ebook THE GUILFORD PRESS DBT® SKILLS MANUAL FOR AdOLESCENts Also from Jill H. Rathus and Alec L. Miller Dialectical Behavior Therapy with Suicidal Adolescents Alec L. Miller, Jill H. Rathus, and Marsha M. Linehan DBT® Skills Manual for Adolescents Jill H. Rathus Alec L. Miller Foreword by Marsha M. Linehan THE GUILFORD PRESS New York London © 2015 The Guilford Press A Division of Guilford Publications, Inc. 370 Seventh Avenue, Suite 1200, New York, NY 10001 www.guilford.com All rights reserved Except as indicated, no part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 LIMITED PHOTOCOPY LICENSE These materials are intended for use only by qualified mental health professionals. The publisher grants to individual purchasers of this book nonassignable permission to reproduce all materials for which photocopying permission is specifically granted in a footnote. This license is limited to you, the individual purchaser, for personal use or use with individual clients. This license does not grant the right to reproduce these materials for resale, redistribution, electronic display, or any other purposes (including but not limited to books, pamphlets, articles, video- or audiotapes, blogs, file-sharing sites, Internet or intranet sites, and handouts or slides for lectures, workshops, or webinars, whether or not a fee is charged). Permission to reproduce these materials for these and any other purposes must be obtained in writing from the Permissions Department of Guilford Publications. The authors have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in behavioral, mental health, or medical sciences, neither the authors, nor the editors and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained in this book with other sources. Library of Congress Cataloging-in-Publication Data Rathus, Jill H. DBT skills manual for adolescents / Jill H. Rathus, Alec L. Miller. pages cm Includes bibliographical references and index. ISBN 978-1-4625-1535-6 (pbk. : acid-free paper) 1. Dialectical behavior therapy. 2. Adolescent psychotherapy. 3. Adolescent psychology. I. Miller, Alec L. II. Title. III. Title: Dialectical behavior therapy skills manual for adolescents. RC489.B4R36 2015 616.89′142—dc23 2013043128 Illustrations by Sam Miller DBT is a registered trademark of Marsha M. Linehan. About the Authors Jill H. Rathus, PhD, is Professor of Psychology at Long Island University—C. W. Post Campus, where she directs the DBT scientist-practitioner training program within the clinical psychol- ogy doctoral program. She is also Co-Director and Co-Founder of Cognitive Behavioral Associ- ates, a group private practice in Great Neck, New York, specializing in dialectical behavior ther- apy (DBT) and cognitive-behavioral therapy (CBT). Her clinical and research interests include DBT, CBT, adolescent suicidality, marital distress, intimate partner violence, anxiety disorders, and assessment, and she publishes widely in these areas. Dr. Rathus is coauthor (with Alec L. Miller and Marsha M. Linehan) of Dialectical Behavior Therapy with Suicidal Adolescents, and she trains mental health professionals internationally. Alec L. Miller, PsyD, is Professor of Clinical Psychiatry and Behavioral Sciences, Chief of Child and Adolescent Psychology, and Director of the Adolescent Depression and Suicide Program at Montefiore Medical Center of the Albert Einstein College of Medicine. He is also Co-Founder of Cognitive and Behavioral Consultants of Westchester and Manhattan. Dr. Miller has pub- lished widely on DBT, adolescent suicide, childhood maltreatment, and borderline personality disorder, and has trained thousands of mental health professionals in DBT. A Fellow of Divi- sions 12 (Clinical Psychology) and 53 (Clinical Child and Adolescent Psychology) of the Ameri- can Psychological Association, he is coauthor (with Jill H. Rathus and Marsha M. Linehan) of Dialectical Behavior Therapy with Suicidal Adolescents. v Foreword Jill Rathus and Alec Miller attended one of my first dialectical behavior therapy (DBT®) inten- sive trainings. They were working on learning DBT and applying it to an urban, multiproblem, suicidal adolescent population at Montefiore Medical Center, Bronx, New York. When they returned for Part II of the intensive training, during which teams present their programs, I was struck by their passion and compassion, by how deeply they grasped the treatment, and by how thoughtfully they applied it to adolescents. I realized then how fabulous their work was for DBT and for teens in need of DBT. Rathus and Miller infused their version of DBT with original, creative, and developmen- tally appropriate elements. They included family members in the treatment through skills train- ing, family sessions, and parent coaching modalities, to directly address adolescents’ environ- ments; this helps not only adolescents, but also their parents, who are often despondent and don’t know what to do. They identified new dialectical dilemmas that they observed in the struggles between parents and teens, parents and parents, and teens and therapists. They developed a new skills module that addresses family conflict by explicitly teaching dialectics as a skill set not only for DBT therapists, but also for teens and their parents; validation, which families desper- ately need; and behavior change, which families often attempt ineffectively and also desperately need. They devised a sensitive way to teach the biosocial theory to parents, developed teach- ing points for the DBT assumptions that address the negative attributions parents and teens often make for one another’s behavior, figured out how to handle matters of confidentiality, and devised mindfulness exercises that appeal to teens—to name just a few of their creative ideas. They thoughtfully explicated these innovations and more in an earlier book, Dialectical Behav- ior Therapy with Suicidal Adolescents. Rathus and Miller developed the teen-based treatment and wrote the 2007 book; I was simply a coauthor, serving as consultant and confidant on DBT when needed. That work has become the primary text on applying DBT with adolescents, and as such is a companion volume to the present book. Throughout the nearly two decades I have known them, Jill Rathus and Alec Miller have also published research, expanded their clinical practices, and trained professionals around the world to conduct DBT with adolescents. They have been a driving force behind the international vii viii Foreword proliferation of adolescent DBT programs, and in disseminating this treatment to youth and families who in the past were often rejected from treatment settings and clinical research trials. The current volume presents their latest contribution to adolescent DBT, and is certain to be as influential as their 2007 book. It is written for clinicians in various settings to use with adolescents coping with a broad array of emotional and behavioral difficulties. The book presents 10 chapters on conducting skills training with adolescents and their caregivers. The first four chapters contain everything practitioners need to know about setting up and structur- ing an adolescent DBT skills training program. This section includes solutions to problems and questions regarding such topics as whom to include in skills training; group management strate- gies; skills training challenges; variations on the basic skills training format; therapy-interfering behaviors of teens and parents; dialectical tensions that arise in skills training; and dialectical dilemmas and their related treatment targets, not only in the context of individual and family therapy with adolescents, but also within the modality of skills training. The next six chapters provide the teaching notes corresponding to each adolescent skills training module: Mindful- ness, Distress Tolerance, Walking the Middle Path, Emotion Regulation, and Interpersonal Effectiveness. These notes contain not only the basic “how-to” of teaching each skill group, but also the authors’ collective clinical wisdom regarding teen- and family-based teaching stories, examples, exercises, role plays, and possible responses to likely questions/challenges by parents or teens. Finally, the volume contains a set of skills handouts and practice worksheets. Whereas we at the University of Washington have used the adult versions of handouts and worksheets with our adolescent clients at high risk for suicide (and teens seems to understand them better than their parents), many clinicians and treatment programs are more comfortable with skills designed specifically for adolescents. These skills handouts and worksheets are wonderfully done. While keeping to the essence of the skills content from standard