Dialectical Behavior Therapy With Adolescents Dialectical Behavior Therapy With Adolescents is an essential, user-friendly guide for clinicians who wish to implement DBT for adolescents into their practices. The authors draw on current literature on DBT adaptation to provide detailed descriptions and sample group-therapy formats for a variety of circumstances. Each chapter includes material to help clinicians adapt DBT for specific clinical situations (including outpatient, inpatient, partial hospitalization, school, and juvenile-detention settings) and diagnoses (such as substance use, eating disorders, and behavioral disorders). The book’s final section contains additional resources and handouts to allow clinicians to customize their treatment strategies. K. Michelle Hunnicutt Hollenbaugh, PhD, LPC-S, is an associate professor in the Department of Counseling and Educational Psychology at Texas A&M University, Corpus Christi. She has several years of clinical experience in a variety of settings and has spent the majority of this time researching and providing Dialectical Behavior Therapy (DBT). She is currently conducting several research studies on adaptations of DBT and continues to facilitate the implementation of DBT-based clinical services for the local community. Michael S. Lewis, PhD, LPCC-S, is a clinical professor at Capital University and has extensive experience working with adolescents and young adults. He has also spent time working in substance-abuse treatment facilities and high-school settings. Michael specializes in wellness- and mindfulness-based innovative interventions. His research interests include college counseling, counselor development, and behavioral addictions. Dialectical Behavior Therapy With Adolescents Settings, Treatments, and Diagnoses K. Michelle Hunnicutt Hollenbaugh Michael S. Lewis First published 2018 by Routledge 711 Third Avenue, New York, NY 10017 and by Routledge 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 2018 K. Michelle Hunnicutt Hollenbaugh and Michael S. Lewis The right of K. Michelle Hunnicutt Hollenbaugh and Michael S. Lewis to be identified as authors of this work has been asserted by them in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. The purchase of this copyright material confers the right on the purchasing institution to photocopy pages which bear the photocopy icon and copyright line at the bottom of the page. No other part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission in writing from the publisher. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Names: Hollenbaugh, K. Michelle Hunnicutt, author. | Lewis, Michael S. (Michael Scott), 1977– author. Title: Dialectical behavior therapy with adolescents : settings, treatments, and diagnoses / K. Michelle Hunnicutt Hollenbaugh, Michael S. Lewis. Description: New York, NY : Routledge, 2018. | Includes bibliographical references. Identifiers: LCCN 2017036111 (print) | LCCN 2017036683 (ebook) | ISBN 9781315692425 (eBook) | ISBN 9781138906020 (hbk) | ISBN 9781138906037 (pbk) | ISBN 9781315692425 (ebk) Subjects: | MESH: Cognitive Therapy | Adolescent | Mental Disorders—therapy | Mental Disorders—diagnosis Classification: LCC RC489.C63 (ebook) | LCC RC489.C63 (print) | NLM WM 425.5.C6 | DDC 616.89/1425—dc23 LC record available at https://lccn.loc.gov/2017036111 ISBN: 978-1-138-90602-0 (hbk) ISBN: 978-1-138-90603-7 (pbk) ISBN: 978-1-315-69242-5 (ebk) Typeset in Frutiger by Apex CoVantage, LLC Visit the eResources: www.routledge.com/9781138906037 Contents List of figures vii List of tables ix Contributors xi 1 Introduction and Overview 1 K. Michelle Hunnicutt Hollenbaugh 2 Treatment Delivery and Implementation 19 K. Michelle Hunnicutt Hollenbaugh 3 Treatment Team and Continuity of Care 29 K. Michelle Hunnicutt Hollenbaugh and Jacob M. Klein 4 Outpatient Settings 39 K. Michelle Hunnicutt Hollenbaugh 5 Family Counseling 53 K. Michelle Hunnicutt Hollenbaugh 6 Partial Hospital Programs and Settings 63 Garry S. Del Conte 7 DBT in Inpatient Settings 85 K. Michelle Hunnicutt Hollenbaugh and Jacob M. Klein 8 Working Within School Sites 97 Richard J. Ricard, Mary Alice Fernandez, Wannigar Ratanavivan, Shanice N. Armstrong, Mehmet A. Karaman, and Eunice Lerma 9 Eating Disorders 109 K. Michelle Hunnicutt Hollenbaugh 10 Conduct Disorder, Probation, and Juvenile Detention Settings 123 K. Michelle Hunnicutt Hollenbaugh and Jacob M. Klein 11 Substance Use Disorders 137 K. Michelle Hunnicutt Hollenbaugh v CONTENTS 12 Other Diagnoses for Consideration 149 K. Michelle Hunnicutt Hollenbaugh 13 Comorbid Diagnoses and Life-Threatening Behaviors 161 K. Michelle Hunnicutt Hollenbaugh 14 Summary and Conclusions 171 K. Michelle Hunnicutt Hollenbaugh Handouts 177 Index 235 vi Figures 1.1 Biosocial Theory 4 6.1 Model of a Dialectical Milieu 66 9.1 Biosocial Theory as Applied to Eating Disorders 111 10.1 Biosocial Theory as Applied to Conduct Disorder/Criminal Behavior 126 11.1 Clear Mind, Clean Mind, Addict Mind 138 13.1 Behavior Chain Analysis 164 vii Tables 1.1 Definition of Terms in the Structure and Implementation of DBT 3 1.2 DBT Dialectical Dilemmas 7 2.1 Pros and Cons of Implementing Standard DBT vs. DBT Informed 20 3.1 Treatment Team Members and Roles 30 4.1 Traditional DBT Treatment Targets and Hierarchy 40 4.2 Sample Skills Training Schedule 47 5.1 Options for Implementing Family Counseling in DBT 54 5.2 Treatment Targets in DBT Family Interventions 55 5.3 Sample Format of Multifamily Skills Group (Six Weeks) 59 6.1 DBT Treatment Assumptions in an Adolescent Partial Hospitalization Program 69 6.2 Curriculum Template for a DBT Partial Hospital Program 70 6.3 Curriculum for Six-Week Parent Middle Path Skills 73 6.4 Hierarchy of DBT PHP Behavioral Targets by Role and Mode 75 6.5 Treatment Targets for a DBT PHP 77 6.6 Daybreak Treatment Center Staff Agreements 79 7.1 Treatment Targets for Inpatient DBT 89 7.2 Sample Skills Training Format for Inpatient DBT 92 8.1 Teen Talk: Treatment Team Members and Roles 101 8.2 DBT Treatment Targets in the Teen Talk Program 102 8.3 Overview of the Teen Talk Skills Group Sessions 103 9.1 Treatment Targets in DBT for Eating Disorders 113 9.2 Sample Skills Training Schedule for DBT-ED 117 10.1 DBT Treatment Targets and Hierarchy With Conduct Disorders and in Juvenile Detention Settings 127 10.2 Sample Skills Training Schedule for DBT for Conduct/Behavioral Problems 132 11.1 Adapted Treatment Targets for Treating Clients With SUDs 142 11.2 Sample Skills Module Format 144 12.1 DBT Treatment Targets and Hierarchy for Anxiety Disorders 150 12.2 DBT Treatment Targets and Hierarchy for Depression 153 12.3 DBT Treatment Targets and Hierarchy for Bipolar Disorder 155 ix