Dialectical Behavior Therapy
Cognitive behavior therapy includes many types of therapy and can be applied in a variety of circumstances. Dialectical behavior therapy (DBT) is most commonly known for use on clients with borderline personality disorder (BPD). However, DBT is becoming more popular and often used when working with adolescents. Some adolescents participate in nonsuicidal self-injury (NSSI). Counselors find DBT is an effective therapy to help youth acquire the coping skills needed to stop NSSI. A review of DBT, and adolescents suffering with NSSI will better help one to understand why this technique is beneficial.
NSSI is defined as the direct and intentional destruction of one's own body tissue without an intent to die. Therefore, any form of self mutilation not intending to result in suicide qualifies as NSSI. The number of adolescents practicing NSSI is alarming. Youth practicing NSSI include both sexes and every racial and ethnic group. This alarming behavior is not secluded to any particular type of adolescent. NSSI often appears in the form of cutting with sharp objects, scratching, hitting, burning, and inserting objects under the skin. These behaviors typically develop between the ages of 12-14, indicating that adolescent years are particularly vulnerable to such practices. In addition to NSSI, these behaviors are often in conjunction with other self-harming behaviors like eating disorders, substance abuse, and depression. Puberty can be an extremely difficult time for many people and adolescents cannot reason and rationalize as adults can; therefore, youth often develop self-harming issues because they lack proper coping skills. Last, NSSI specifically refers to injuries not acquired while attempting suicide; however, 50-75% of those with a history of NSSI have also attempted suicide at least once. As one can see, NSSI is an alarming behavior that needs attention (Choate, 2012).
Addressing the Issue
NSSI is a prevalent and serious issue that must be properly handled. Counselors and people working with NSSI youth must have an understanding of the complexity of this matter and be familiar with treatment options. DBT is an excellent method to attempt to help adolescents overcome NSSI behavior. The effectiveness of DBT has been shown in at least seven controlled trials conducted by four independent research teams. DBT shows the most improvement, when compared to prior therapy options, to treat NSSI (Choate, 2012). DBT uses a comprehensive multimodal 16-week treatment approach for NSSI. The multimodal addresses skills for interpersonal effectiveness, self-regulation, and distress tolerance; provides structure to motivate, reinforce, individualize, and generalize these skills; and identifies and alters learned behavior patterns leading to NSSI. This therapy treatment includes individual therapy, family therapy, multifamily training groups, and telephone consultations for those involved in the process. Additionally, a support team for the counselors is a part of this process. Counseling NSSI adolescents is an extremely stressful position so it is important for counselors to have professional peers to share their thoughts. DBT therapy for NSSI adolescents can be practiced in many settings, including inpatient or outpatient treatment (Choate, 2012).
Interventions and Techniques
A primary counselor is paired with the adolescent through the DBT process. The relationship between the primary counselor and the client is extremely important. The key goal for the counselor is to help the adolescent develop skills for coping with stressful thoughts, events, and emotions. An important aspect in the client therapist relationship is for the counselor to convey acceptance, validity, and trust. The primary counselor needs to remain calm and listen with interest yet...
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