Parent-teen dialectical behaviour therapy explained
There are many different approaches for psychotherapy that are effective treatments.
Dialectical behaviour therapy (DBT) is one, and it is different from other forms of therapy because it is skills-based with the goal of helping people to build a life worth living.
DBT assumes that people are doing the best they can in dealing with their life circum-stances, which may be very painful and difficult as they are currently being lived. It also assumes that people need to do better, try harder and be motivated to change by learning and practicing more positive and healthy coping skills.
These assumptions are at the heart of dialectics and are based on concepts written about in DBT Skills Manual for Adolescents. Dialectical means that two opposite ideas can be true at the same time, and when considered together can create a new truth and a new perspective or way of thinking about a situation. In DBT, we move away from “either/or” language to using “both / and” language. The core dialectic of DBT is about both acceptance and change. This treatment emphasizes both validation of our experiences of difficult emotions (i.e., acceptance) and at the same time, the need for replacing problem behaviours with skillful behaviours (i.e., change).
There are five skills training modules in the parent-teen version of this treatment that focus on increasing skills to change or reduce problem behaviours. The first four modules are the same in the therapy for adults. These skills are briefly described here:
- Mindfulness skills to improve self-awareness, focus and confusion about self, including not being aware of what you are feeling, why you get upset or why you have trouble staying focused;
- Emotion regulation skills to cope with emotional reactivity, emotional vulnerability, or intense and sudden mood changes with little control and/or a steady negative mood state like anger, anxiety or depression;
- Distress tolerance skills to decrease impulsive behaviours or acting without thinking things through as well as avoiding or escaping from difficult emotional experiences;
- Interpersonal effectiveness skills to improve interpersonal problems such as difficulties in keeping stable relationships, difficulties getting what you want, maintaining your self-respect and decreasing loneliness;
- Walking the middle path skills to work on teen and family challenges, including difficulty navigating family conflict, difficulties effectively influencing others’ behaviours as well as addressing extremes in thinking, feeling and acting and difficulties in perspective-taking.
One of the key concepts of the walking the middle path skills that I particularly appreciate is helping parents and teens see the “kernels of truth” in each other’s perspective. For example, parents and teens commonly argue about the hours spent on screens whether on social media or gaming and are often seemingly standing on either side of a canyon with opposing views.
One way to help build the bridge between the two sides of the canyon is for you, the parent, to consider why your teen spends so much time online – for example, is it to connect with friends, chat, get distracted, feel included, etc.? These are good questions to ask even if you see this behaviour, and validly so, as addictive and unhealthy for their mental well-being.
Likewise, teens can reflect on why their parents want them off their electronic devices. Perhaps among other reasons, par-ents are worried their teen is withdrawing from the family, ignoring their chores and responsibilities, and not studying enough to maintain their grades. That is the dialec-tic. These differing perspectives are both valid and true at the same time.
Finding your teen’s kernel of truth does not mean you agree with or approve of their point of view, and it does not mean that you need to give in to your teen’s demands. However, it does allow for improved communication, understanding and negotiation of differences.
Stephanie Margolese, Ph.D., is a clinical child and adolescent psychologist at the Jewish General Hospital and an associate member of the Department of Psychiatry at McGill University. She has written and collaborated on therapeutic resource books for young children.
