Academic journal article American Journal of Psychotherapy

Dialectical Behavior Therapy for Suicidal Latina Adolescents: Supplemental Dialectical Corollaries and Treatment Targets

Academic journal article American Journal of Psychotherapy

Dialectical Behavior Therapy for Suicidal Latina Adolescents: Supplemental Dialectical Corollaries and Treatment Targets

Article excerpt

The primary aim of this paper is to describe extreme behavioral patterns that the authors have observed in treating Latina adolescents who are suicidal and their parents within the framework of dialectical behavior therapy (DBT). These extreme patterns, called dialectical corollaries, serve to supplement the adolescent/family dialectical dilemmas described by Rathus and Miller (2002) as part of dialectical behavior therapy for suicidal adolescents with borderline personality features. The dialectical corollaries proposed are "old school versus new school" and "overprotecting" versus "underprotecting," and they are described in-depth. We also identify specific treatment targets for each corollary and discuss therapeutic techniques aimed at achieving a synthesis between the polarities that characterize each corollary. Lastly, we suggest clinical strategies to use when therapists reach a therapeutic impasse with the parent-adolescent dyad (i.e., dialectical failures).

KEYWORDS: Latina adolescent; suicide attempt; treatment; culture; trauma; parenting; Hispanic; dialectical behavior therapy

INTRODUCTION

In 2011, the Youth Behavior Risk Surveillance System found that 21% of Latina adolescent females seriously considered a suicide attempt (SA) during the past 12 months and 14% had engaged in at least one suicide attempt (Centers for Disease Control and Prevention). These SA rates were higher than those for African-American (8.8%) and Caucasian-American adolescent females (7.9%). At Montefiore Medical Center's Adolescent Depression and Suicide Program in the Bronx, NY, the majority of patients are Latina adolescents. Our team conducted studies with Latina adolescents, parents, and treating clinicians with the goal of improving our treatment protocol for this high-risk group (Germán, González, & Rivera-Morales, 2013; Germán, Haaz, Haliczer, Bauman, & Miller, 2013).

A promising treatment for Latina adolescents who are suicidal is dialectical behavior therapy (DBT), an evidence-based treatment originally developed for adults with borderline personality disorder (BPD) who were chronically suicidal (Linehan, Armstrong, Suarez, Allmon, & Heard, 1991; Linehan et al., 2006; Van den Bosch & Verheul, 2007; Verheul et al., 2003). Dialectical behavior therapy was adapted for use with teens by Rathus and Miller (2002). Studies comparing DBT to treatment-as-usual conditions have shown promising results in reducing deliberate self-harm behavior, psychiatric hospitalizations, suicidal ideation, depression, hopelessness, and borderline personality disorder symptomatology (Mehlum et al., 2014; Rathus & Miller, 2002).

Marsha Linehan (1993) proposed that individuals who engage in suicidal and nonsuicidal self-injurious behaviors (NSSI) with a diagnosis of BPD often resort to extreme behavioral patterns, which are referred to in DBT as dialectical dilemmas. When these patterns occur, the individual shifts between polarized behavioral extremes in an effort to regulate his or her emotional state. However, these patterns are ineffective and often function to over or under regulate the individual's emotions and behaviors, and are thus deemed as "dialectical failures." Accordingly, Linehan (1993) developed treatment targets to find a synthesis between the extreme behavioral styles by decreasing these maladaptive behaviors (e.g., active passivity, apparent competence, self-invalidation) and increasing adaptive behaviors (e.g., active problem solving, effectively asking for help, and self-validation). See Linehan (1993) for a full review of the original DBT dialectical dilemmas.

In working with adolescents who have multiple problems and BPD features, Miller, Rathus, and Linehan (2007) described additional extreme behavioral patterns that were transactional in nature and occurred between the adolescent and his or her environment. They identified three dialectical dilemmas specific to working with adolescents and their parents (i. …

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