How is DBT Different and How Does it Help?

DBT stands for Dialectical Behavior Therapy and it is a therapeutic approach for treating certain conditions that commonly impact teenagers.  Although it was originally created as a way to help those diagnosed with borderline personality disorder, it is also proving effective at helping teens who are participating in self-harming activities and those who have acknowledged having suicidal thoughts.  It is an approach to treatment that combines several different kinds of therapy and mental health coping mechanisms into a single overarching program.

One of the most important aspects of a DBT program is the type of relationship that the provider strives to achieve with the client.  In some programs and even during individual therapy practices, the practitioner operates in an adversarial capacity, especially in working with teenagers.  However, in DBT programs, the provider’s goal is to build a different kind of relationship, one where the teen feels supported and the provider is their ally rather than another enemy.

The program also pulls from a variety of therapeutic approaches and techniques aimed at treating the whole person as well as the whole problem.  DBT generally include individual cognitive behavioral therapy, group therapy sessions, mindfulness training and activities, reality testing, distress tolerance, and some assertiveness training.  Let’s look at each of these individually.

  • Individual Cognitive Behavioral Therapy Sessions –This type of therapy helps clients address issues with emotional dysfunction and behavior modification.
  • Group Therapy Sessions – This type of therapy works on building the client’s skills in regulating their own emotions, modifying their behaviors, and tolerating stressors in a more productive way.
  • Mindfulness Training – This practice can help with stress reduction, present awareness, relief of anxiety and depression symptoms, and overall wellness.  This is a core part of DBT as it provides the foundation for accepting, enduring, and overcoming the powerful feelings that clients may be using unhealthy behaviors to manage.
  • Reality Testing – This helps clients understand and differentiate between what is happening in their mind and what is happening in the outside world.
  • Distress Tolerance – This approach helps clients learn to tolerate pain and distress in a non-judgmental way so that they can make decisions and react without becoming besieged by the torrent of negative emotions and self-destructive behaviors they have been using to cope.
  • Assertiveness Training – This part of the program helps clients learn to create healthy boundaries, say no, and handle conflict with other people.

The combination of all this components is what makes DBT such an effective form of treatment for teens.  By learning mindfulness techniques, teens can learn to pause before reacting to negative events.  The distress tolerance and reality testing elements build from there, providing teens with new skills to cope with painful circumstances and past stressors while also being able to separate what is happening from their perception of what is happening.  In their individual sessions, they gain a better understanding of themselves and their emotions and learn new skills for challenging and changing their behavior.  Group sessions provide an opportunity to practice the skills they have learned with their peers and improve their interpersonal skills.  Lastly, the assertiveness training gives them a framework for using the things they have learned out in the world.   When you combine all the skills, strategies, techniques, and tools together, clients get the attention they need to work through complex emotional issues while also building a solid skill set that will enable them to self-manage.  This comprehensive approach is what makes DBT so successful at treating maladaptive behaviors like cutting, self-harm, and suicidal tendencies.

DBT helps because it enables teens to develop a more balanced approach to their lives.  For teens that feel overwhelmed or out of control emotionally, this type of program can provide a sense of regaining some control.   By enabling teens to replace unhealthy behaviors with higher distress tolerance and more appropriate coping mechanisms, it enables them to become better self managers now and as they move into the future.  It is most effective at treating teens with the following problems:

If you have a teenager who is experiencing any of these problems, participation in a DBT program may offer real and lasting benefits by providing your teenager with a safe space to work through their emotions and a new set of skills.

Family Counseling Provides a Foundation

Kids from military families enjoy Teen Wildern...

Even though one person in the family may be struggling with a disorder, the whole family is affected and must work together towards health. (Photo credit: Virginia Guard Public Affairs)

When we first work with a new client, one of our goals is to find the right program to help that person overcome whatever obstacles they are facing.  In many cases, our work with teenagers leads to a recommendation that some form of family counseling be incorporated into the program.  When this recommendation is made, one of the most common questions other family members have is why they need to participate when they are not the one with the problem.  This is completely understandable, especially in circumstances where the client’s problems have already caused hardship or dysfunction within the family.  Siblings and even parents can struggle to understand why they have to disrupt their lives when they are not the one causing or having the problem in the first place.

We find that in families where this happens, where there is ambivalence or animosity towards the client by other family members, family counseling is almost always needed.  To understand why it is so crucial, it helps to understand what family counseling can do for families, even when they are not in crisis.  The simple fact is that all the members in the family are responsible for creating the dynamic within the family and when one of those members is dysfunctional, the family dynamic will most likely be too.  Teens who are victims of abuse, neglect, or trauma may be experiencing symptoms that impact the family.  Mental health conditions and eating disorders may only be experienced by one person, but they effect the whole family.  Regardless of where the dysfunction originates, the family is being affected and in order to repair the dysfunction, the family has to work together.

To illustrate this point, let’s look at a tale of two teenagers.  One is a popular, athletic, friendly senior who is on the wrestling team and appears to be heading toward a bright future.  The other is a nice, pretty, well-liked freshman with perfect grades and a penchant for science.  On the surface, these two teens seem to be well-adjusted and highly functional.  But follow them home and you will find that the senior boy is struggling with an eating disorder.  His obsession with his weight causes strife within the family around meal-times.  He works out for hours each day and suffers from mood swings.  At school, he can put up a front but at home he can’t.  His sister resents him because his obsession and subsequent obsession means he gets more attention from their parents.  His behaviors impact almost every interaction between all the family members.  She is also stressed out underneath because she feels like she has to keep his secret at school and that is very wearing.  Even though he is the one with the eating disorder, everyone in the family is being affected which means everyone needs to participate in order to overcome the current challenges.

Family counseling provides the foundation on which successful recoveries from eating disorders, substance abuse problems, and other dysfunction corrections happen.  Families and individuals are the most successful when the members of the unit pull together to solve their common problems regardless of where those problems are coming from.  This is why it is so critical for all family members to participate when this kind of therapy is recommended as part of a client’s program.

What is IOP?

Teen Advisory Committee-13

Doorways Arizona currently offers two ongoing IOP groups. (Photo credit: Vancouver Public Library)

To most people, there are two kinds of mental health treatment. First, there is inpatient treatment where you live at a facility for weeks to months and which includes treatment for chronic issues or addictions and secondly, Outpatient treatment, which is meeting with a group or an individual provider, typically once a week. Here at Doorways, we understand that there are times where adolescents and young adults need more than a weekly one on one with a therapist or other provider, but who don’t need to be in an inpatient program.  In an effort to fill this need, we developed an adolescent and young adult-specific Intensive Outpatient Program (IOP) that target specific disorders.

IOPs meet several times over the course of a week and participants are part of several different kinds of therapy each day.  These programs enable us to provide more comprehensive treatment options in the specific areas where a more intensive experience is warranted.

Doorways currently offers two ongoing IOP groups, the Young Adult Trauma IOP and the Adolescent Eating Disorder IOP.  These specialty groups each meet three days a week and have rolling, open enrollment.

The Young Adult Trauma IOP is for those ages 17-25.  The program requires 10 hours a week spread over a three day period.  Each week, attendees participate in the following different types of therapy and group sessions.

  • Art Group – These groups are designed to enhance and reinforce positive emotion.  Participation helps promote peace and calm.
  • Process Group – These groups help participants practice identifying and expressing emotions, learning to let go of shame, and how to build relationships with interpersonal skills.  By sharing their experiences, participants grow and learn to trust others.
  • Yoga and Mindfulness – This group uses yoga and mindfulness practice to increase participants’ awareness of thoughts, feelings, urges, and actions in an observational and non-judgmental way.
  • DBT Skills Group – These groups use the concepts and theories from Dialectical Behavior Therapy to help participants develop effective life coping skills.
  • Skills Card Process Group – This group expands on the skills learned in the DBT Skills Groups and helps participants learn to process thoughts, emotions, feelings, self destructive behaviors, and urges.  The emphasis is to put the skills, learned in the DBT Skills Groups, into practice.
  • Voice, Power, & Trust Group – This group provides participants with a place to tell their story in a safe space and is designed to help trauma victims recover their voice and learn to trust again.
  • Trauma Theory – This session combines psychoeducation and processing in an effort to explore a model of trauma and how it is manifested in adulthood.

The Adolescent Eating Disorders IOP is for those ages 13-18.  The program requires 13 hours a week spread over a three day period.  Each week, attendees participate in a variety of therapy and group sessions.  In addition to the Process Group, Yoga/Mindfulness Group, and DBT Skills Group outlined above, this IOP also includes the following:

  • Group Meals – Each meal or snack is an Exposure with Response Prevention (ERP) session supervised by a dietician or therapist.  ERP is a premiere method of learning to tolerate the kind of anxiety often experienced with eating disorders.
  • Nutrition Group – This group’s focus is promoting a healthy, balanced approach to eating that is supported by the latest research and is taught by a registered dietician with years of experience treating children and adolescents with eating disorders.
  • Body Image Group – This group provides participants with a place to tell their story in a safe space and is designed to help those with eating disorders recover their voice.
  • CRT Group – Cognitive Remediation Therapy (CRT) is on the cutting edge of eating disorder treatment.
  • Parent Group – The goal of this group is to give parents and guardians the necessary information to assist in their loved one’s recovery process.  This group is for parents and guardians only.
  • Parent Update – The focus of this group will be to discuss client progress, barriers, obstacles, concerns, and expectations for the weekend while establishing the type of structure that is conducive to the recovery process.

What is Dialectical Behavior Therapy (DBT)?

When most of us think of therapy, we picture a scene similar to the one most commonly portrayed on TV.  There is a wood paneled office featuring a therapist in a chair and a patient on a couch.  In reality, therapy can look very different depending on the kind of therapy that is going on.  There are several types of therapy that can be very beneficial in helping teens overcome their mental health challenges.  DBT, which stands for Dialectical Behavior Therapy, is a specific kind of therapy that can be very beneficial for a variety of issues.

DBT was originally developed as a treatment for borderline personality disorder (BPD).  DBT combines several different therapeutic approaches in an effort to help participants develop more comprehensive and extensive coping mechanisms.  This approach uses individual cognitive behavioral therapy techniques, mindfulness, reality testing, distress tolerance, assertiveness training, and group sessions to facilitate modifications in behavior.

A foundational part of DBT is building a relationship between the mental health practitioner and the teen that focuses on creating an alliance rather than making enemies or acting adversarial.   By offering validation and acceptance, the mental health practitioner creates a safe space for the teenager to express feelings that can then be redirected into healthy behavior changes.

DBT incorporates both individual therapy sessions and group sessions.    This two-pronged approach is part of the reason DBT can be so successful.  The group sessions give teens the skills they need to overcome challenges like regulating emotions, practicing mindfulness, increasing effectiveness, and tolerating distress.   Interacting with others their age also gives them the opportunity to practice utilizing these skills with their peers.  The individual sessions provide time to deal with emotional issues in a one-on-one setting.  By incorporating both types of therapy, DBT ensures that teenagers get the individual attention they need while they build and practice the skills they need to self-manage.

Across the different approaches to therapy, DBT is the approach that puts the most focus on developing coping skills.   DBT has been used for 40 years and in the last decade has become an integral part of most, successful eating disorder treatment programs.   DBT breaks the teen’s life up into four main areas, relationships, thoughts, feelings and behaviors.   Because all of these areas are typically deregulated during the course of the illness, DBT is tailor-made for treating eating disorders.

In addition to helping those dealing with eating disorders, DBT can also help teenagers who are engaging in self-harm and struggling with suicidal thoughts.  This approach helps teens develop the skills they need to regulate their emotions, control their behavior, and become more resilient when faced with difficult situations.   The benefit of taking DBT approach is that troubled teens can get the help they need to overcome maladaptive behaviors.

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Phoenix Teen Counseling: Mental Health 101: Teen Troubles

The teenage years can be troublesome and traumatic.  Faced with a myriad of pressures from every direction, teenagers often feel that they need twist and morph themselves into someone else in order to fit into other people’s molds.  This is made more difficult because they are only beginning to discover who they are and what they want.   They feel pressured to look a certain way, get good grades, fit in with friends, make the team, get the part, and be popular and sometimes that pressure can be too much.  Teens also have to deal with other issues like family financial problems, divorce, and illness.  Although the majority of teenagers make it through these tumultuous times to become well-adjusted adults, some teens struggle enough that they need professional help.

For parents, understanding when a teenager’s behavior is normal teen angst and when it is not is one of the biggest challenges.  In order to get teens the help they need to successfully navigate whatever challenges they are facing, parents need to know what to look for, what to expect, and when to seek help.  Here is a list of the most common mental health issues teens experience to help parents know when it’s time to seek outside help.

Mood Disorders

Bipolar Disorder – A teen with bipolar disorder has periods of mania and periods of depression.  When they are in a manic period, they may be extremely happy, hyperactive, and/or irritated.  They get by on very little sleep, get involved in multiple projects and activities, and may participate in risky behavior.  When they are in a depressive period, they display the signs of depression.

Depression – When teens are clinically depressed, they experience feelings of sadness and irritability along with several other symptoms that can include changes in appetite or sleep, rapid weight loss or gain, fatigue, loss of interest in previously enjoyable activities, problems concentrating, feeling hopeless, and suicidal thoughts.

Anxiety Disorders

General Anxiety Disorder – Feelings of anxiety are common in teens, but in some cases these feelings can rise to the level of a disorder.  Teens may worry excessively about situations, events, or activities to the extent that it interferes with their normal life.  Symptoms include feeling restless, having trouble sleeping, being irritable, and being unwilling or unable to participate in everyday activities.

Obsessive-Compulsive Disorder (OCD) – Teenagers dealing with OCD have distressing thoughts or impulses that occur over and over and repetitive behavior patterns like hand washing, counting, and hoarding that interrupt their ability to live their life normally.

Eating Disorders

Anorexia Nervosa – Teens with anorexia nervosa do not eat enough to maintain a healthy body weight.  Signs and symptoms include being significantly underweight, dry skin, low blood pressure, depression, moodiness, and unwillingness to eat around others.

Bulimia – Teens with bulimia participate in a cycle of bingeing and purging, eating a large amount of high calorie food and then inducing vomiting.  Bulimics may also use laxatives, exercise, diuretics, and diet pills to prevent weight gain.  Signs of bulimia include obsessing over weight, exercising hours at a time, eating in secret, spending time in the bathroom directly after eating, and low self esteem.

Trauma and Abuse

Teens who have been physically, emotionally, or sexually abused or who have lived through a traumatic event may need assistance to overcome the lasting damage these circumstances can cause.  Teens may experience Post-Traumatic Stress Disorder (PTSD), anxiety, depression, substance abuse, suicidal tendencies, and self harm.

Suicidal Tendencies

According to the American Academy of Child & Adolescent Psychiatry, suicide is the third leading cause of death amongst teenagers.  Warning signs include depression, frequent thoughts of and conversation about death, substance abuse, previous attempts, and traumatic events.

How is Faith Based Counseling Different?

Faith Based CounselingWhat type of counseling is right for your teen? (Image via Wikipedia)

For parents who are looking for someone to help their child through a difficult time, the world of mental health can be very confusing.  Within the sphere of mental health services there are psychologists, psychiatrists, therapists, counselors, nurse practitioners, and social workers.  It can be a struggle to determine which type of mental health practitioner is the right type to provide the assistance your child needs.  Additionally, there are specialties within this sphere that can muddy the waters even more.

There is an easy way, however, to know who to turn to when your adolescent needs help.  It comes down to three things.  First, you need to choose someone who is a licensed and trained to assist people with mental health issues.  Second, you need to choose a practitioner that specializes in working with children, teens, and their families.  Third, you need someone who your child can connect with, someone they are comfortable with, and someone with whom they can develop a rapport.

This third element is why you may decide to pursue faith-based counseling.  Shared faith and beliefs can provide a foundation for the connection and rapport that can make all the difference in managing mental health.   Additionally, adolescence is one of the first times in life that people begin to question the beliefs that were handed down to them from their parents in an effort to establish themselves as a separate being.  Religious beliefs are one of these handed down belief systems that may be called into question and having a counselor to talk to who shares those beliefs can make this process less tumultuous.

Faith-based counseling can also be very beneficial for those families and teens that have a strong religious belief and practice.  For these families, their beliefs are so foundational to who they are and how their children are raised that it is critical to have a mental health practitioner who understands not only their faith but how integral that faith is to who they are and how they were raised.  Families and teens can seek the mental health services they need without feeling as though they need to disregard or defend their beliefs.

Some faith-based counseling programs and counselors approach treatment holistically and look to integrate the mental, relational, emotional, and spiritual aspects of care to help the whole person.  Faith-based mental health practitioners may combine faith, spirituality, theological concepts into the traditional therapeutic process.  This approach to mental health management believes that treating these types of problems works best when faith and modern science combine to treat the whole person.

If you feel this is the best approach for your family, make sure you look for faith-based practitioners who also meet the first two qualifications above.  They must be a licensed mental health practitioner and specialize in working with children, teens, and families.  Mental health problems can be very serious and it is crucial that the person you trust with your adolescent’s well-being is trained in treating mental health issues first and foremost.

Common Types of Psychotherapy

For parents new to the world of mental health, the different types of practitioners and the different therapeutic techniques can seem overwhelming.  The good news is that you don’t have to know all the answers in order to find a mental health professional that can help your child.  However, it is helpful to have a basic understanding of the most common types of psychotherapy in use today so that you can feel like you are making an informed decision.  To help you with that understanding, here are the basic definitions of the most common types of psychotherapy.

Cognitive-Behavioral Therapy

One of the most common types of psychotherapy in use today, Cognitive Behavioral Therapy is often combined with other techniques and methodologies to provide the most comprehensive treatment for a client.  In essence, the cognitive-behavioral approach to mental health rests on the idea that children learn what they live.  The environment a person is raised in, the circumstances of their upbringing, and the major events of their childhood and adolescence play a large role in who they become.  If a child is raised by parents that don’t express their emotions in a healthy manner, the child will mimic this dysfunctional response and may struggle to identify and express their own emotions.   Cognitive-Behavioral therapy (CBT) works to replace those dysfunctional thought patterns, responses, and behaviors by introducing healthy alternatives and reinforcing the change through positive experiences.  As the problems each client is facing are different, the techniques, tools, and strategies used in CBT can vary and are generally specific to the needs of the individual client.

Behavioral Therapy

Behavioral therapy is also based around behavior but differs in that it seeks to use changes in behavior to change thought patterns and emotional responses.   This approach to psychotherapy is very structured and includes techniques like self-monitoring, role playing, and behavior modification.

Dialectical Behavior Therapy 

This type of psychotherapy combines cognitive-behavioral techniques geared at learning to regulate emotions and learn to identify reality versus perceptions with practices like mindfulness, acceptance, and distress tolerance.  It was primarily developed as a way to treat people with borderline personality disorder (BPD) and is the first therapy to prove effective in helping those with BPD.  It also shows promise in helping those with spectrum mood disorders like self injury and can an effective approach for treating teens who exhibit cutting behaviors.

Humanistic Therapy

The Humanistic Therapy method of treating those with mental health concerns takes a very different approach than the behavior-based methodologies.  It centers on the concept of self-actualization and the idea that people are responsible for their own choices.  This means that childhood experiences, learned behaviors, and any resulting dysfunction are irrelevant, what matters is taking responsibility for the thoughts, feelings, and behaviors experienced.   Therapy may focus on major internal conflicts like acceptance, authenticity, and individualism.

Psychodynamic/Psychoanalytical Therapy

This is one of the oldest schools of thought around treating mental health concerns and centers on how someone’s childhood, upbringing, and parental relationships are impacting their current lives.  Although psychodynamic analysis may be part of a mental health professionals approach to treatment, it is not generally the only tool in their toolbox.

It is important to remember that these are not the only types or techniques used by mental health practitioners.  There are many other approaches and methods that are valid and proven to help those in need.  The most important factor in getting your child the help they need is to find a mental health professional that your child is comfortable with and partner with them to find the right approach for your child’s needs.

Finding Help for Your Teen

You know your teenager is struggling and for whatever reason, you don’t seem to be able to help.  You know you need to find a mental health professional that has the right skills and experience to provide the support and assistance your teen needs.  You know you would do anything to help them find their way through the trials and tribulations of being a teenager.  What you don’t know, is how to get your teen the help he or she needs in order to overcome their obstacles.

There are several factors you need to consider when looking for a therapist, counselor, or other mental health professional to work with your child.  In order to develop a short list of people who might be a good fit for your teen, follow these steps.

1.     Know What You Need

If you are looking for someone to help your teen, odds are you will want someone who specializes in or has experience with working with teenagers.  While this isn’t the most important factor in selecting a professional, it is a good starting place to create a list of candidates.  If your child has a very specific need like treatment for an eating disorder or help with a mental illness like bipolar or depression, you may want to target professionals that specialize in helping with that issue.

2.     Consider Comfort Levels

In order to find the best fit for your teen, you need to consider the type of person they are going to be most comfortable working with.  Do you need a male or a female?  Do you need someone older or younger?  Do you need someone who is more authoritarian and commanding or flexible and fluid?  Look at the type of teachers, coaches, and other non-parent adults that your child has a good connection with for clues about what kind of counselor will be a good fit for them.

3.     Ask for Referrals.

Your teen’s medical provider is a good place to start as many family practice providers and pediatricians have experience working with the local mental health professionals and can recommend those they think would be a good fit for your child.  You can also reach out to other parents, friends, and even coworkers for referrals.

4.     Schedule a Session.

Once you have a list, call each person on it to see if you can come in and talk to them and get a feel for whether or not they will be a good fit for what your teenager needs.   Some professionals provide a brief free consultation for this purpose while others charge a fee for this initial visit.  Use this time to find out about their education, certifications, experience, philosophy, and expertise.  You will also want to determine if their services are covered by your health insurance plan.

Following these steps will make it easier to find a mental health professional that is a good fit for your teen.  The most important factors in choosing a mental health professional for your teenager are how comfortable your teen is with the person and how well they can connect with each other.

Onsite Counseling and Nutritional Services

Doorways is available by contract  to provide confidential, professional, onsite counseling (counceling) services to schools and universities, community organizations, associations and more. Onsite services offered include counseling for:

  • Substance Abuse
  • Domestic Violence
  • Grief & Loss
  • ADHD
  • Anger Issues
  • Sexual Abuse & Trauma
  • Eating Disorders
  • Stress Management
  • Bullying Workshops and Seminars
  • Suicide Prevention Workshops
  • Communication with Teens
  • Alcohol and Drug Abuse Prevention
A dietitian is available to go to your site to provide nutritional advice for:
  • Athletes
  • Vegetarians
  • Internationals confused about American food
  • Allergy sufferers
  • Disordered eating or eating disorder awareness
  • Weight management, how to lose or gain weight
  • Diabetes, and other medical conditions
Workshops are also available on topics such as hydration, how to eat healthy in the cafeteria, snack ideas, how to avoid the freshman 15 and more.
Other counseling and nutritional services are offered off-site at Doorways, LLC for teens and young adults. Cost for offsite services vary.  Please contact Doorways for more information about counseling for teens and young adults-ages 13-25.  Additional services offered at Doorways include:
  • Psychiatric Evaluations
  • Family Counseling
  • DBT Skills Groups
  • Medication Management

For more information about onsite counseling services for your school, university, business, or organization contact Doorways at 602-997-2880.