A significant portion of our practice at Kalamazoo DBT is devoted to working with adolescent clients and their families. The young people who are referred to us are usually struggling with issues related to emotion "dysregulation" (experiencing emotion very intensely, slow return to emotion baseline, great difficulty separating mood from behavior). This difficulty regulating emotion causes great pain as the young person navigates social and family relationships, copes with school issues, and grapples with building their own identity while approaching young adulthood. The adolescents we work with have often developed ways of coping with these emotional storms through use of behaviors that work in the short-term but cause greater difficulty in the long-term like:
*eating disordered behaviors
*suicidal thinking or behaving
*intense fighting with others
In many cases, these behaviors have developed as ways of tolerating reality, and directly function to decrease painful emotions (like sadness or anger) or sometimes to increase other emotions (for example, when feeling "numb", self-harm releases brain-chemicals that actually feel similar to what we feel when we are happy, thus the brain learns, "if you want to feel better, self-harm is the way to do that").
In DBT, we try really hard not to assume we know the reason a young person uses behaviors, just as we try not to do that for our adult clients. Our aim is to work with our young clients to figure out how the behavior functions for them (there may be multiple functions) and find the part of the behavior that MAKES SENSE (who wouldn't want to feel better if they were feeling really badly??). We call this "validation" which is a key part of DBT therapy. At the same time, we have to acknowledge the reality that the behavior isn't working long-term and there are more effective, BETTER ways of feeling better that we teach through the DBT skills.
The skills are the ACTIVE INGREDIENT in DBT therapy. Without the skills getting "in" there is no way for the therapist to help the young client put them in place in their lives.
In our adolescent DBT, we teach the skills to the family unit in 25 weeks of "family skills". Each member must commit to learning the skills and to coming to all sessions ready to learn, do the work, and practice outside of skills class. The family unit consists of whomever is an active part of caregiving for the adolescent client and who can commit to the process.
Just as with our adult clients, DBT for adolescents also consists of individual therapy for the adolescent, skills coaching between sessions, and consultation for the therapist (all members of Kalamazoo DBT meet weekly to get support from each other and keep each other true to the treatment. We are all working towards DBT accreditation).
In DBT we require that those we work with come with a willingness to do the work it takes to build the life that they want. It's not easy and none of us at Kalamazoo DBT would tell you different, but we will say that the skills really do work if you give them a chance and that it is possible to feel better. We are committed to helping you in that process.
DBT will not work as a "forced" treatment. DBT requires a teamwork approach between therapist and client and we know not everyone is ready to be part of that team. There are other therapy choices and we hold that if DBT does not seem like a fit for you at this time, you are free to make another choice.
Now you may say, "but my parents are making me do this".
Here's our take on that: your agreements about therapy are between you and your parents. We will tell your parents DBT does not work as a "forced" treatment and we can not work with those who are absolutely not willing to work with us. It's that simple. In some cases, we may work with the parents separately in order to help them learn skills on their own, but we prefer to actively involve the adolescent client.
Here is a link to a clear and *SHORT* video explaining DBT to young clients.:
This video is also displayed at the top of the page.
Please note that one element of DBT discussed in this video, "phone coaching" is provided by therapists with differing limits. The limits discussed in the video are 24 hours per day availability. This is not true for every DBT therapist and your therapist's limits around this service will be made clear by the therapist.
Here is a great (okay I'm biased) clip of Marsha Linehan discussing DBT with adolescent expert, Laura Kastner. Forward about 5 minutes past the intro. This video is essential viewing for parents and caregivers of adolescents coming into the DBT program as it helps to explain some of the core concepts and assumptions of DBT.