Supporting Parents in Adolescents’ DBT Treatment

The support and understanding of parents if often vital to successful Dialectical Behavioral Therapy (DBT) treatment for adolescents; however, parents (or parental figures) may feel a range of negative emotions surrounding the child and the therapeutic intervention, like shame, guilt, anger, or helplessness. Working with parents to create an open, compassionate environment where their feelings are validated helps ensure that everyone is focused on the recovery of the adolescent—and, by extension, the entire family.

If a parent brings an adolescent into therapy, he or she has already undoubtedly weathered years of intense emotions and the resulting maladaptive behaviors. Often, parents don’t know what to do or where to start because of the conflicting advice they have received from other practitioners, guidance counselors, or well-meaning family and friends. Because of the confusing, contradictory messages parents may be receiving, DBT practitioners need to be especially sensitive to the strong emotions that these parents may feel.

One of the most difficult things parents can experience when their children are undergoing DBT is the discomfort and fear associated with learning their own limits. Only the adolescent can choose to make the changes necessary for successful treatment. While letting go of the perceived responsibility to solve their children’s problems is difficult for parents to do, it will ultimately make the treatment more successful for both the patient and the parent.

Holding strategic family meetings in which a practitioner adapts emotion regulation skills for parents is one way to help mitigate anxiety, take parents’ perspective into account, and move toward treatment goals. Parents learn skills from the same five modules as the adolescents: mindfulness, the middle path, distress tolerance skills, emotion regulation, and interpersonal effectiveness. These meetings can be effective whether working with parents one-on-one or in larger, multifamily groups.

Pat Harvey and Britt Rathbone, authors of DBT for At-Risk Adolescents: A Pracitioner's Guide to Treating Challenging Behavior Problems, make the important point that practitioners should highly threat response. One of the most concerning and emotionally taxing things a parent can experience is a child’s threat of suicide or self-harm. Helping parents respond to threats, and taking into account the painful, conflicting emotions they may be feeling, allows them to minimize guilt so as to more effectively handle the situation at hand. A dialectic frequently at play in this situation is the tension between wanting to ensure the adolescent’s safety and recognizing that his or her behavior can’t be entirely controlled by the parent. The treatment provider can step in, providing guidance. In the meantime, Harvey and Rathbone emphasize the importance of parents’ creating as safe an environment as possible, remaining calm and validating, encouraging the use of DBT skills, ensuring the means of suicide or self-harm are inaccessible, and seeking medical or emergency help when necessary.