By Debra Moreno Garcia, PhD, and Wilson Ho, MF, coauthors of The Dialectical Behavior Therapy Skills Workbook for Teens
In our ever-changing and dynamic world, one thing is for certain—today’s adolescents are in need of mental health support and guidance more than ever.
Our global society has created complex urban microsystems for adolescents entering their most critical phases of development within an ecological context rife with political turmoil, wars, climate-based travesties, institutional discriminatory practices, a global pandemic, economic scarcity, and fragmented family systems. In fact, today’s Generation Z adolescents are experiencing heightened levels of psychosocial stressors more so than any other generation in American history (APA, 2014).
To compound this issue, the typical Gen Z teen must cope with a series of developmental changes marked by uncertainty, tension, adversity, and emotional stress—all whilst managing complex familial expectations, self-pressure, academic demands, interpersonal conflict, prejudice, and inequality.
A teen population of particular concern are Black, Indigenous, People of Color (BIPOC ) adolescents who bear additional stress relating to structural racism, social-based discriminatory practices, microaggressions, and challenging environmental spaces such as inequitable community resources and opportunities. When one or more of these life complexities escalate, BIPOC adolescents begin to question their own mental health status, which causes them significant amounts of personal distress (Garcia et al., 2017, 2020).
Underrepresented and marginalized in clinical settings, BIPOC teens are expected to take on the added responsibility of culturally brokering their lived experiences with ethnically incongruent clinicians in a space that has stigmatized and/or invalidated their worldview.
The goal is to have culturally sensitive clinicians to merge modernist theories in a collaborative manner to cocreate a joint partnership with BIPOC adolescent mental health consumers. A therapeutic framework that could be used in mutual cooperation (and support elusive rapport with teens) in a clinical setting is dialectical behavior therapy (DBT), developed by Marsha Linehan in 1979.
Although DBT is not frequently used as a treatment protocol for teenagers, it may be especially useful in managing common teen challenges such as mood vacillations, interpersonal conflict, self-injurious behaviors, emotional dysregulation, and distress intolerance. BIPOC youth additionally suffer from race-based trauma, where internalization of negative biases and discrimination can lead to harmful psychological reactions. Research has shown that teens struggling with multiple symptoms along with treatment noncompliance will benefit from a DBT approach (Miller et al., 2007).
A central mechanism to DBT is dialectics—two positions in opposition to one another. In DBT, balancing opposing forces, thoughts, and emotions through synthesizing dualities is the holy grail to secure internal harmony. For many BIPOC teens fraught with internal confusion due to acculturation, inequity, and feelings of oppression in a dichotomous society of resources, the foundation of DBT is more than a promising technique. As a clinical tool for adolescents facing many life transitions, harsh societal structures, and emotional challenges, DBT may be particularly apt to improve BIPOC teen stress and mental health.
Furthermore, it’s encouraged that clinicians wrap their DBT program around the family system, where parents of color can learn the same skills as their teens, who may oftentimes feel isolated between two cultural worlds as the “identified patient.” Since the COVID-19 pandemic, minority youth have had to confront their mental health (Garcia et al., 2022, 2023) and have taken on the challenge of seeking services. BIPOC parental involvement in DBT can support familialism (priority of family) where parents can learn and model DBT skills in the home while maintaining cultural connections. Parents of color can improve their interactions; remove culture-based stigma relating to mental-health; and support full, family-based compliance into DBT treatment.
Clinicians using DBT can help their BIPOC teen mental health consumer change maladaptive behaviors, find emotional calm, and have flourishing relationships within the meaningful, cultural context in which they thrive. Let’s take a look at the four core DBT themes listed below:
● Emotion Regulation: DBT helps teens identify, understand, and manage heightened emotions to cope with daily stressors. However, clinicians must be in tune with the flavor of emotions that may be suited for various cultural contexts, e.g., a dramatic exasperation to express a healthy mood change.
● Interpersonal Effectiveness: Teens improve their relationships with friends, family, and other adults through effective communication and self-assertion to best resolve conflicts. Clinicians should consider patterns of cultural communication within BIPOC families.
● Distress Tolerance: DBT teaches coping mechanisms to handle distressing situations to promote resilience and manage unforeseen circumstances. For BIPOC youth, social inequality and injustices are prime for agitation. Clinicians should explore these issues so teens can learn adaptability and self-advocacy.
● Mindfulness: DBT supports teens to be keenly aware of their present state of being, which reduces stress and boosts mental well-being. Many religious and indigenous practices of BIPOC youth already incorporate elements of mindfulness. Use genuine curiosity to learn and support your BIPOC teens’ cultural practices that adhere to mindfulness.
So, what do you think? Can you incorporate DBT skills to a culturally and developmentally sensitive population? We encourage clinicians to continue their ride toward cultural competency. Our current Generation Z BIPOC youth depend on you for their mental health journey.
Debra Moreno Garcia, PhD, is a faculty member in the psychology department at California State University, Los Angeles; and has worked with children, adolescents, and their families for more than twenty-five years in clinical and research settings. Garcia’s adolescent stress and wellness research focuses on dimensions of adolescent stress, generational communication patterns, family well-being, and advocacy for healthy school climates. She also conducts psychometric research for the development of new stress measures and assessments authenticated by the voice of teens and college students. Garcia is a community leader, speaker, and advocate for healthy neighborhoods and infrastructure systems for marginalized youth with minority status.
Wilson Ho, MFT, is an associate marriage and family therapist working at Para Los Niños, a community mental health organization dedicated to helping marginalized community members navigate through mental health support; and providing therapeutic services to children, families, and adults. Ho and Debra Garcia’s research has helped promote advocacy and empowerment in amplifying the voices of teenagers, and establishing equality in parent-child relationships. Wilson is also part of the Los Angeles chapter of the California Association of Marriage and Family Therapists mentorship program, to share his experiences and support other marriage and family therapists.
Part 2: What to Do When a Client Is Participating in Self-Judgment?