parent-focused work, Supersensors can expect to participate in individual therapy where they examine various problematic situations and develop new, helpful ways of coping. Supersensors will also experience skills training both in and out of session. Supersensors and their parents are required to practice and utilize DBT-C skills in the home environment.

 

The DBT-C therapist supports parents in reinforcing the Supersensor’s use and development of adaptive behavioral skills. Much like traditional DBT, DBT-C offers phone coaching but to parents. Phone coaching in DBT-C is a treatment mechanism used to support the family’s ability to generalize new and helpful ways of managing strong emotions. Depending on the Supersensor’s history, a DBT-C provider might also recommend an evidence-based treatment to address traumatic stress if clinically indicated.