Profile: Dialectical Behaviour Therapy (DBT)

DBT is a principle-based psychotherapy developed by a Psychologist called Marsha Linehan. It blends standard cognitive-behavioural therapy with Eastern philosophy and meditation practices. The therapy was developed to help people who were suicidal and/or self-harming. It is now a widely used therapy to help children and young people (aged 12 to18) experiencing difficulties in their life and has been proven to be effective in many studies across the world with adults, teens and children.
DBT is useful for young people struggling with:

• Impulsivity/Emotional Regulation difficulties
• Depression/Anxiety/Self harm
• Confusion about identity
• Adolescent and family dilemma’s including relationship difficulties
• Substance misuse/Eating difficulties
• Risk of placement breakdownVulnerable to sexual exploitation
• Violence

DBT aims to work on five main areas of difficulty or “dysregulation”:

1. Emotion dysregulation e.g. emotional instability and problems with anger
2. Interpersonal dysregulation e.g. unstable relationships
3. Behavioural dysregulation e.g. suicidal behaviour, deliberate self injury and impulsive behaviours
4. Cognitive dysregulation i.e. difficulty in thinking clearly
5. Self dysregulation i.e. unstable self or self image

An important element in the application of DBT to adolescents is that therapy works on enhancing five functions:

1. Adolescents capabilities
2. Increases adolescents motivation
3. Structures the environment to increase the likelihood of success
4. Works to assure generalisation from therapy to the natural environment
5. Enhances therapists’ ca¬pabilities and motivation to treat adolescents effectively.

DBT for adolescents uses four modes of treatment:

1. Weekly individual therapy
2. Weekly skills training
3. Telephone coaching
4. Weekly therapist consultation team meetings

The individual therapy focuses on a hierarchy of targets in the first stage of DBT:

1. Eliminate life-threatening behaviour e.g. self harm
2. Stop therapy-interfering behaviours e.g. not showing up to sessions
3. Change behaviours that interfere with the adolescent’s quality of life e.g. substance abuse
4. Enhance the adolescent’s use of skills.

The skills training addresses skills deficits believed to be causing the adolescent’s problems. DBT systematically teaches five skill sets:

1. Core Mindfulness

Learning to control thoughts and feelings.

Learning to be more aware and to live in the moment.

Developing a sense of self.

2. Interpersonal Effectiveness

Learning to feel more effective in communicating with people.

Building skills in asking for help and in making requests.

Learning to say “yes” and when to say “no.”

3. Emotion Regulation

Learning to control emotions by understanding them.

Finding ways to feel less vulnerable.

Learning to increase positive emotions.

4. Distress Tolerance

Increasing ability to cope with feelings of distress and manage crises more effectively.

Learning to accept reality to help with coping.

Reduce impulsive or self-harming behaviours.

5. Walking the Middle Path (Carers/Parents)

Learning and developing skills in order to help the young person cope with change and to deal effectively with it.

The telephone consultation element of DBT is a brief (five to fifteen minutes) telephone conversation between the adolescent and the therapist and the purpose is to enhance the likelihood of effective behaviour, coach the use of skills and decrease the likelihood of problem¬atic behaviours.

What kind of changes do you aim to achieve with DBT for adopted and fostered children?

DBT aims to help the individual learn the skills mentioned above. Most importantly the treatment is about the adolescent learning to regulate their emotions, which helps them to manage relationships.

How does DBT work for adopted and fostered children?

DBT bases itself on the four modes of treatment (above). However, given that adolescents reside with carers/parents who play a significant role in the young person’s emotional experience, the carers also participate in the skills training groups. The principle is that the carers will require skills to effectively assist the adolescent in becoming skilful. The carers participate fully in the group in that they are there to learn the same skills as the adolescents and do the homework. The involvement of carers in the group allows the skills trainers to observe the interactions between caregiver and adolescent and provide skills coaching.

Who does DBT? What kind of training do DBT therapists have?

DBT can be undertaken by any professional who has trained in a primary occupation first e.g. clinical psychologist, nurse, social worker and who then undertakes additional specialist training in DBT. The specialist training consists of a two-week intensive team-training course. Further training is also required to keep abreast of new research.

Why are you passionate about DBT for fostered and adopted children?

I have been working with looked after children for nearly 17 years. I am passionate about this model for fostered and adopted adolescents because it has a core aim of helping children regulate their emotions and research shows that this is a core part of helping them to heal.

The DBT model aligns with the developmental needs of young people very nicely. It incorporates concrete skills that are easily understood and helps young people with their relationships. It also instils a sense of empowerment and hope for the future for young people in care. What I love about DBT is that the core aim of the model is to help these children develop a life worth living.