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Dialectical Behaviour Therapy (DBT): Teens & Families

What is Dialectical Behavioural Therapy (DBT)?

DBT is based on the theory of dialectics. As in accepting, integrating and finding a balance between opposites. The core dialectic in DBT is acceptance vs change. Dr. Marsha Linehan originally developed DBT in the late ‘80s as a treatment for borderline personality disorder. Since then, DBT has been used to treat various conditions and concerns.

  • Attention-deficit/hyperactivity disorder (ADHD)

  • Mood disorders (depression, anxiety, bipolar disorder)

  • Eating disorders

  • Obsessive-compulsive disorders (OCD)

  • Posttraumatic stress disorder (PTSD)

  • Substance use disorder

  • Self-harm

  • Suicidal behaviours

It is particularly effective in helping individuals who have difficulties managing intense emotions and impulsive thoughts and behaviours.

DBT focuses on mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness.

  • Mindfulness is learning to “live in the moment.” The ability to be present, mindful and accepting.

  • Distress tolerance is developing coping skills and resilience towards stress and crisis.

  • Emotional regulation is learning how to identify and manage emotions.

  • Interpersonal effectiveness is learning how to better communicate with others and maintaining healthy relationships.

How has DBT been adapted for teens?

Since the late 1990’s, Dr. Alec Miller and Dr. Jill Rathus worked on adapting DBT to be used with adolescents and families.

While maintaining the general theory and structure, they modified it by:

  • shortening treatment time,

  • incorporating family members in skill training and therapy sessions

  • reducing the number of skills taught and simplifying language to make it age-appropriate.

The core intention in DBT is finding a balance between acceptance and change. When it comes to teens and families, it is about finding a balance between:

  • Too slack vs Too strict Parenting

  • Normal teenage behaviour vs Atypical teenage behaviour

  • Dependence vs Independence

Dr. Miller and Rathus developed an additional module specific to With teens and families, Walking the Middle Path is a concept specific to DBT with adolescents and consists of learning to accept and incorporate differences in opinions and perspectives (finding balance), validating one another (acceptance), and changing and improving behaviour (change).

What conditions or concerns in teens can benefit from DBT?

  • Disruptive behaviour disorders (oppositional defiant disorder (ODD) , conduct disorder (CD), disruptive mood dysregulation disorder(DMDD))

  • Disruptive/Impulsive behaviour

  • Self-harm and suicidal behaviours

  • Substance use

  • Eating disorders

  • ADHD

  • Mood disorders (depression, anxiety, bipolar)

  • Poor coping skills

  • Relationship conflict

  • Intense emotions and mood swings

You can learn more about DBT and how we use it at our clinic by clicking here.


Rathus, J. H., & Miller, A. L. (2000). DBT for adolescents: Dialectical dilemmas and secondary treatment targets. Cognitive and Behavioral Practice, 7(4), 425-434.

Rathus, J., Campbell, B., Miller, A., & Smith, H. (2015). Treatment acceptability study of walking the middle path, a new DBT skills module for adolescents and their families. American Journal of Psychotherapy, 69(2), 163-178.

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