DBT Treatment Assumptions for Teens in Group Skills Training

Dialectical behavior therapy (DBT) is an evidence-based therapeutic model originally developed by Dr. Marsha Linehan. She found that traditional cognitive behavioral therapies did not always help people who experienced chronic suicidal ideation or symptoms of borderline personality. Since then, DBT has been found to be effective with several other groups of people, including teenagers.

One component of DBT involves group skills training in addition to weekly individual counseling. In the group setting, people can learn and practice skills in a helpful and supportive environment, with active peer feedback. (Individual counseling can then focus on how a person is applying the skills to their own life, as well as process any concerns or issues that pop up over the course of the week.)

Positive Assumptions for Teens in DBT Group Skills Training

Many people know the playful phrase, “When you assume, you make an ass out of you and me.” Why is this? Because assumptions are unproven beliefs. If you assume wrongly, without taking the time to gather or confirm your assumptions with credible sources, it can hurt relationships. However, assumptions can benefit the therapeutic process when everyone agrees on the same positive assumptions.

The following are DBT’s Treatment Assumptions for Teens in a Skills Training Group. Agreeing to these assumptions is believed to be helpful for teens, their caregivers, and the skills trainers. The idea is to become more accepting, less judgmental, and to think and act more dialectically (one of the core concepts of DBT).

• Everyone in the group is doing the best they can. People are behaving, thinking, and emoting the best way they are capable at this time. It is hoped that, with time and practice, their “best” will improve.
• Everyone in the group wants to improve. People don’t want to stay feeling, behaving, or thinking the way they currently are. As humans, we are always striving to grow and develop in meaningful ways.
• Everyone needs to do better, and be more motivated to change. This assumption goes hand-in-hand with the first two assumptions. While people are doing the best they can and want to improve, they need to do (or behave) better and increase their motivation in order to make these changes.
• People may not have caused all of their problems, but they have to solve them anyway. The phrase “the best-laid plans oft go awry” applies here. If someone rear-ends your car, you may not have caused the accident or be considered “at fault,” but you still need to figure out how you are going to fix your car. The same concept applies to group members’ experiences. Note: For adolescents, given that they are underage, they may need to reach out to supportive adults to help solve problems that are beyond their control or ability to solve on their own.
• The lives of group members are painful as they are currently being lived. The average person experiences many challenges. However, if you consider the experiences that contributed to a group member being recommended and accepted to a DBT skills training group, it would be ridiculous not to consider that life may be extra hard and painful right now.
• Group members must learn and practice new behaviors in all important situations in their lives. It’s always awesome when a group member can master a skill in the therapy or group room. However, if you aren’t taking and using the skills all the other hours of the week you spend outside of these rooms, you aren’t getting the most bang for your buck. This means practicing and discussing your experience using these skills in daily life experiences.
• There is no absolute truth. This is a difficult concept to grasp and live. By valuing the validity of two viewpoints, even when they seem like polar opposites, people can learn to value and respect each other. This is a concept that is often further discussed and practiced when members learn more about how to think and act more dialectically.
• Teens and their family members cannot fail in DBT. This is a radical concept for some people. Often, people in therapy and their families are blamed for not being motivated enough, working hard enough, or trying hard enough. In DBT, blame is not effective (plus, you would never tell someone suffering from a broken bone that isn’t healing properly that they aren’t working hard enough to heal themselves). It may simply be time to consider a different course of treatment if things are not improving, just as an orthopedist may discuss a different treatment if a broken bone is not healing as expected.

If these assumptions make sense to you, and you are interested in enrolling yourself or your teen in DBT skills group therapy, I urge you to talk with your therapist or contact one about options in your community.

Reference:

Rathus, J. H., & Miller, A. L. (2015). DBT Skills Manual for Adolescents. New York, NY: Guilford Press.

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