Dialectical Behavior Therapy
Dialectical Behavior Therapy
Our Goal
DBT is an evidence-based treatment using multiple approaches (individual therapy, skills training, live 24-hour coaching by phone) to help children, teenagers and their families who struggle with a variety of problems. Families seeking DBT for their children and teens often describe them as having big feelings and big behaviors such as:Thinking about things in extremes — everything is great or everything is horrible, “sticky” thinking
Behaving in extremes — hurting themselves or others, breaking objects or possessions, making decisions quickly and without thinking through the consequences Feeling in extremes — highly sensitive to their own feelings and the feelings of others, beating themselves up over things that seem small, feeling their emotions more strongly than their siblings or friends, and having trouble moving on from negative feelings
Parents and teachers sometimes say that they have to “walk on eggshells” around these preadolescents in order to avoid explosions of feelings and behaviors. Children and adolescents often have difficulty maintaining friendships or knowing when to let go of them because of the extreme way they experience their feelings. Research shows that children and teens who experience these extremes in thinking, behaving, and feeling have an increased risk of developing more severe mental health problems later in life.
DBT for preadolescents and adolescents seeks to decrease this risk for later problems. We do this through structured, mulit-modal treatment to improve upon the abilities of children, adolescents, and their families to gain more control over their sticky thoughts, big feelings, and big behaviors. DBT also helps preadolescents and teens learn how to make and keep appropriate friendships and relationships with other people.
Treatment approach
Comprehensive treatment: Families participating in our comprehensive DBT program receive specialized teaching and support from our clinical team to manage big behaviors and big emotions at home, at school and in the community. They also receive unique learning and support from the members in their respective skills groups. Parents work through ways to effectively support their preadolescent in a collaborative learning environment together with other parents dealing with similar difficulties. Children and adolescents learn and practice new ways of managing their behaviors, emotions, and choices with a group of peers with the same sensitivities as they work towards the same goals of mastering their mood. Both groups provide parents and children/adolescents with a safe, non-judgmental space to learn and practice new skills.
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Individual therapy sessions are typically held weekly or twice weekly for 30-45 minutes each. These sessions help children and adolescents learn and practice new behavioral and emotional regulation strategies to use in their day-to-day lives. DBT individual therapy sessions follow a particular evidence-based structure that may look somewhat different from individual therapy sessions that children or teens have participated in previously.
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These groups are held weekly for 75 minutes for 26 weeks; clinicians may recommend that families complete a second 26-week “cycle” at the conclusion of the first 26 weeks. Children/adolescents and their parents/caregivers attend separate DBT groups to learn the core DBT skills. In addition to learning the core DBT skills, parents will also learn behavioral parenting skills and how to enhance their own coping ability while supporting their child’s use of DBT skills.
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Targeted coaching with DBT clinicians is available at any time in between sessions for parents to help support their use of certain skills in the moment. Phone coachings are used to support the application of these new skills in the real world.
Skills group and skills coaching by phone or text message are ONLY available to those participating in the comprehensive DBT program.
DBT Parent Management Training (as needed): Parents have the opportunity to work on specific problem behaviors and parenting goals by combining techniques learned in the skills group with parent management training. Sessions are held weekly or twice-weekly with an experienced clinician.
A Comprehensive Guide To Dialectical Behavior Therapy
FREQUENTLY ASKED QUESTIONS
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Families who are already receiving treatment at Milestones will not need to undergo a comprehensive diagnostic evaluation. Instead, they will have a shorter appointment with one of our team clinicians for the same purpose: to determine if DBT is the most effective treatment option for their specific problems.
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DBT is a comprehensive, multi-modal approach to treatment. Each of the different modes of treatment– skills group, individual therapy, skills coaching by phone or text– serves an important and unique function in the treatment. We therefore do not offer group-only treatment at this time.
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Skills coaching by phone/text is a component of comprehensive DBT that is specifically designed to help children, teens and parents generalize the skills they are learning and practicing in their individual and group sessions. The goal of these calls is to help implement skills before a situation becomes a crisis and begin to create new patterns of behavior for the participants in treatment. It is typically available 24/7, and your individual clinician can explain specifics once you start treatment. Calls are brief, typically 5-10 minutes in duration, and are not designed to go into depth on particular issues that arise between scheduled individual, parent and/or group sessions.
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Because of the specific way in which individual therapy is structured in DBT, it is strongly encouraged that those participating in the treatment do not engage in any other form of therapy at the same time. This increases the likelihood of treatment being fully effective to treat the specific problems your child and family are seeking help for, and they are welcome to return to their previous provider upon completion of the treatment program. The exception is for children and adolescents who are seeing a provider for medication management; families are encouraged to maintain regular appointments with their medicating provider throughout the course of DBT treatment, and treatment is likely to be even more effective if the DBT provider can collaborate with the medicating provider.
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There are multiple randomized controlled trials (RCTs) showing the effectiveness of DBT across multiple populations including for children and adolescents. Please click on these links to see some of the scientific evidence behind this treatment.
DBT-C is more effective than standard treatment in a sample of children ages 7-12: https://doi.org/10.1016/j.jaac.2017.07.789
Efficacy of DBT for Adolescents at high risk for suicide: https://doi.org/10.1001/jamapsychiatry.2018.1109
DBT for adolescents with non-suicidal self-injury: https://doi.org/10.1111/camh.12452
DBT for suicidal self-harming youth ages 13-15: https://doi.org/10.1016/j.jaac.2021.01.016
DBT-based skills treatment for adolescents with ADHD ages 15-18: https://doi.org/10.1186/s12888-022-04435-8
