Using Dialectical Behavior Therapy with Suicidal Adolescents

Troubled teen cutting

Description and Purpose of DBT

Dialectical Behavior Therapy (DBT) is a multi-modality, evidence-based treatment created by Marsha Linehan (1993) to treat individuals suffering from Borderline Personality Disorder (BPD). This particular personality disorder is characterized by challenges with emotional regulation, resulting in chronically strained interpersonal and familial relationships and a weakened identity with incredibly vulnerable self-esteem. The severely painful emotions experienced by an individual with BPD often translate into maladaptive behaviors, such as repeated suicidal ideations and non-suicidal self-injury. DBT was designed specifically to address the unique and challenging needs specific to this population through an intensive treatment program focused not solely on change in cognition and behaviors, but also simultaneously on acceptance and mindfulness. The seemingly paradoxical relationship between the aforementioned components (change and acceptance) is integral to treatment. Clients are taught the nature of a dialectical perspective, or that “reality is an interrelated system comprised of internal opposing forces that are in a continuous state of change because of the inherent tensions of reality” (Klein & Miller, 2011, p.206). DBT calls for empathetic understanding and communication about patients’ maladaptive behaviors and psychoeducation about the interrelated relationship between a person and his/her environment.


DBT’s Focus on Critical Skills

The DBT treatment model includes a one-year long commitment of weekly individual sessions and group skills-based sessions. In group session, five sets of skills are covered: core mindfulness, interpersonal effectiveness, emotion regulation, distress tolerance, and Walking the Middle Path (an exercise to practice seeing reality in balance of oppositional tensions). Additionally, frequent contact between therapist and client is encouraged to support patients through emotionally intense experiences and allow time to address any therapeutic issues between therapist and client. The clinical treatment team also commits to weekly sessions to troubleshoot clinical issues and suicidality and to ensure professional support for clinicians. 


DBT Adapted for Adolescents

Linehan’s original DBT model was subsequently adapted by a team composed of Miller, Rathus, & Linehan (1997) for use among adolescents. To this purpose, a few modifications were made to account for differences in development and context. Treatment length was decreased from a one year commitment to 4 months, and family members were included in weekly skill coaching appointments, phone calls, and full family sessions as needed. DBT, whether in treatment of adults or adolescents, requires “a collaborative, nonjudgmental approach to improve patient motivation to change, enhance patient capabilities, promote generalization of new behaviors, structure the environment, and enhance therapist capability and motivation” (Klein & Miller, 2011, p. 208).


DBT Treatment Stages

There are four stages of treatment in DBT, prioritized by severity of symptom and level of immediate danger to an individual’s safety. In this vein, stage 1 aims to address suicidal behaviors and non-suicidal self injury. Target behaviors are addressed to decrease life-threatening, therapy-interfering, and quality of life interfering behaviors. Stage 2 aims to decrease posttraumatic stress and aid clients in emotionally processing historical events; whereas stage 3 is geared toward increasing self-respect and creating a path forward toward goal achievement. Finally, stage 4 aims to assist clients in developing a sound sense of self, with capacity for joy and peace (Klein & Miller, 2011).


The Promise of DBT with Adolescent Populations

Klein & Miller (2011) cite literature reviews that demonstrate DBT is a promising treatment for adolescents with a range of clinical issues, including suicidal ideation and non-suicidal self-injury associated with BPD, bipolar disorder, eating disorders, and other problematic behavioral externalizations. Rathus et al. (1997) conducted studies that showed significantly fewer psychiatric hospitalizations in adolescents after DBT treatment and higher treatment completion rates than peers undergoing other treatments. Klein & Miller (2011), the researchers who compiled the literature review and described the foundation of DBT in this article, urge researchers to continue to study the effects of DBT on adolescents and to refine the intervention through increased understanding of its results and continued intensive training of clinicians preparing to work with this high-risk population.


DBT Skills Group offered in New York

New York Behavioral Health does have a new DBT Skills Group starting.  If learning mindfulness, emotion regulation, interpersonal efectiveness, and distress tolerance could help you or someone you know, please feel free to call us or click the link below for more informaiton about the leader and the group.


Click this link:

DBT Skills Group in NYC




Klein, D., & Miller, A. (2011). Dialectical behavior therapy for suicidal adolescents with borderline personality disorder. Child & Adolescent Psychiatric Clinics of North America, 20, 205-216.


Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.


Miller, A., Rathus, J., & Linehan, M. (1997). Dialectical behavior therapy adapted for suicidal adolescents. Journal of Practical Psychiatry & Behavioral Health, 3(2), 67-95.

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