Extending an Adult DBT Program to Adolescent Clients

Article excerpt

Adapting Dialectical Behavior Therapy (DBT) for younger clients and parents proves helpful

In June 2010, with all components of the Adult DBT program in place at Jewish Family and Children's Service (JF&CS) in St. Louis (see "New Approach Energizes Agency," June 2010), we anticipated expanding our DBT program to adolescents, pending the availability of funding through the St. Louis County Children's Service Fund or another source. When this funding came through, the first group of DBT program adolescents and parents began skills training in October 2010.

The Adolescent DBT skills group covers the same modules as the Adult DBT program: distress tolerance, emotion regulation, and interpersonal effectiveness. Each of these modules is preceded by one session of "core mindfulness" - an essential element of trai ning for every DBT component.

In addition to these modules, there is an additional module - specific to the Adolescent DBT skills group - that is called "Walking the Middle Path." This module teaches clients how to find a balance between acceptance and change by thinking and acting dialectically, validating self and others, employing behaviorism supports (positive/negative, reinforcement/ punishment), and improving relationships with parents.

Results to date

The adolescent DBT program requires attendance of a parent or other reliable adult to participate in weekly skills group side-by-side with the adolescent. Results seen thus far from the adolescent DBT program include:

* Development of healthier relationships between parents and their adolescent, among adolescents and the other adolescent participants, and among the participating parents.

* Development of common goals and team mentality among the adolescent and parent participants.

* Development of effective communication skills for the participants.

* Use of DBT skills by adolescent and parent participants between sessions

* Parent and adolescents learn from the experiences of their peers.

DBT coaching by phone

Another element of the DBT program that we have further developed over the last year is a telephone coaching element. A DBT therapist uses a phone coaching format to help keep the client (or the parent of a client in the case of the adolescent DBT program) on track with skills coaching.

Coaching calls may be in response to an emergency on the part of the cl ient; however, our DBT structure for the call requires that the client make an attempt to utilize at least one DBT skill before making the call. The purpose of the call is to troubleshoot why the skills didn't work for the client and for the therapist to possibly recommend additional DBT skills. Over the past two years, our DBT team members have grown in their ability to handle the coaching calls.

As more clients have begun to understand the value of contracting with their therapist for the "full" DBT program, which includes the telephone coaching, there has been a great demand for the full model of DBT from our clients. The clients see the full model of DBT as a significant support for their recovery beyond usual and customary psychotherapy.

In keeping with the current technology, and because of the structure and brevity of a telephone coaching call, a number of adolescent and adult clients opt to use "texting" as a way of making the "coaching call." Our revised coaching contracts with DBT clients spell out their consent to use of cell phones and related technology for the purposes of coaching calls.

A new "graduate" group

Just recently, one of our original DBT staff members began facilitating our first adult DBT "graduate" group, which is composed of clients who have gone through all of the DBT skills training modules and stabilized sufficiently to be considered graduates. The clients are not considered finished with therapeutic work, but they have sufficient skills to begin and complete trauma work, usually in individual therapy. …