Dialectial Behavior Therapy (DBT)
Individual DBT Skills training is provided to children, adolescents, and parents:
Dr. Spector was a member of the second cohort of the Marsha Linehan Behavioral Tech's Intensive Training for Independent Practitioners in Dialectical Behavior Therapy.
Dr. Spector completed a two year intensive program in Dialectical Behavior Therapy (www.behavioraltech.org) in October, 2015. She provides Dialectical Behavior Therapy Skills Training to children (ages seven and older), adolescents, adults, and parents, and incorporates teaching DBT skills in her work with all patients. In addition, Dr. Spector currently collaborates with the Intensive Outpatient Program (IOP) at Silver Hill Hospital in New Canaan, CT and provides individual DBT to adolescents who are participating in the program. She also provides supplemental skills training to individuals who are receiving psychological or psychiatric treatment with other practitioners.
According to Behavioral Tech the modules include:
- Mindfulness: the practice of being fully aware and present in this one moment
- Distress Tolerance: how to tolerate pain in difficult situations, not change it
- Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
- Emotion Regulation: how to change emotions that you want to change
Dr. Spector teaches the DBT skills of Interpersonal Effectiveness, Emotion Regulation, Walking the Middle Path (designed for adolescents and families), Mindfulness, and Distress Tolerance. Skills are taught individually to children, adolescents, and parents. Telephone coaching is provided as needed. Parents are taught how to practice skills with their child or adolescent. Parents participate in sessions or parts of sessions with their child. Dr. Spector, as a child clinical psychologist, teaches the skills to children as young as age 7. Current DBT research which is ongoing at Columbia University is working on how to modify the skills for young children.
According to Rathus and Miller, “Emotional and behavioral dysregulation often contribute to an adolescent’s difficulties in establishing a stable sense of self and forming fulfilling and stable relationships with peers and family members. Furthermore, problematic impulsive or avoidant behavior is often a consequence of emotion dysregulation or an effort to re-regulate. The five sets of skills directly correspond to the five major problems that are associated with emotional dysregulation in adolescents. Mindfulness skills help adolescents increase their self-awareness and attentional control while reducing suffering and increasing pleasure; distress tolerance skills offer tools to reduce impulsivity and accept reality as it is; emotion regulation skills help increase positive emotions and reduce negative emotions; interpersonal effectiveness skills help adolescents improve and maintain peer and family relationships and build self-respect; and walking the middle path skills teach methods for reducing family conflict by teaching validation, behavior change principles and dialectal thinking and acting”.
Rathus and Miller explain that “DBT skills can be applied broadly to middle school, high school, and early college-age youth with normal moodiness, occasional relational difficulties, and perhaps experimentation with at risk behaviors. Many normal adolescents exhibit some degree of emotional dysregulation, and training in DBT skills, by itself, may benefit these teens. Secondary prevention programs are intended to protect against the full blossoming of mental health disorders for at-risk individuals characterized by mild or early indicators of mental health needs (e.g., school difficulties, attentional problems, sad or anxious mood, family conflict). When problem behaviors show up on a teen’s diary card, the individual DBT therapist conducts what we term behavioral chain and solution analyses with the teen. This process identifies places in the behavioral sequence where skills can be used to replace the problem behaviors. Teens are encouraged to call their individual DBT therapists for intersession telephone coaching of skills to interrupt their impulse to engage in problem behaviors.”