Dialectical thinking allows us to see how two seemingly opposite ideas can both be true at the same time. DBT strives to balance the dialectic of acceptance and change. Some of my favorite dialectics are:
- You may not have caused all your problems, and you need to solve them anyway!
- You are doing the best you can and you need to try harder, do better, and be more motivated to change.
- I like myself and I need to change my behaviors.
- You are right and I am right.
This therapeutic approach applies an integration of cognitive behavioral therapy techniques and acceptance-based Eastern practices (mindfulness) to treat what is commonly referred to as emotion dysregulation. Emotion dysregulation looks like a strong and quick emotional response, a long period of time spent in this strong emotional state, and/or a difficulty returning to “baseline.” DBT is an evidenced based practice, meaning that the effectiveness of this therapeutic approach has been consistently researched and measured. DBT puts an emphasis on building and maintaining the therapeutic relationship, validation of client, and confronting avoidance.
DBT is a very effective treatment for adolescents who engage in self-injurious behaviors and suicidal thinking. DBT is not a suicide prevention program, it is a life improvement program. DBT acknowledges that the lives of people engaging in self-injurious and suicidal behaviors are painful as they are currently being lived, and works to help build a life worth living.
DBT is also an effective treatment approach for children and adolescents who experience intense emotions that interfere with everyday living. This might look like rapidly shifting and intense moods, and impulsive and/or risky behaviors.
Art therapy provides clients with opportunities to integrate, externalize, and expand on thoughts, feelings and urges that are difficult to give voice to. Art making provides opportunities for divergent thinking and problem solving, creating new neural-pathways in the brain. Art therapy provides clients with a unique way to engage in corrective emotional experiences in a non-verbal and non-threatening way. The American Art Therapy Association states that through creation of art and reflection of the products and processes; one can increase awareness of self and others, cope with stress and traumatic experiences, enhance cognitive abilities, and experience gratification from the process of art making. Art making allows for opportunities to explore new behaviors by experimenting with them first through image making. The imagery allows a bridge between the cognitive and emotional realm, and reality. In this transitional space, new behaviors and ideas can be explored. This becomes the first step towards these behaviors, ideas, and/or actions being utilized in reality. Art making emphasizes the client’s ability to make choices, implicit in art making. Long-term projects encourage the development of delayed gratification. In addition, as one of my favorite art therapy founders, Judith Rubin, often says, “art making fosters joy.”
TF-CBT is a step-by-step treatment for people who have experienced trauma. Trauma is loosely defined as a scary, unexpected event where danger is felt.
“The traumatic experience is kept in your memory like a book. You are trying to keep this book closed and never read it. But, what is actually happening is that the book opens by itself, suddenly and unexpectedly, on different pages, and you find yourself “reading” scary parts against your will. Our goal is to help you read this book from beginning to end several times until we manage to put some order into the pages. As a result, in the future, you will be able to open up the book on whatever page you want, read it, browse through it, or just leave it closed, not out of fear but out of boredom.”
Foa, E. B., Chrestman, K. R., & Gilboa-Schechtman, E. (2009). Prolonged exposure therapy for adolescents with PTSD: Emotional processing of traumatic experiences: Therapist guide. Oxford: Oxford University Press.
TF-CBT is easily integrated with art therapy techniques, theories and practices. Denise has skillfully made clinically sound adaptations to this treatment approach, so that it is applicable to children, adolescents, and young adults.