Dialectical behavior therapy (DBT) is one of the best resources available to help teens learn how to regulate their emotions, cope with stressful situations, and maintain positive relationships with others.
If you notice your teen is struggling with controlling their emotions, reducing interpersonal conflict, or avoiding certain problematic behaviors, DBT can help them work through these problems.
How DBT works:
While DBT can work wonders for your teen, it is important to realize that this will take time. All of your teen’s concerns cannot be addressed within a single session, so therapists who practice this form of therapy have to decide which behaviors to target first.
In order to maximize success and make sure your teen is in a healthy place, DBT uses a hierarchy to organize treatment so that the most dangerous or unhealthy behaviors are the highest priority and are addressed before anything else.
There are three levels to this hierarchy: life-threatening behavior, therapy-interfering behavior, and quality-of-life-interfering behavior.
Life-threatening behavior
As its name suggests, life-threatening behaviors are any behaviors that contribute to or increase the immediate risk of suicide or death, like self-harm and suicidal ideation.
Although behaviors like drug use or alcohol use can lead to death, they are not considered life-threatening behaviors because they are not a clear and present danger to your teen’s life.
At the beginning of each therapy session, your teen will be asked if there is anything either currently happening or upcoming that might make them more likely to engage in any life-threatening behaviors. Your teen will also be asked to share the diary card where they have kept track of their urges, moods, and target symptoms throughout the week so their therapist can see if they mentioned or checked off any suicidal behavior or acts of self-harm.
This will give your teen the opportunity to share about these situations with their therapist so the two of them can work through them together during the session.
Prioritizing these behaviors is essential. The last thing any therapist wants is to spend the entire session discussing a minor situation or behavior that has a minimal impact on your teen’s quality of life, only to realize at the end of the session that they are having suicidal ideations, experiencing severe symptoms of PTSD, or some other major life event is happening that is causing them to contemplate taking their life or engaging in self-harm.
Therapy-interfering behavior
Therapy-interfering behaviors are any behaviors that get in the way of productive therapy sessions. This can include anything from arriving late to refusing to complete the DBT diary card to argumentative behavior during the session.
While these behaviors are not as serious as life-threatening behaviors, so they are not prioritized over situations and actions that pose an imminent threat, they are still important to address.
For example, if your teen is showing up late for a session without a diary card, and they are refusing to communicate with their therapist, it will be hard for the therapist to discuss any life-threatening behaviors that might be present or to work on any quality-of-life-interfering behaviors.
For this reason, therapy-interfering is prioritized right after life-threatening behaviors. When teens can nix the behaviors that are hindering their success with dialectical behavior therapy, they will be able to start making meaningful progress.
Quality-of-life-interfering behavior
Quality-of-life-interfering behaviors can include relationship issues, anxiety, school concerns, or any other issues that are having a negative impact on your teen.
While you may want your teen’s therapist to tackle these issues right away, it’s important to realize that since these concerns do not pose as great a threat as life-threatening behaviors, they will not be the therapist’s primary target when more serious concerns are present.
Once your teen’s therapist has determined that there are no life-threatening or therapy-interfering behaviors, they will start working on these quality-of-life-interfering behaviors with your teen.
By targeting the most severe, life-or-death behaviors first, DBT helps ensure that teens are getting the help they need to stay alive and reduce their risk of committing suicide or self-harm. This will allow them to be in a position where they can continue to receive therapy for other behaviors in future sessions.