At CDCBT our Dialectical Behavior Therapy for Adolescents Program (DBT-A) focuses on helping teenagers and their families to master the challenging bridge from adolescence to adulthood. Often fraught with behaviors that are difficult to understand, adolescence can be traumatic at worst and difficult at best. Like standard DBT (see DBT in a Nutshell Section), DBT-A helps with the problematic actions sometimes used to deal with extreme emotional intensity. The treatment has been modified to include a specific focus on commitment strategies, a group for parents, and a fifth skills module entitled “Walking the Middle Path.”
Adolescent DBT Program: Adolescents are required to attend a 16-18 week program that combines individual psychotherapy and group skills training. Typically, one would attend one weekly individual psychotherapy session along with one skills training group. In addition, parents are required to regularly attend a multi-family skills training group. Both the adolescent and multi-family skills training groups focus on the following skills modules and associated problems:
• Mindfulness: focusing the mind, directing attention, understanding how you feel
• Emotion Regulation: reducing emotional intensity
• Distress Tolerance: reducing impulsivity
• Interpersonal Effectiveness: keeping relationships steady and getting what is needed
• Walking the Middle Path: helping with teenager and family problems
Modifications of Standard DBT for Adolescents:
Commitment Strategies: A cornerstone of DBT Treatment, commitment strategies arose from evidence suggesting that people were more likely to behave in a particular way if they agreed to do so beforehand. Thus, adults in DBT “commit” to certain behavioral changes even though they have not yet learned to master them. In our work with adolescents, we strongly encourage this same level of commitment; however, we understand that few adolescents would “choose” to be in therapy if left alone. In fact, they have not often experienced the consequences of their behaviors and may feel immune to them. Given this, adolescents are often encouraged or mandated by parents, teachers, therapists or friends to seek treatment, and may not be “motivated” initially to attend therapy. It is for this reason that adolescents are required to meet with a DBT-trained therapist in individual therapy in addition to attending a once weekly skills group. In the context of individual therapy, special commitment strategies are used to help adolescents understand the precipitants of their behaviors, the consequences, both positive and negative, of their behaviors, and the implications for behavior change.
Parents’ Group: As part of our DBT-A Program, parents are required to attend a multi-family parents’ group where they, themselves, learn the DBT skills of mindfulness, distress tolerance, interpersonal effectiveness, emotion regulation and “walking the middle path.” In addition, parents learn to understand and respond to specific adolescent behaviors, to encourage the use of skills at home, and to receive support from each other in a DBT framework.
Walking the Middle Path: A fifth skills module focuses on teaching adolescents and their parents the concepts of dialectics, validation, and behavioral therapy, with specific emphasis on the relationship between parents and teens. Because these relationships can often be very problematic and stressful, parents and children are often locked in power struggles that can be overcome by learning the concepts of dialectics, validation and reinforcement.