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Dialectical Behaviour Therapy with Suicidal Adolescents

Year: 2008
Type: book-review
Abstract: This textbook has been long anticipated by many clinicians who work with suicidal and self harming adolescents. The work of Marsha Linehan on Dialectical Behaviour Therapy (DBT) has been modified and used with adolescents for a number of years and has been based on some of the earlier publications of Miller and Rathus regarding DBT and suicidal adolescents. A summary textbook covering this area has been long overdue, but as the forward in this book by Charles Swenson suggests, the effort and time put into this book was an attempt to “get it right” as opposed to “getting it done fast”. This text provides an excellent review of the literature, as it stands, on effective treatments for suicidal adolescents. It then goes on to outline the various treatment stages, targets and strategies related to the application of DBT in this age group. For those less familiar with this treatment, DBT skills modules include addressing emotional regulation, interpersonal effectiveness, distress tolerance, “walking the middle path” and core mindfulness. DBT incorporates a “compassionate stance” by therapists using the biosocial theory related to borderline type features, focusing on validation and the application of a dialectical approach which, for example, incorporates “we are doing the best we can” (acceptance) with behaviourism (change). DBT functions and modes are described in length in chapter 4, including improving motivation for change via individual therapy and enhancing capabilities by skills training. The authors address the need to adapt DBT to the adolescent setting, including the involvement of family members in treatment. For the reader looking for concise information, the authors break it down using concise subheadings and summarize theory and information via figures and tables. Chapters 5 to 10 represent the core of the application of DBT in this age group including: addressing “dialectical dilemmas”, assessing adolescents for treatment feasibility, orienting adolescents and their families to this treatment and gaining commitment, using individual therapy with the adolescent, and utilizing family treatment in the application of DBT. Chapter 10 outlines the skills training used with youth and raises specific group strategies for managing concerns such as motivation and homework compliance. Chapter 11 reviews approaches to termination as well as evaluating progress. The final chapter discusses programmatic issues that may affect feasibility of the application of adolescent DBT, an important aspect to consider prior to undertaking such an endeavor. The core of this text, in this reviewer’s opinion, may well be in the two appendices. Practical aspects such as the use of mindfulness exercises (many examples are given), “lecture and discussion points” and handouts regarding the skills module “walking the middle path” are presented. Unfortunately, the handout section is not complete as it does not cover all six skills modules. In addition, those that are available may be less than adolescent friendly despite the attempts to modify language and simplify the presentation. The authors do acknowledge that other treatment teams have further modified these handouts to meet the needs of their own clinical setting from both what they have offered and what is available in the DBT manual for adults. While the information provided by this book is well written and of much use to clinicians, it is not in itself a fully practical manual for the application of DBT in adolescents. The results of any randomized trials of DBT in this age group are yet to be published along with an accompanying manual. Such work, as we all know, is painstaking and time consuming. This text represents a pioneering effort in this field and provides the reader with an excellent account of the theory and general application of DBT in suicidal youth.
Language: English
Field: Psychology
Open Access status: green
OpenAlex ID: W2339167012
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Cited by: 40
Related to: 10