Implementing Dialectical Behavior Therapy With Adolescents and Their Families in a Community Outpatient Clinic

Dialectical behavior therapy (DBT), an empirically supported treatment for adult women diagnosed with borderline personality disorder (BPD), has been increasingly adapted for use with adolescents across a variety of settings. This article describes a community-based application of DBT principles and strategies for adolescents and their families. It is the first study of DBT with suicidal and self-injuring adolescents to provide parent as well as adolescent reports of change. Uncontrolled pre- to posttreatment effects ranged from d = .62 to .94 for adolescent-reported depressive symptoms, anger, dissociative symptoms, overall symptoms and functional difficulties, and items on which adolescents reported wanting to hurt or kill themselves. Not only did parents report similar changes (d = .55 to .65) in adolescent internalizing, externalizing, and total problem behaviors, they reported a large change (d = .72) in their own depressive symptoms as well. The consistency of these effects with those of other preliminary studies of adolescent DBT suggests that this model is indeed feasible within a naturalistic community treatment setting and may have benefits for families as well as adolescents.