Child DBT Program

What to expect in the Child DBT Program (Ages 8-11)

Assessment

At the outset of treatment, children and their caregivers have a 90-minute consultation with a DBT therapist. An important initial part of treatment is evaluating the “goodness of fit” between DBT and the child’s problems and treatment goals. To this end, we assess for the presence of the following 5 problem areas:

• Confusion about Self (including how one feels and thinks; as well as difficulty consistently maintaining attentional control)
• Impulsive Behavior
• Emotion Dysregulation
• Interpersonal Difficulties
• Child-Family Challenges

Pre-treatment

We have found that the use of special commitment strategies is very important in the pre-treatment assessment. That is, we ask children to commit to making certain behavioral changes even though they have not learned to master them. This is based on ample evidence suggesting that people are more likely to behave in a particular way if they agreed to do so beforehand. We also explain all aspects of treatment to the child and his or her parents, and anticipate and problem-solve any potential treatment barriers (e.g., not attending sessions, staying silent in sessions, feelings of hopelessness). We seek commitment not only from the child but also from the accompanying caregivers. The use of commitment strategies is crucial for children, given that many would not “choose” to be in therapy if given the option. It is for this reason that the individual DBT therapist spends time during the early phases of treatment using commitment strategies that aim to help the child understand the triggers of his/her behaviors, the consequences, both positive and negative, of their behaviors, and the implications for behavior change.

Treatment

In weekly individual therapy, DBT therapists will help the client to:

• Identify and maintain focus on the primary problems to be addressed
• Stay motivated to work hard in treatment and apply new skills in their daily lives
• Coordinate and consolidate the different parts of treatment and make sure it is all tailored for the particular child and family

In addition to individual therapy, the child and family participate in a weekly multi-family skills class. This class meets for 90 minutes in the evening for approximately 6 months and includes 3-5 children along with their caregiver(s). For the first half of the group session the children and caregivers will learn the DBT skills (described below) together. For the second half of the group session, the group will be divided into two smaller groups. The children will continue to practice the newly learned skills with one of the DBT skills trainers while parents learn specialized behavioral management strategies to effectively handle the children’s behavioral difficulties. The class is led by two skills trainers who combine lecture, discussion, and practice exercises in order to teach the following skill modules:

• Core mindfulness: teaches participants how to focus the mind, direct attention, and how to non judgmentally observe and describe what they are feeling and thinking in the moment. These skills can help build awareness of thoughts and emotions and reduce reactivity to painful thoughts and emotions.
• Distress tolerance: targets impulsivity by teaching how to effectively distract and soothe themselves while considering pros and cons of their actions. These skills typically replace problem behaviors such as leaving the classroom, oppositional and defiant behavior at home and/or at school, and emotional outbursts at home and/or school.
• Emotion regulation: addresses extreme emotional sensitivity, rapid mood changes, and other unregulated moods such as chronic depression, anxiety, or hostility. Examples of specific skills include learning to identify and label emotions, learning how to increase positive moods, and learning how to make yourself less vulnerable to negative moods.
• Interpersonal Effectiveness: addresses difficulties in maintaining consistent and rewarding relationships by teaching skills such as how to ask for what you want, how to say no in a gentle yet effective manner, and how to maintain your sense of self-respect and independence in the face of peer pressure.
• Walking the Middle Path: targets extreme, rigid, or non-balanced thinking and behaviors among children and their caregivers. These skills involve learning about common areas of conflict in relationships, and reducing the conflict by learning methods of behavior change as well as methods of validation and acceptance.

Telephone coaching with the therapist is designed to promote skills use where it matters most–in the real world. When clients feel “stuck” and unsure what to do, they are encouraged to contact their individual therapist for help in applying their newly learned DBT skills in “real time.” In addition, parents are able to contact one of the skills trainers for coaching in how to apply skills with their children.

Family therapy occurs on an as-needed basis to increase behavioral skill use within the family system, improve communication between family members, and to reduce family interactions that interfere with the child’s or their family’s quality of life.

Parents may also benefit from additional sessions with a parenting coach (who is typically one of the multi-family skills group leaders so the parents are already familiar with this person). The coach offers specialized parenting strategies to assist parents reaching their goals in a planful and proactive manner rather than relying on a reactive crisis-oriented approach.

All DBT therapists at CBC participate in a weekly, two-hour consultation meeting. The DBT treatment team meets weekly to assist each other in providing effective, efficient, and compassionate treatment. We spend time problem-solving difficulties that interfere with client progress in treatment and help keep each other practicing within a dialectical framework.