What is DBT for Children (DBT-C)?
Dialectical Behavior Therapy for Children aims to relieve presenting problems, as well as to reduce the risk of the associated psychopathology in the future by targeting both the relationship with the environment and the relationship with self (a major addition to the standard DBT model).
The relationship with the environment
DBT-C aims to stop the harmful transaction between a child and an environment and replace it with an adaptive pattern of responding. The relationship with an environment includes events that elicit, reinforce, punish and shape responses. On this level, DBT-C addresses symptoms, such as verbal and physical aggression, self-harm, suicidal ideation, drug and alcohol use, stealing, lying, sexual misconduct, etc.
To address these symptoms, DBT-C retains the theoretical model, principles, and therapeutic strategies of the standard DBT model. Further, it incorporates almost all of the adult DBT skills and didactics into the curriculum, including individual therapy, coping skills training, consultation team meeting for therapists, and phone coaching in between sessions. However, the presentation and packaging of the information are considerably different from DBT for adults and adolescents to accommodate for the developmental and cognitive levels of pre-adolescent children.
The relationship with the self
In DBT-C, the relationship with self includes vulnerabilities in the core senses of self-love, safety and belonging. On this level, DBT-C addresses problems from which the above-described symptoms may stem. Such problems may include self-hate, external locus of control (i.e., orientation to controlling others instead of oneself), and difficulties with establishing and maintaining relationships.
In DBT-C, the therapist assesses vulnerabilities by conducting a Core Problem Analysis (CPA) with children as well as parents and directly targets decreasing these vulnerabilities during and between sessions via CPA-specific interventions.
The Parental Component
To address difficulties in the relationship with self and with the environment, DBT-C includes an extensive parenting component to 1) educate parents on how to effectively address the child’s problematic responding and 2) increase their ability to implement learned strategies on a consistent basis. DBT-C teaches parents everything their child learns (e.g., coping skills, problem-solving, didactics on emotions, validation, CPA), plus effective contingency management techniques. DBT-C maintains that parental own emotional regulation, modeling of effective responses, daily practices of skills with a child, reinforcement, shaping, ignoring of maladaptive responses, validation, unconditional love and genuine acceptance of child’s maladaptive responses are key to achieving lasting changes in a child’s emotional and behavioral regulation.
In sum, DBT-C: 1) instructs parents how to create a validating and change ready environment; 2) prepares parents to become coaches for their child so as to promote adaptive responding during treatment and after the therapy is completed; 3) teaches parents and their children effective coping and problem-solving skills; 4) teaches parents and children how to identify functions of their responses and meanings they make about events; and 5) provides specific interventions to decrease vulnerabilities in the core senses of self-love, safety and belonging.