Dialectical Behavior Therapy (DBT) is all about change. From emotions to behaviors to modes of thinking, the essence of DBT lies in learning how to transform life-interrupting thoughts, emotions, and actions to life-affirming thoughts, emotions, and actions.
At Evolve Treatment Centers, we take a comprehensive approach to treatment in order to address all aspects of our adolescent’s lives. We consider their physical, emotional, social, and spiritual lives simultaneously. That’s why, whenever possible, we engage families directly in the therapeutic process. Family is a critical part of the big picture for adolescents in recovery from mental, emotional, and/or substance use disorders.
We can do all the work in the world with a teenager, and they can make amazing progress while they’re here with us. But if the family is not involved in treatment, then the chances of a successful outcome are significantly reduced.
Because no one lives in a vacuum.
Every individual grows and matures as part of a group of humans who have a direct impact on their development. The actions of any individual member of that group affect the dynamic of the whole group, and the collective norms and behavior of the group affects the actions of individual group members. This is a basic tenet of Family Systems Theory, which informs our approach to family involvement in our residential DBT programs.
Here’s the way we explain the Family Systems concept to the families of our adolescent patients:
- Each individual is part of a complex system of relationships, which, for the sake of efficiency, we’ll call a family.
- The dynamics of the family contribute to the development of the individual.
- Therefore, the behavioral patterns the individual develops – including substance use or mental health issues – are influenced by the relationship dynamics of the family in which the individual grew up.
Family relationships form the foundation of how teenagers experience the world. They shape their attitudes, opinions, choices, and behavior. When a teenager begins residential treatment at Evolve, it’s critical for their families to learn as much as they can about the changes they need to make to achieve sustainable mental health and sobriety. For those changes to stick, family members have to make changes, too. Sometimes the changes are small, sometimes they’re large – whatever the case happens to be the particular family, a growing body of evidence shows that when families are involved in the treatment process, good things happen:
Positive Outcomes of Family-Centered Treatment
- Rates of substance use decrease
- Rates of relapse decrease
- Time spent in treatment increases
- Behavioral issues such as aggression and opposition decrease
- Symptoms of co-occurring emotional issues such as depression and anxiety decrease
- School performance measures such as grade point averages and attendance improve
- Family relationships improves
- Family discord deceases
Families with teens living with mental health or substance use issues want all those changes for their child. And while those things are easy for us to simply write and share in an article like this, it takes work to facilitate those changes in the real world.
So how do families get there?
And once they get there, how do they make the positive changes last?
Family DBT At Evolve: The Middle Path
Our approach to Family DBT is based on a treatment module developed by Wise Minds called The Middle Path. Like many aspects of DBT itself, the concept of The Middle Path applies ideas found in mindfulness practices, which in turn use ideas derived from Zen Buddhism, such as:
- Accepting the world as-is, non-judgmentally, in the here and now, without trying to change it.
- Understanding there is more than one way to see a situation or solve a problem.
- Validating everyone’s perceptions and experience of a situation or set of circumstances.
- Validating your own perceptions and experience of a situation or set of circumstances.
- Believing that change comes through action guided by mindful thought. Through acceptance, understanding, and validation, you can change how you react both internally (thoughts and feelings) and externally (words and behavior) to your situation and circumstances.
In application, The Middle Path asks families to avoid defaulting to points of view that embrace extremes. We encourage families to see things not as black and white or all or nothing. Instead, we ask them to explore the gray area between those extremes. We want them to understand that fertile ground for positive change exists in the space between polar opposites. Family conflict often arises when one party – sometimes the parent, and sometimes the child – becomes so entrenched in their perception of reality they’re unwilling to accept reality as it is, compromise, and move forward toward a mutually beneficial solution.
The Challenge to Change
We ask our teenagers in residential treatment to face this aspect of themselves every day. We challenge them to drop the zero-sum thinking and open their minds to new possibilities. When families engage in the therapeutic process, we ask the same thing of parents. We challenge them to let go of their previous modes of thinking and open themselves to new ideas about both parenting and their relationship with their children.
Research shows three primary areas where parents get stuck in the extremes, and need help navigating the middle path:
Disengaged/Excessive Leniency vs. Authoritarian Parenting Styles
Most people recognize these terms because over the past twenty-five years they’ve become mainstays of what we affectionately refer to as Parenting Lingo 101. The Permissive and Authoritarian styles represent two extremes of a continuum that identifies four common approaches to parenting: Authoritarian, Authoritative, Permissive, and Disengaged. Authoritarian parents lay out strict rules and consequences and enforce them in a rigid, my-way-or-the-highway manner. Authoritative parents communicate clear rules and consequences for children and enforce them in a loving and supportive environment. Permissive parents lay out few rules, provide a loving and supportive atmosphere, but rarely enforce consequences when rules are broken. Disengaged parents are absent as authority figures. They neither set rules nor enforce consequences, and rarely interact in a meaningful way with their children.
Disengaged vs. Authoritarian: Both Too Extreme for Teens
Research shows what you might expect: the Authoritarian and Disengaged styles cause problems, particularly with regards to drugs, alcohol, and problem behavior. It’s easy to understand why. Teens tend to rebel when parents present rules as if they’re set in stone, but when they understand the why behind rules, they’re more likely to follow them.
On the other side of the continuum, the Disengaged style of parenting – characterized by an absence of rules, boundaries, and consequences – gives teens too much leeway. When they make mistakes or break what rules do exist, they don’t experience significant consequences. Therefore, they don’t learn valuable lessons that lead them toward mature and responsible life choices, and away from drugs, alcohol, and problem behaviors.
Studies indicate the Authoritative and Permissive styles – both of which occupy the middle ground between two extremes – are the most effective approaches with regards to teen behavior around drugs, alcohol, and problem behavior.
The DBT Middle Path module helps parents – in collaboration with our therapists – find out which style works best for them, their teen, and family.
Normalizing Pathological Behaviors vs. Pathologizing Normal Behaviors
During the toddler years, most parents have tough days when they honestly think their child may be an unhinged, violent sociopath with no regard for the feelings of others. Young children scream, cry, and use physical violence to get what they want. But then parents talk to other parents and realize those behaviors are typical – for a toddler.
The teenage years present a similar conundrum: how do parents discern between typical teenage behavior and dysfunctional behavior?
Adolescent behavior often includes mood swings, boundary pushing, experimentation with sex, drugs, and alcohol, rapidly changing identities, and a dramatic, topsy-turvy social life. Unfortunately for parents, all these behaviors overlap with symptoms of severe emotional and substance use disorders. The challenge for parents and teenagers lies in finding the middle ground between pathology and normalcy. Both parties must learn to discern the difference between behavior that’s age appropriate and productive and behavior that’s dysfunctional and has long-term, negative consequences. It’s a tough nut to crack, and often requires the help and support of a trained mental health professional. Parents, teens, and therapists collaborate to determine what’s healthy and what’s not. Teens learn to look within to identify the root motivation behind their behavior, while parents learn to look within to ensure they’re neither overacting to typical behavior nor underreacting to dangerous behavior.
Fostering Dependency vs. Forcing Autonomy
This is another practical conundrum foreshadowed by a question parents wrestle with during toddlerhood: when is helicopter parenting helpful and when is it harmful? Do you let your child find natural limits at the playground or do you jump in every time there’s a slight chance they might hurt themselves? Do you micromanage tricky social interactions with other kids, or do you let them sort things out for themselves?
The teenage equivalent of these questions revolves around determining the difference between appropriate vs. inappropriate levels of dependence and appropriate vs. inappropriate levels of autonomy.
The Work for Parents
Parenting involves pursuing two sometimes contradictory goals: on the one hand, their job is to protect their children from harm, while on the other hand, their job is to teach them how to become independent, self-sufficient adults. Fostering too much dependency results in a clingy teen unable to make decisions for themselves, while forcing autonomy too early can result in poor, uninformed decisions and feelings of abandonment. The DBT Middle Path module helps parents find the middle ground between these two extremes.
The Work for Teens
Teenagers need to learn when to rely on their own instincts and judgment and when to seek help and guidance from their parents or other adults with real-life experience. The DBT Middle Path module helps teens find the middle ground between the excitement of independence and the comfort of dependence. This is another tough nut to crack, just like identifying the difference between typical teen boundary-pushing and dangerous dysfunction. Families who have difficulty finding balance welcome the input of a therapist or mental health professional, who can offer an objective opinion – supported by data and research – on what supports their teen’s natural trajectory toward adult independence and what hinders their healthy growth, learning, and path to self-sufficiency.
The Dynamic Interplay of Fundamental Opposites
Classically speaking, dialectic or the dialectic method is the practice of discovering truth by purposefully creating a dialogue between two opposing viewpoints. Its roots extend from the present day back to antiquity. From 20th century sociopolitical discourse to post-Enlightenment philosophy to Greek and Roman thought to the spiritual teachings of Buddhism and Taoism, the operating principle of the dialectic method is that the process itself effectively weeds out falsehoods, dispels misconceptions, and encourages the type of lively, informed debate that results in productive, fact-based compromise.
Family Dialectical Behavior Therapy at Evolve creates a similar outcome by employing The Middle Path module. Parents and teenagers learn tools to break free from their habitual patterns of thought and behavior. Patterns that – whatever way one views them – resulted in residential treatment for the teen.
Breaking these patterns can lead to practical solutions that promote growth and restore balance to the family. The resulting compromise is often something neither the parent nor the teen would have considered before entering the dialogue – and that’s the point. Families seek help because they face challenges they’re unable to overcome by themselves. Parents and teens retreat to their corners, unwilling to let go of opposing points of view.
They land in a dysfunctional stalemate, which we help them move past.
At Evolve Treatment, our skilled therapists teach families and teens The Middle Path principle from DBT to give them a way out, a way forward, and a way to restore harmony that’s based on communication, collaboration, and mutual respect.
Angus is a writer from Atlanta, GA who writes about behavioral health, adolescent development, education, and mindfulness practices like yoga, tai chi, and meditation.