Child and Adolescent DBT

What Families Experience

Many of our most talented and gifted children and teens regularly encounter intense emotions and extreme thoughts.

While many people think of these issues as a curse, it is possible to harness and channel them in a way to create lifelong benefits. Once they learn how to manage their thoughts and emotions effectively, they can use these gifts to blossom into the best versions of themselves for the rest of their lives.

Intense emotions and thoughts can be very upsetting to experience and can even disrupt an otherwise “normal life.” These powerful states seem to descend on children and teens without warning and sometimes without an easily identifiable cause often at an early age. Emotional intensity can be confusing, isolating, and socially limiting for kids and teens during a critical time of social learning and personal development. A once happy child is now withdrawn, refuses to engage in previously normal activities, and may even have a new baseline of a low or even depressed mood whenever we see them.

Dr. Marsha Linehan, the founder of DBT, developed a list of common characteristics of emotional dysregulation in children and adolescents:

Mood Intensity – may exhibit angry/irritable moods and shifting moods
Temper Tantrums / Meltdowns – a full loss of control or meltdown (skills breakdown)
Verbally, Emotionally, or Physically Aggressive
Higher Chance of Self-Harm – may practice various forms of non-suicidal self-injury (NSSI) like cutting or burning or may even have suicidal ideation
Significant Interpersonal Issues – can experience difficulties interacting with family members, authority figures, and peers
Extreme Thinking Styles – all-or-nothing, black-and-white thinking, etc. are common
Need For Immediate Gratification – displayed a consistent low tolerance for delayed gratification
Resistance To Change – may have a low tolerance for change and transitions and become extremely upset when even minor life characteristics change
Distracted When Upset – when emotionally triggered, the child can have difficulty with concentration and rapidly shifting attention
Low Tolerance For Boredom – may become overly reliant on the environment to provide a sense of self and/or constant entertainment
Hyperactivity Depending on Mood
Regular Avoidance, Escaping, and Impulsive Behaviors
Prone To Reactivity – difficulty modulating emotions and action urges (i.e., thinking before we act)
Higher Likelihood of Sensory Processing Issues

Since many people view these strong reactions and intense emotions as “not normal,” they begin to redefine their self-image around self-doubt and shame and develop negative core beliefs. They often miss developing age appropriate psychological resources like effective coping skills or the ability to adapt and be effective in new situations. They may begin to refuse to engage with new or novel situations or require exceptional amounts of preparation to even leave the house.

When a setback or disappointment occurs, their mood can rapidly shift downward and lead to emotional shutdown or complete meltdown as a result that weary parents have sadly grown accustomed to handling to the best of their ability. Both parents and the child are left feeling helpless and lost in the wake of these explosions, and both parties often simply hope that it’s a phase and won’t become a permanent part of their lives. They may become increasingly avoidant of each other in an effort to survive the situation and hopefully not cause any more problems. Unfortunately without proper intervention, these emotional and behavioral patterns do not resolve on their own.

Understanding SuperSensors

A leading psychologist and DBT-C clinician, Dr Francheska Perepletchikova notes that many children with “big emotions” are born emotionally sensitive and are prone to overwhelming emotions throughout their development. However, children with big emotions can be incredibly compassionate, concerned for others, and are often gifted in reading other people’s reactions. They also tend to be gifted academically and are often creative. Dr. Perepletchikova calls these children SuperSensors, analogous to supertasters and super smellers, and their emotional sensitivity is referred to as a super ability.

She notes that “Using the term super sensor avoids pathologizing and helps children feel understood, validated and not judged, which decreases their self-critical thinking and increases their willingness and interest to learn what we term “super-skills” to help achieve control over their “super-abilities.”

DBT for Children and Adolescents equips child and adolescent super sensors with the super-skills they need to navigate the world.

Treading Water With Well Meaning Therapists

Many parents view their primary task as a problem solver for their child and their family with “What is the problem, here is the answer” becoming almost an automatic response over time. With an ever-changing emotional state in their child or teenager, they often feel that these are problems that cannot be solved or at least solved without help. Many families deal with these issues regularly for years before truly understanding what is happening to their child and often without seeking any professional help. If they do eventually seek professional help, they often turn to pediatricians, family doctors, or psychiatrists to help them find solutions. Medical professionals often make a referral to well-meaning mental health professionals who do their best to support or “talk out the problem” while waiting for medication to kick in and hopefully settle things down.

Unfortunately, many clinicians are no longer formally trained in their graduate studies in deep psychological theory and may not have sought out rigorous postgraduate training from a seasoned mental health practitioner or expert in the field. As a result, they tend to focus on short-term interventions or superficial therapies only. They may unintentionally neglect the basic issues in emotion regulation and coping mechanisms since they were likely not trained in these systems and do not know what they are looking at.

Almost every session is focused on the “crisis of the week” and only addresses immediate issues without addressing fundamental psychological architecture that likely causes them in the first place. While many clients may enjoy these sessions or find them helpful in some respects, the therapist acts solely as a “sounding board” in between psychological storm systems moving in and out of the client’s life. This form of counseling rarely leads to true growth for either the child or the family, and they may spend months or even years dependent on a counselor’s weekly routine without forward progress.

The Science of Change

Sadly, this classical form of counseling keeps families treading water week to week without knowing that psychological science has invented much more effective ways to handle these strong emotions and mental health issues before they arise. The child or teen does not learn what the real problem is and how to fix it on their own. They need to be shown how they can be proactive in handling their own thoughts and emotional reaction patterns more effectively and without necessarily needing help from someone else. No longer do they have to disrupt their lives to regulate negative thoughts and explosive emotions. However, insight and analysis alone does not create lasting change.

The science of change requires clearly defined steps to foster growth in clients. Simply giving a directive or command will not work. If they could “get control of themselves,” they simply would do it after so much suffering for months or even years. Psychological researchers now argue that the best way to achieve change, particularly for children and teens, requires defined, disciplined steps to get the child on their path moving forward. It requires both awareness and action.

How We Practice DBT for Children and Adolescents

DBT is a disciplined, evidence-based approach that builds emotion regulation and distress tolerance skills incrementally through a curriculum based structure coupled with individual therapy.

The skills sessions walk the child or teen through the emotional regulation skills skill-by-skill while their individual therapist coaches the child on how to implement and use these skills effectively out in the real world. Many therapeutic interventions and even DBT skills can fail if the client doesn’t understand how to practice, choose, and use a skill when things fall apart. Both the skills and therapy side work together to form the engine of change for your child.

We start with teaching kids and parents exactly what emotions are and how the child can learn to “ride the wave” of emotions without being pulled under and saturated by the emotional reaction. Once committed and enrolled in our DBT therapy program, parents and children are often amazed at how effective the approach is, especially if they have been in other counseling situations. The philosophy of DBT recognizes that the child is doing the best she can, with the current skills that they have. However, that doesn’t mean that they cannot do better if given the right tools and coaching.

Our DBT program for children and adolescents provide a clear path to emotion regulation including:

Initial identification of what the emotion is
How to discern similar emotions and emotional intensity
Choosing the skill to handle the emotion
Notating the effectiveness of the chosen skills on the diary card
An open forum to discuss skills one-on-one to ensure understanding and proper usage
Coaching and practice sessions for skills
Follow up sessions discussing real-world implementation based on diary cards
Identifying crises where skills interventions would have been helpful
How to use skills to regulate emotions more effectively in crisis situations
Learning how to increase self awareness for better application of skills
Transitioning skills from initial learning to mastery where effort is barely required
Applying the entire skills system of DBT every day
Utilizing skills to prepare for new and novel situations
Long term skills usage for transition into young adulthood and new challenges (e.g., college, moving away, starting a career, relationships, etc.)

Change Is Possible

In DBT, your child is going to learn that emotions are important, even when they are upsetting. Avoidance emboldens negative emotions, and we must be able to acknowledge our emotions without being hijacked by them. Emotions are sources of valuable information, and we must make peace with our feelings even when they don’t feel good.

Best of all, DBT restores a sense of hope and trust that a psychotherapy system can actually work and that change is possible. Parents and children no longer simply try to tolerate each other or endure a counseling process that is unending and does not produce measurable results. Since skills can be tracked and practiced, accountability for therapy progress is much easier to provide compared to traditional nondirective counseling.

Overview of DBT For Children and Adolescents

Think of DBT as having two overarching goals: 1.) to help your child learn how to handle negative emotions and thoughts skillfully and effectively and to make better decisions when dysregulated, and 2.) to create more positive states of being through better communication skills, improved methods of self-care, higher self-esteem, better boundary setting, more self-confidence and most of all, the confidence to modify and to create a brand new, improved way of relating to their emotions and thoughts.

DBT Skills classes work through four types of skills – Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. Broadly speaking, the Mindfulness and Distress Tolerance skill sections are classified as “Acceptance Skills,” and the Emotion Regulation and Interpersonal Effectiveness skills make up the “Change Skills.” Using Acceptance skills, we teach your child how to accept where they are currently in their life, the state of their thoughts and emotions, and the value and possibility that the present moment brings to their life – peace, joy, and a renewed perspective.

Change Skills teach your child how to be proactive in their experience rather than reacting to everything with extreme thoughts and emotions. Regularly being overwhelmed or constantly surrendering control to your emotions can be exhausting, and many children and teens fall into patterns of “learned helplessness” where they stop even trying to change things. Instead, they may simply try to survive their emotions. Change skills give them a new way to navigate life and usher in a brand new era of actively processing emotions, learning how to modify them, and fundamentally change our emotional minds.

GearingUp’s founders, Dr. Sylvia Gearing and Dr. Milt Gearing, have been pioneers in the field of teaching children and teens about emotions and how to change their response patterns. They have also completed Dr. Linehan’s Intensive Training Program in DBT years ago to further augment their skills in teaching coping skills to children and teens who are struggling with powerful feelings. Since the 1980’s, they have inherited thousands of cases from other well meaning mental health professionals where treatment has failed. All of these children, teens, and their families were welcomed to GearingUp with a renewed hope that their emotional reaction patterns will not only get better but stay better once they learn new skills. Our internal metrics and research show that over 90% of clients who complete six to twelve months of GearingUp’s prescribed treatment recommendations see significant and lasting results. At such a critical time of development, children and teens need a sense of self-efficacy and resilience that will enable them to develop and flourish into their adulthood.

If you are ready to get started and take the first step, please Contact Us today by calling our office, filling out a contact form, or through the chat window on this page. Our staff will follow up with you as soon as possible to schedule your first appointment.