Dialectical Behavior Therapy, otherwise known as “DBT,” has become widely known and practiced by clinicians over the last twenty plus years. This model of therapy was first created to help the chronically suicidal population, and self-injurious behaviors. As a result of extensive research of this approach, DBT became known as the only proven method of therapy to effectively ‘cure’ someone with a diagnosis of Borderline Personality Disorder. The developer of this model, Marsha Linehan, was, and is, exceptional at conducting research and collecting outcome data, which has provided efficacy for the use of DBT with various populations since its inception, including teens.
When I first learned about this therapeutic approach I was in my first job in the field working as a clinician helping a population identified as being “severe and persistently mentally ill.” We had 5 out of 100 clients that were diagnosed as having borderline personality disorder and many more clients that were chronically suicidal. I was fortunate enough to have been one of three clinician’s selected to receive the highest level training available at the time (2004-2005) for DBT. Over the course of my career, since learning about DBT, I have found myself referring to specific DBT skills and teaching them to clients, especially teens, when I felt it could be beneficial.
Teens often struggle with regulating and managing impulses, emotions, and relationships. When teens struggle to manage these aspects effectively they begin to experience many additional issues including: self-esteem, depression, anxiety, poor grades, etc. As parents, we do a great job teaching our children about safety, hygiene, and how to do well in school, but what about teaching emotional and physiological self-care? Kids are not provided a lot of guidance or information in the school system or at home on how to handle emotions, relationships, and their physical wellbeing. I am happy to see that things are slowly beginning to change, but right now teens need more. DBT teaches four core skills and then provides coaching for how to effectively implement these skills including: Mindfulness, Emotion Regulation, Distress Tolerance and Interpersonal Effectiveness.
Mindfulness is defined by Jon Kabat-Zinn, as a way “to focus your mind in the present moment, on purpose and without judgement.” The benefits of this practice are many: gaining awareness of your thoughts, behaviors, emotions, environment in a nonjudgemental way to enhance your capacity to respond appropriately; being able to access more joy as a result of staying present in the moment; and diffusing unwanted or disturbing thoughts and feelings, to name a few. I often describe the benefits of mindfulness to my teens as being similar to the ways we interact with and learn about our pets. The more we observe our pets, the better able we are to engage with them. We begin to learn and know what they prefer to eat, where they like to sleep, how they like to play and what toys they prefer to play with, what things they are scared of, ways they like to be pet, etc. This wouldn’t happen without mindfully observing their habits and behaviors. So too, teens can learn the nature of their own emotional system, thoughts, behaviors, and other people’s behaviors.
Emotion Regulation teaches us about the nature and functioning of the emotional system including all the components involved in the system and strategies we can use to influence each component, which can result in an emotional shift. The more we gain an understanding of how the emotional system works, the more effective we can be at managing the emotional system.
In Interpersonal Effectiveness, teens learn about the benefits of managing relationships better, ways to identify personal interests- with respect to relationships, and ways to achieve these interests in the context of a relationship. Teen learn skills related to how to assert themselves, how to maintain self-respect, how to gain, maintain, and end relationships, and how to assess the quality of relationships to determine which of the previous three goals they would want to pursue.
Finally, Distress Tolerance teaches us many skills to tolerate highly stressful situations, urges, impulses in effective ways without making things worse.
If your teen is struggling, whether it be with relationships, impulsive behaviors, emotions, or self-awareness, consider reaching out to me to provide you more input as to whether this approach may be beneficial.
