National Alliance on Mental Illness
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Adapting DBT for Children

By Emily Cepla, NAMI Program Manager, Child and Adolescent Action Center

Being the parent of an adolescent child can be difficult, but it can be even harder when your child lives with a mental health condition. Luckily dialectical behavioral therapy (DBT), a form of cognitive behavioral therapy (CBT), has been adapted to strengthen the relationship between parents and children living with mental health conditions by focusing on changing certain behaviors and reinforcing the idea of acceptance to the therapy.

Parents and children engage in individual skill-building sessions and then joint sessions where they practice using these skills to communicate more effectively. These skill-building sessions include learning the following:

  • Mindfulness: learning to be in the present and to pay attention without judgment and respond in effective and strategic ways.
  • Interpersonal effectiveness: finding ways to get your needs met without compromising yourself.
  • Emotion regulation: understanding why we have emotions and how to live with intense emotions.
  • Distress tolerance: coping with intense feelings effectively without harming yourself.
  • Middle path: validating each other’s thoughts and feelings.

These skills are practiced in the presence of a therapist so that when emotional situations develop in the real world, adolescents and their parents are able to effectively restructure the situation to a more positive one.

DBT therapists also work with parents to identify the best ways to deescalate emotional situations. Parents come to understand and accept that their child is doing the best that she or he can at this moment in the context of his or her life and, at the same time, explain that their child has to do better and be motivated to change his or her behavior to get the life that they want. For example, parents are encouraged to say “I understand why you’re acting this way and there’s a level of abuse that you are exhibiting that is unacceptable in this house. We need to set some limits.” This validates their child’s feelings while working together to alter behavior in the future. This form of DBT has been shown to build trust between adolescents and parents and build emotional regulation skills for adolescents living with mental illness.

Pat Harvey and Britt Rathbone spoke about DBT and adolescent/adult relationships on NAMI’s Ask the Doctor call in March. For a schedule of future Ask the Doctor calls and to listen to this call or other past calls, visit