DBT for Adolescents

Our DBT team for adolescents, led by some of the first DBT Board Certified clinicians in the Northeast, is deeply experienced and extensively trained in DBT.  Please visit our About Us section for more details.

At The Dialectical and Cognitive Behavior Therapy Center, 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, DBT-A helps with the problematic actions sometimes used to deal with extreme emotional intensity. The treatment has been modified to include a more specific focus on commitment strategies, parent and teen skills training, and a skills module entitled “Walking the Middle Path.”

For DBT to be successful, the treatment has to do two things effectively: (1) teach skills that people need in order to move closer toward their life goals, and (2) help people cultivate an ability to work these skills into their daily lives.

Part One, DBT Skills Training: DBT skills are taught through our twenty-four-week DBT skills group which is based on Marsha Linehan’s updated curriculum. When people sign-up for the DBT skills group we ask that they make a commitment to attend the entire twenty-four-week course.  We offer these groups in the late afternoons and evenings.

The DBT skills group is run very much like a class or a seminar. It meets once per week for ninety minutes. Participants are provided with notebooks that reinforce the skills taught in group.  Homework that corresponds with the DBT skills taught in a particular week is assigned and reviewed.

Parents and their adolescent attend together. Usually a group will consist of four adolescents and one parent for each adolescent. In addition to learning the DBT skills, parents also learn through the skills training group how to understand and respond to specific adolescent behaviors and to encourage the use of skills at home.

Our skills training curriculum teaches the following DBT skills which are arranged in four, six week modules:

Core Mindfulness: teaches participants how to focus the mind, direct attention, and to observe and describe what they are feeling and thinking in the moment without judgement. These skills can help to people develop a more stable sense of who they are, and can help reduce reactivity to painful thoughts and emotions.

Distress Tolerance: targets impulsivity by teaching adolescents how to effectively distract and soothe themselves while considering pros and cons of their actions. These skills typically replace problem behaviors such as self-injury, substance use, binge eating, and angry outbursts.

Emotion Regulation: addresses emotional sensitivity, rapid mood changes, and other unregulated moods such as chronic depression, anxiety, or anger. Learning how to identify and label emotions, how to increase positive moods, and how to make one less vulnerable to negative moods are examples of specific skills that we cover in this module.

Interpersonal Effectiveness: addresses difficulties in maintaining consistent and rewarding relationships by teaching skills such as how to ask for what you want, how to say no in an effective way, and how to maintain a sense of self-respect and independence in the face of external pressure.

Middle Path: targets extreme and non-balanced thinking and behaviors. These skills involve learning about common areas of conflict and polarization, both internal and external, and reducing this conflict by learning methods to change behavior, as well as methods of validation and acceptance.

Part Two, Individual DBT psychotherapy: This is the main way of developing and refining the ability to apply skills taught in DBT skills group to daily life. DBT skills group clients usually meet individually with their therapist one to two times per week for a forty-five minute session. As is the case with the DBT skills group, when people enroll in individual DBT psychotherapy we ask that they make a twentyweek commitment.

Phone coaching: This part of the treatment is designed to promote skills use where it matters most – in daily life. When our clients feel unsure of how to approach a particular situation, they are encouraged to contact their individual therapists for help in using DBT skills.

Commitment Strategies: We ask clients to commit to making certain behavioral changes even though they have not learned to master them. “Commitment strategies” are a cornerstone of DBT treatment. They arose from evidence suggesting that people were more likely to behave in a particular way if they agreed to do so beforehand. We understand that few adolescents would “choose” to be in therapy. 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.   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.

Weekly therapist consultation team: Our DBT treatment team meets weekly for ninety minutes to share feedback and discuss methods to ensure effective and compassionate treatment. We spend time problem-solving difficulties that interfere with client progress in treatment, and help keep each other practicing within a dialectical framework.