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

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.e., excessive leniency versus authoritarian control, normalizing pathological behaviors versus pathologizing normative behavior, and fostering dependence versus forcing autonomy). These dialectical dilemmas have been helpful to conceptualize adolescents' and their parents' problematic behavioral patterns and to further formulate appropriate treatment targets.

Based on our research findings and clinical observations of Latina adolescents and families, the current authors expand upon the existing adolescent dialectical dilemmas by proposing supplemental dialectical corollaries frequently observed in Latino families. We first review the existing adolescent/family dialectical dilemmas, and then discuss the dialectical corollaries. Our goals are to provide additional interpretations of the adolescent dilemmas to foster a better understanding of the extreme behavioral patterns that can manifest in Latino families and better inform our treatment targets and strategies.

BRIEF REVIEW OF ADOLESCENT DIALECTICAL DILEMMAS1

EXCESSIVE LENIENCY VERSUS AUTHORITARIAN CONTROL

Parents2 often waver between two extremes in this dilemma. …

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